Click on the title in this index to go directly to the discussion below.
From: Menang JOSHUA in Cameroon
I have been having it really tough understanding how some insects can treat stuttering; as it is widely believed here. I have never really come across someone who has been cured using this special insect, can anyone with better knowledge help me better?
From: Judy Kuster
Joshua, Throughout history, and even now, there are many ideas about how what causes stuttering and how to treat stuttering that not effective, such as eating certain insects. Some people call them "folk myths." I have collected some of those ideas and put them on the Stuttering Home Page (www.mnsu.edu/comdis/kuster/Infostuttering/folkmyths.html). Joseph Lukong, Jonas Berinyuy, and Acheng Thomas from Cameroon and Moussa Dao from Burkina Faso have shared some of these "folk myths" in their countries on a past ISAD online conference. Their papers are linked to the folk myths page URL provided above. I encourage you to read their papers. Most people in my country do not talk about a "cure" for stuttering in adults who stutter. Instead they talk about becoming an effective communicator. This conference, as well as learning as much as you can about stuttering on websites such as the two listed in the introduction to this conference will provide you with a lot of good information about stuttering. I am glad you are participating in the online conference!
From: David Shapiro
Hi Joshua, Thanks for your question. I appreciate Judy Kusters reply as well. I am a speech-language pathologist and a person who stutters. As a result of some research and attendance at the African Stuttering Conference in Douala, Cameroon last October, I have become intrigued by the �folk myths� and indigenous healing practices for people who stutter. I am hoping that I may learn from you and others who visit this section of the conference. As you (and others) discover materials and publications related to the question you posed, would you kindly share your discoveries with me (shapiro@wcu.edu). Thanks in advance.
From: joseph/uganda
Why is it that there are many male stutterers than female in the world?
From: Ken St. Louis
Dear Joseph, Thanks for your question. I wish we knew the answer to the sex ratio question. A summary of all the data comparing males and females and all their various skills and abilities would be very long indeed. About all we can say for sure is the females seem to be better at some aspects of verbal abilities than males. Males are more likely to have other speech and language problems than females as well as reading, learning, and attention deficit problems. Relative to stuttering, females are more likely than males to recover from stuttering if they begin to stutter at the age of 2-4 years. A related and interesting fact is that those females who do not recover may have more genetic influence behind their stuttering than average males who stutter.
From: Joseph Nsubuga, Uganda
What can you say about the effect of witchcraft in causing stuttering in the world as evidenced in some part of Africa against genetical causes and hereditary?
From: Yemi Akintunde Stuttering Association of Nigeria
Is it possible for witchcrafts to cause stuttering in someone especially in our environment here in Africa as Joseph Nsubuga stated? I reason with him too.
From: Judy Kuster
Joseph, the answer to your question is similar to the answer to Joshua's question above only he asked about treatment and your question is about cause of stuttering. Throughout history, and even now, there are many ideas about how what causes stuttering including witchcraft. As I answered to Joshua -- Some people call these ideas "folk myths." I have collected some of those ideas and put them on the Stuttering Home Page (www.mnsu.edu/comdis/kuster/Infostuttering/folkmyths.html). Joseph Lukong, Jonas Berinyuy, and Acheng Thomas from Cameroon and Moussa Dao from Burkina Faso have shared some of these "folk myths" on what people in their countries thought caused stuttering on a past ISAD online conference. Their papers are linked to the folk myths page URL provided above. I encourage you to read their papers. This conference, as well as learning as much as you can about stuttering on websites such as the two listed in the introduction to this conference will provide you with a lot of good information about stuttering.
From: Gunars
y'all, Could this be a self-fulfilling prophecy? If you believe that you will stutter and fear it, could it not cause further degeneration in fluency?
From: Joseph Nsubuga, Uganda
Dear sir/madam as there are few language experts in Africa, can you please avail to us study (Scholarship) opportunities in the same field such that we can also deal with the problem by ourselves in the future?
From: Nan Ratner
The problem is that most schools offer their own scholarships, rather than any national clearinghouse specifically for this purpose. You would need to examine American (or foreign) universities that have someone specializing in fluency, and then ask the program director of that University's program about possible funding for international students.
From: Joseph Nsubuga, Uganda
Why is that under stress there's high disfluency than in a normal situation? Why is that stuttering is more of a hereditary problem than a result of direct contact etc. How can we access training in language pathology from developed states as its not taught in LDCs and again there are no experts in it?
From: Ken St. Louis
Dear Joseph, You have lots of questions! I wish we had as many answers. I'll comment briefly on your first one here. Why is stuttering more frequent under periods of stress? First, it is important to say that this is not always obvious. There are some people who stutter most when they are relaxed and least when they are in social situations that others would regard as stressful. But stress and stuttering frequency are often related. I don't know the answer for sure, but it has been well established that psychological stress disrupts fine motor skills. If this were not the case, athletes would perform just as well in games and competitions as they would in practice. Many do not. Speech is a very complex motor act. Therefore, it is not surprising to me that stuttering (which at some level of analysis can be seen as a breakdown in motor coordination) follows the same pattern as other parts of the body.
From: Gunars
Ken, Am I not correct that some athletes, especially those on top of their games (the world champions), perform better under stress if and only if they can maintain their focus and get into a psychological state of mind called "FLOW" by Csikszentmihlyz ("Finding Flow: The Psychology of Engagement With Everyday Life")? For example, when Bannister set out to break the four minute mile he had not done so as yet in practice. When I was Second Team All-American in soccer in 1958, I would throw-up before most of the games (as do many basketball stars of past and present), but when I was in the game, I would perform to the best of my ability because I was able to focus on my game. So could it be that EXTERNAL stress is not as important as our reaction, our INTERNALIZED stress?
From: Ken St. Louis
Hi Gunars, Good point. I think you are right about the external stress versus internal stress. I liked hearing about FLOW. Thanks. But many athletes, especially those who are not world class, do "choke" under pressure. Also, stutterers, who presumably have more going on than excess stress and pressure would be more likely to have difficulties under stress than most otherwise normal athletes would.
From: Joseph Nsubuga, Uganda
I am so happy for your kid effort to make this conference a success and also your team with whom this would not have been easy. Can you please help some of us without computers in Africa to have one otherwise it so hard to stay on a computer in cafe without being asked to give space to others.
From: Judy Kuster
Joseph, this is only a partial help because it does not provide a computer, but Viren Gandhi has made a zip file and an exe file of the entire conference on Saturday which you can download and put on a disk so that you don't have to be at an Internet cafe to access the actual papers. You will still have to go to an Internet cafe to ask questions about the papers, but you will be able to read the papers off-line.
From: Joseph Nsubuga, Uganda
Why is that people who stutter are discriminated in public and what can you say about putting up an international law to protect them since they are also disabled in one way or another.
From: David Shapiro
Hi Joseph, I am happy to read all of your questions posted here; they are excellent. The issue of attitudes and discrimination is complex indeed. In the USA, we have legislation that prohibits discrimination. Many other countries have similar legislation; other countries are following in these footsteps. However, laws do not always reflect what might be in someone's heart. For this reason, heightening public awareness and acceptance of people with exceptionalities, including people who stutter, is a significant and shared responsibility of professionals (speech-language pathologists), consumers (the self-help community), and many others (educators, social advocates, politicians, etc.). The good work you are doing in Uganda, in my opinion, is such an important step in the right direction. By bringing together people who stutter and their (our) families with the professional community, there is nothing that we cannot accomplish together when we learn and work together. One year ago in Cameroon, I learned from the Lamnso dialect, Boyoo dze kiwo-oh kimo-on kikur kifah — ("One hand cannot tie a bundle."). If you are considering having your legislators introduce bills to prohibit discrimination, many of us could provide you with a copy of such legislation that is already in place in the USA. Keep up the good work.
From: Yemi Akintunde Stuttering Association of Nigeria
Hi, I would like to ask if it is possible for someone to have all three types of stuttering at the same time i mean prolongation, repetition, blocking. It seems am having these problems all together but do not understand. Does it occur in other stutterers too?
From: Dale Williams
Hi, I would like to ask if it is possible for someone to have all three types of stuttering at the same time i mean prolongation, repetition, blocking. It seems am having these problems all together but do not understand. Does it occur in other stutterers too?
From: Dale Williams
Yes Yemi, it is possible for one person to present all 3 of these disfluency types. Based on history interviews I've done, I'm not even sure it's uncommon, although most people report that they experience one type more frequently than the others. Dale
From: David Shapiro
Hi Yemi, You've asked an important question. Indeed, many different types of disfluency can occur at the same time. I have found this pattern to be more common than not among the people who stutter I have worked with over the years, as well as in my own speech patterns during times past. You will find elsewhere in this conference a number of different personal accounts of people who stutter in which they discuss the complexity of their own stuttering and the strategies they have utilized to maximize their communication freedom and feelings of personal acceptance and success. You are not alone. Many of us who stutter continue to learn from the experiences of others, both within the professional community and the self-help community. Keep up the good work you are doing in Nigeria.
From: Holly Baker
Yes it is possible to present all three characteristics. I have seen it in several people who stutter so you are not alone. I have also seen secondary characteristics stacked on top of all those.
From: Susan
My son stuttered at one time. This stopped for a long time after therapy when he was very young. He is now older and has started repeating the last letter in occasional words: "cookies-s-s-s". Is this common? Would you say it was stuttering? Never at the beginning of the word.
From: Brian Humphrey
Susan, For a detailed discussion, you may be like to read a paper that I co-authored with John Van Borsel for the 2001 International Stuttering Awareness Day Online Conference. It is called "Word Final Dysfluencies: Ten Infrequently Asked Questions." You can find it at: http://www.mnsu.edu/comdis/isad4/papers/humphrey.html . Word-final dysfluencies are not common. They are generally not discussed in stuttering textbooks, but they can occur. They may be under-reported. We have not strictly considered word-final dysfluencies to be stuttering, but it is interesting that your son formerly stuttered. Is your son aware of his speech pattern? John Van Borsel has a bit of evidence suggesting that some children who are gently made aware may decrease their word-final dysfluencies.
From: susan
Thanks for that reference. what do you think about this in relationship to a child having problems figuring out what they are going to say next (the next word).
From: Gunars
Susan, Often I knew when I would stutter and I would "wait out" the stuttering. To an observer this would appear as "problems figuring out what they are going to say next". Y'ALL, Is "waiting out" a common strategy of avoidance? Gunars
From: [no name]
I cannot speak for all cases of word-final dysfluency, but I have not heard word-final dysfluencies that sound like someone may be trying to think of the next word to say. In mid-sentence or at the end of a sentence, the boy I worked with said things like: "night ight" "trolley olley" "daylight aylight" ... and then he would go on immediately with the rest of his message.
From: John Tetnowski
I would agree with you Brian. I also might add that John Van Borsel has really studied this phenomenon as extensively as anyone. John and I have recently submitted an article to JFD on this topic. There does seem to be a link with other concomitant disorders and conditions. Hopefully, this article will make it to publication soon. If not, I could at least send the manuscript to those who are interested.
From: Ken Logan
Hello everyone: I was reading your posts on final- sound repetitions and thought I'd add a few (belated) thoughts. First, I agree with the others that it is not very common, at least as a primary characteristic of disfluent speech. I've seen only a handful of people over years who repeat final sounds frequently. In contrast with classic developmental stuttering, these individuals had relatively limited awareness of the repetitions. It may be that they repeated the final sounds to buy time for retrieving/producing the upcoming word, but it's difficult to say for sure what the source of the repetitions were. I saw one person who repeated the final word or words of a sentence, sometimes multiple times, gradually tapering off to a whisper with each successive repetition. This was done even when the person was finishing a speaking turn (i.e., there were no upcoming words). Granted, this is not exactly like final sound repetition, but I've wondered whether the two patterns have some common basis.
From: Cayla Park
So in general a pws and repeats the final sound or syllable of a word would benefit from being made aware of this type of dysfluncy? More so than a pws with typical dysfluncies?
From: Joseph Nsubuga, Uganda, East Africa
Whenever I am going to address people my stuttering rate increases and so the pressure or heart beat and i sweat a lot, this at times prevents me from active participation, why do you think this happens. This even makes me fail to perform well in interviews.
From: Shelley Brundage
hi Joseph: You may be interested in an article by Alm (2004), in the Journal of Fluency Disorders, 29, 123-133. The title is "Stuttering, emotions, and heart rate during anticipatory anxiety: a critical review." The behaviors your describe occur frequently in many persons who stutter; Alm (and others) suggest that these behaviors are related to anticipatory anxiety about speaking and stuttering. Some of the behaviors you describe (e.g., increased heart rate, sweating) also occur in persons who do not stutter.
From: joseph Nsubuga, Easy Speak Association, Uganda
I have tried so many herbs in search for treatment of stuttering as my future was dented due to disfluency, Is there any modern treatment so far discovered. I would like to know more about the treatment results at the StarFish project in the UK.
From: Joseph Nsubuga, Uganda
Sir/Madam In my country there many children who have fluency disorders, are there any training kits that can help and how can they be accessed?
From: Nan Ratner
I cannot refer you to any "kits" per se. But the Stuttering Foundation of America has many inexpensive DVDs that show actual intervention techniques with many American experts. You can find them at http://www.stutteringhelp.org/
From: Gloria
I have heard the Lidcome Training kit cures stuttering in children. Could this training kit also be used with adults?
From: Nan Ratner
No, the Lidcombe program is meant to be used by parents and very young children. It is not even known if clinicians can use it effectively with children because it makes use of the contexts of parent-child interaction. It is not known exactly what permits the parental feedback to help children gain fluency, but even its authors would not propose using it with adults at this time. Sydney folks, care to respond?
From: joseph nsubuga, Easy speak Association, Uganda
Why is that people can start stuttering at an old age yet they were okay at childhood. Can this be prevented?
From: Walt Manning
Joseph - Beginning to stutter at an "older" age is extremely unlikely. On the other hand, a fluency disorder such as psychogenic or (especially) neurogenic stuttering may occur, the latter as the result of an insult to the central nervous system. In a related matter, there are very few studies concerning what happens to people who stutter as they reach the last several decades of their life, but what there is generally indicates that stuttering behavior stays at the same level but the handicapping effects are somewhat less.
From: Debra B
I was wondering as a clinician if you have a preference to a certain type of treatment approach. I am in graduate school and we are learning about fluency shaping and stuttering modification. I have observed clinicians using the Synergistic Approach (Bloom & Cooperman, 1999) which seems to be a combination. In your experience, what do you see as being most beneficial to individuals who stutter.
From: Gary J. Rentschler
I always cringe a little at the thought of a "favorite" approach to therapy. Clients are so different and have such varied needs. My general approach to therapy is to give the client what they need, whether it be more of a fluency-shaping approach or stuttering modification. Both approaches have their merits; our goal is to provide a client with the tools he or she needs to be successful. When I was in therapy as a client, I used the traditional Van Riper approach. I personally find this therapy very engaging now that I'm a clinician. I enjoy therapy because I can help clients through their fears and anxieties in addressing and confronting their stuttering. To my personal tastes, fluency-shaping lacks much of the "richness" that I find in stuttering modification. However, and most importantly, therapy can't be directed by what I like, but what's most effective for the client. Many people, including me, use an integrated approach in response to the symptoms of a client's difficulty. Best wishes in your graduate studies!
From: Charlie Osborne
Gary I concur with your response regarding a "favorite" approach. I know that for me, personally, I have moved from using an approach or "the approach," as a novice clinician, to gradually developing how I approach helping individuals with stuttering problems. As a beginning clinician I was uncertain as to how to do therapy or what to do in therapy and the structured confines of an approach helped me determine where to go and what to do. With the experience of working with different individuals and helping them learn to cope with stuttering problems, I not only learned about how to use the variety of tools available (stuttering modification and/or fluency shaping), I began to discover who I was as a clinician and how I related with clients in the therapy process. The process of self-discovery, paired with the constant learning from the clients you are helping, allows you to develop your own clinical skills. As you develop as a fluency clinician you will learn how to be attentive to each of your client's needs and to respond to each of them accordingly. Debra, it is a challenging endeavor to undertake, learning to be an effective fluency clinician, but it can be one of the most rewarding that an SLP can experience!
From: Gunars
And do we in stuttering therapy field let the client play a role in choosing the type of therapy, the therapist with a certain personality, and the individualized homework assignments as part of the therapy process?
From: Walt Manning
Hello Gunars. It's good so see that you are doing well with your practice. I agree with the comments by you and Gary about letting the client take the lead. Some thoughts: When choosing someone to help you through new and sometimes frightening territory, it's good to have a guide who has made the same or a similar trek before, someone who understands the nature of the journey. I conceive of good clinicians who are guides who have been on similar journeys with others, and possibly ourselves. Sometimes guides are in the front, sometimes not. There are times, as a guide, that you need to let the other person set the pace, choose the way, and even take a trail that we suspect is not the best. It is possible that the trail we prefer is not the best one for the other person, at least at that time, on that particular journey. It could be that the trail that is chosen does not make much difference as long as the destination is achieved. It may be than a less efficient trail is better if it results in greater learning about the nature of the trek. All of these things may be particularly true in those cases when then final destination is not always knowable until you arrive.
From: Gunars Neiders
Dear experts, Y'all, In losing weight, there does not appear to be one system of exercise and change of eating habits that helps everyone. Yet there are many "MASTERS" who have lost the weight and kept it off using very different systems although based on the same principle: Calorie intake needs to be less the number of calories we burn. There are many of us who have increased our fluency so it does not at all hold us back. (For example, I have successfully finished two years of practicum in psychology, where as when I was 13 it took me up to seven breaths to get a word out.) I I used REBT others have used other techniques. Have we arrived at a basic principle(s) of increasing fluency yet? Isn't that our holy grail? What have all of us who have been successful done/have in common?
From: William Rosenthal
Hi there Gunars. We have not talked in quite a while. Glad to know that your graduate studies are going well. I think that your question is significant and important. And it can mean only one thing, that you have carved out a lifelong area of research for yourself. You will never be bored, I think.
From: Gunars
Bill, Do you know of any qualitative longitudinal studies of children some of whom have spontaneous remission while others don't? Have any differences in their makeup or environment been isolated?
From: Ken St. Louis
Hi Gunars, Ehud Yairi's long program of longitudinal research with children who stutter will be a "must read" for you. He and Nikki Ambrose have a new book on the subject.
From: William Rosenthal
Gunnars, Ken has beat me to the answer. I concur with him. Those studies will help with your question.
From: Shelley Brundage
In response to your first question (not about kids and recovery, but the other one) Laura Plexico and Walt Manning have a nice article in a recent Journal of Fluency Disorders. They used qualitative methodology to guide interviews with a group of adult PWS who felt they were successful in managing their stuttering. The authors then summarized 5-6 "themes" that appeared across the interviews. This article seemed related to the "holy grail" or at least, to the quest to find it.
From: Bob Kroll
Interestingly, we all seek the ever-elusive fluency, and yet the common thread to all of the successful people who have come to grips with the problem appears to be attitude change. A solid program of training fluency skills combined with effective support in modifying attitude and belief systems appear to represent the formula.
From: Gunars
y'all, What I meant is increasing the flowing of the speech and living a full, happy life. Not a perfectly fluent speech. Pursuit of perfectly fluent speech is a mental disease similar to anorexia nervosa and bulimia. I would discourage an individual to become obsessed with keeping perfect weight or perfectly fluent speech; they both probably lead to compulsive behaviors that in the end are counterproductive.
From: Katrina, USA
Late evidence suggests that stuttering is more prevalent in middle class or upper-middle class families. In doing therapy, has there been a trend with socioeconomic status and communication disorders? I'm not sure of the validity of this evidence, I just wanted to know if there could possibly be a trend.
From: Ken St. Louis
Dear Katrina, I am not sure what "late evidence" you are referring to. Some older research suggests just the opposite, i.e., that stuttering is more prevalent in lower and lower middle classes. Some of this was reported by Andrews and Harris in England in the 1960s. Relative to your questions about trends, I assume you are referring to correlations between communication disorders (or stuttering in particular) and differences in socioeconomic status. There is a need for good epidemiological research in communication disorders, but so far not very much that deals with this issue.
From: Katrina
I'm actually interested in the correlation between SES and communication disorders, especially stuttering because I've recently reviewed the issue in an undergraduate stuttering class that I am taking. It is older research so I wasn't sure of its validity. I wanted to ask an SLP that is currently practicing if they notice any trends with SES and comm. disorders. Is it that higher class families put more pressure on communication? I think this is such an interesting issue at hand...anything else you've noticed?
From: Dick Mallard
Katrina, you asked about a therapy trend involving socioeconomic status (ses) and stuttering. I believe there is something to this. I have worked with families of children who stutter for about 20 years now. It seems to me that higher ses families bring more issues that impact negatively to treatment than those of a lower ses status (schedule, expectations, etc.). I have had my best success with middle and lower ses families as a general rule. I am interested in why you are interested in this topic. Care to respond? Thanks for a good question. — Katrina, I agree that this is a very interesting issue. I have no data on this subject, just observations from the families I have seen. I believe one of the big issues in treatment involves the time/schedule problem. It seems that upper ses families have a lot going on and it becomes very difficult to find time for the family to meet. I am sure there are other issues as well. I appreciate your interest.
From: Nan Ratner
The data from Bloodstein (1995) do not strongly suggest anything that couldn't be accounted for by things other than stress. For example, higher SES families are usually more able to reach health professionals, thus a higher referral and identification rate. I think the wider issue of stress is better examined within the context of the many studies of parenting, which do not find obvious differences between parents of children who stutter and who do not.
From: Joanie
I'm a speech language pathology graduate student and have been interested in this issue. I have a client right now that attends private school, was adopted, and seems to think the only relaxation in her life comes during the 30 minutes a week I have her in therapy. Her mother has brought her every time at least 10 minutes late for our sessions and I am honestly stuck. I know the mother cares about her daughter's stuttering and the techniques we are working on because she has told me how much it has helped her. I just don't know how to address the stress issue with the mother and was wondering if anyone knew of any handouts I could give the mother or child. Has anyone ever had these issues before?
From: Gunars
Katrina, 1) In my reading Winston Churchill's generation was raised in boarding schools and there was a great deal of demands/stress placed on the kids. For a while in the House of Lords it was considered "fashionable" to stutter and many people such as Charles Darwin had a stutter that was so severe it kept him from becoming a preacher. 2)Formerly in US it was acceptable to have the middle class children have a childhood without having demands to do well in school to get into better universities, having soccer, ballet lessons, etc. the pressure was off in 1950's, 1960's (I was there I know it). The lower class children or immigrants, like me, had to work after school, had a working mother, etc. and therefore were much more stressed. 3) Now my son's kids (upper middle class) are the ones that are under real pressure: learning to read as soon as they start to talk, soccer, ballet, pre-school, and their mother works as an ER doctor. Talk about stress! :-) I do not dismiss that there is stress in the lower SES, but it is of a different kind. Boy this could be an interesting social research topic: What kind of stress is more detrimental to fluency? 4) When I was young first the Russian's occupied Latvia (1939 when I was learning to talk), then the Germans drove them out and WWII ensued. In my cohort there was an unusually high number of people who stuttered. The numbers of stutterers were much lower in the older kids and much lower in the younger ones. Y'ALL: Is it possible that the stress is the common factor?
From: Greg Snyder
With all due respect, Gunars, what you're citing isn't data. It's the recollections, perceptions, and inferences of someone within 1 particular paradigmatic view. In short, it's an attempt to use corroborative evidence to support one's belief. Another person could use different corroborative evidence to support an entirely different belief with equivalent parsimony and validity. So while interesting, I honestly wonder the merit of discussions that do not cite actual data that has been collected in a valid and reliable fashion.
From: Gunars
Do you intend to do a manualized research, a research that can be duplicated by other researchers? Y'ALL, Has there been any manualized research done in the area of stuttering therapy?
From: Nan Ratner
A manualized approach would imply that a single, unvarying approach would work for all stuttering regardless of client or clinician attributes. Is this really what you are asking?
From: Gunars
Nan, What I was asking are there any conceptually accepted "Evidence Based Therapies" (EBTs) that exist for stuttering therapy. The manualized aspect is maybe an overkill although guidelines would be necessary to replicate the studies. In psychology and medicine the EBT concept does not include the assumption that it works for all people, but that a research study (or preferably more than one) has been performed to show that certain approaches have given positive outcomes. When one approach fails that has been adjudged to have the most beneficial effects fails, then another one is used. This example is clearly demonstrated in medicine where certain drug regimens are tried first and when they fail another drug is chosen and finally surgery may have to be performed. The insurance companies have turned the model somewhat on its head by having the doctors try the least expensive medicine first and only then the ones that are considered more efficacious, but less effective. — In psychology Cognitive Behavior Therapies (and there are a number of them) are considered often the "gold standard". This unfortunately may possibly be so because they are more standardized and sometimes even "manualized" to a certain extent. If I recall the Lidcombe system and Coopers' works are practically manualized. — Nan, I took a day off from my psychology studies and researched the current stuttering literature. I find it very encouraging that you and your colleagues are working hard. Hopefully soon we will arrive at number of approaches that will help the "perseverative stuttering syndrome".
From: Zach, USA
how does this approach work with stutterers?
From: Judy Kuster
The Prof is In is designed for consumers (people who stutter and their families and teachers) to find answers about stuttering. Zach, if you are a student, your question is very broad and would take a long time to answer adequately. The answer is probably in your textbook about stuttering or in your university library. If you are a person who stutters, you can find information about Van Riper's approach online -- for example, Charlie Osborne's and Linda Hallen's students have added PPTs and handouts about several stuttering therapy approaches (including Van Riper's) to the online student journal at http://www.mnsu.edu/comdis/kuster/journal/journal.html on the Stuttering Home Page. Darrell Dodge has also put online an extensive review of Van Riper's approach on http://members.aol.com/dmdodge/dw/vriper.htm
From: Ousmane (Chad)
There is something that I can't understand. Why sometimes we stutter a lot and why sometimes we don't stutter? It is because of stress or something else? For example, I can talk without stutter for a while. And if I think that I'm a stutter then I begin to stutter. There is something linked to that?
From: David Shapiro
Ousmane, You've asked an important question. The patterns of stuttering, including its predictability and its variability, have intrigued both speech-language pathologists and people who stutter. Surely certain conditions precipitate or perpetuate stuttering. Also, our thoughts about stuttering may influence our stuttering behavior. When identifying speaking contexts that people who stutter perceive to be of increasing levels of difficulty from the easiest to the hardest, and when analyzing the conversational samples of people who stutter, I have learned that stuttering does vary with each individual, although often there are common features across people who stutter. So, yes, the patterns you described often are experienced by others. With appropriate guidance, moving gradually from the least to the most challenging situations often enables people who stutter to develop fluency control and feelings of improved communication independence. It is interesting how stuttering provides an opportunity to continue to learn about our communication and ourselves.
From: Gunars
y'all, The more I see and talk to adults with perseverative stuttering syndrome who exhibit severe stuttering the more I am reminded of my psychological clients with unresolved Post Traumatic Stress Syndrome (PTSD). Surely, most of us who had severe stuttering were from time to time traumatized by other people's reaction to our stuttering. For example, my family were almost excluded from coming to United States due to my stuttering. For three days at the age of thirteen I could not sleep or eat, because I could not say my name in front of the U.S. consulate for what seemed to me at least seven breaths. Do any of you know if any research has been done applying techniques of PTSD such as Marsha Linehan's "Dialectic Therapy" to stuttering?
From: Judy Kuster
Gunars, you might enjoy reading an article from the 2003 online conference written by Woody Starkweather and Janet Givens, Stuttering As A Variant Of Post Traumatic Stress Disorder: What We Can Learn
From: Gunars
Judy, Thanks for the heads-up. This, I believe, is an important aspect of stuttering therapy. I think that many young people have been traumatized not only by stuttering but also by insensitive stuttering therapy. (Only my conjecture.)
From: Ed Feuer
At the site of the Speech and Hearing Clinic of Auburn University's Department of Communications Disorders under the heading "Stuttering Therapy," one of the approaches listed under "Types of Therapy" is: "Multidisciplinary treatment, integrating appropriate professionals from other disciplines in the treatment." While multidisciplinary assessment exists elsewhere, genuine multidisciplinary treatment integrating professionals from other disciplines in a coordinated team, particularly for adults, seems extremely rare. I have asked Auburn's department whether such multidisciplinary treatment is actually offered for stuttering at its clinic and whether modalities for such multidisciplinary treatment are taught in its department's fluency courses and part of the practicum for graduate students. To date, my questions have not been answered. My question to the professors: Is multidisciplinary treatment of stuttering, integrating professionals from other disciplines, taught in your department and does it exist in practice at your school's clinic -- or anywhere for that matter?
From: Brian Humphrey
I have referred two clients for psychological treatment. One was an adult who had been diagnosed with an anxiety disorder. The other was a very anxious boy. In both cases, the psychologists chose to treat independently and to focus on the anxiety. In both cases, we communicated very well about our shared clients.
From: Ed Feuer
"Don't talk ABOUT us, talk WITH us!" is the slogan of the ISAD 2006 Online Conference. Well, I tried. I posted my question on the subject "Multidisciplinary Treatment Team" on Oct. 5, 2006, to the section . Let the record show that as of 8:28 p.m. Central Time, Oct. 10, 2006), there still has been no response. I am very disappointed that no professor has been "in" to respond to my question. I can only conclude that the subject is, like the title of Canadian filmmaker John Vaskevitch's new documentary on stuttering, Unspeakable. I can also only conclude, sadly, that the professors here have not seen fit to respond because they are too well invested in the dismal status quo. I would, however, remind the professors that on ASHA's site in the section titled "Division 4, Fluency and Fluency Disorders" at: http://www.asha.org/about/membership-certification/divs/div_4.htm#stud in the part headed "Professional Issues," one of the items listed is "multidisciplinary interaction." I would also remind the professors that at the end of that section, members are encouraged to: "Help shape future developments in these and other areas of activity!" It would appear that regarding multidisciplinary interaction, the profession only pays lip service -- altogether an appropriate term in the region speech-language pathology and stuttering. The frustrations of people who stutter that I see elsewhere in the ISAD site only serve to reinforce the fact that what currently passes for stuttering therapy is severely lacking, and that it is time to look at a new delivery approach.
From: John Tetnowski
Ed, No offense, but notice that, speaking for myself, I have not responded to all questions. I think we respond to the ones that we have something to say about and the ones that we have some knowledge about (not to mention time). I have a "little" experience and knowledge in the area of your question, so I will try to respond. I think that the multidisciplinary approach runs contrary to most training. I agree that we all talk about making appropriate referrals, etc., but may not always do so. I think that there are at least a few reasons why this does not happen. 1) The first one is probably our fault....professional domain. Even though I have worked for PWS with other professionals, it still "ruffles my feathers a little" when clients come to me and tell me that they have been seeing psychologists, counselors, social workers, etc. I say to myself, "what do they know about stuttering?", when the answer may be "just as much as me....maybe even more.... about some aspects". I NEVER discourage them, but I do have those thoughts. I should let you know, however, that I have worked for PWS in conjunction with counselors, physicians, psychiatrists, psychologists, and even in one case a "hypnotherapist". I do think that we need to look at the needs of the PWS. 2) The second reason has to do with a particular sector of SLP, that is, the school SLP. Granted that the role of the school is to meet the "individual needs of the child". Truth is, there are some restrictions due to allocation of resources. I have heard many schools SLPs (and been there myself years ago) say that they are discouraged from making referrals because it puts the school system on the line to pay for that service. I don't think we need a political arguement in this forum, but I am reminded of a bumper sticker taht I see once in a while that reads, "Wouldn't it be wonderful if teachers could buy whatever they need and the Navy had to hold a bake sale in order to buy a new aircraft carrier?" You know what I'm saying; there just isn't enough money these services. However, I do know that in recent years, there is much more emphasis on meeting academic needs. This has forced many SLPs out of their therapy rooms and into the classroom, where they work with teachers, assistants, etc. I think that there is SOME progress on multidisciplinary therapies. 3) In private practices and clinics, it again boils down to cost. It is hard enough to get reimursed for stuttering therapy, period. Making referrals, team approaches, etc, are probably very difficult to get reimbursed for. I am not in private practice any more, but maybe someone who is can talk about the difficulty in getting reimbursed. 4) In my setting (the university), we often make referrals. It is however up to the family to follow-up. We cannot pay for otehr services. Some universities are attched to facilities that can provide multidisciplinary interventions, and probably do so. I know for example, that at one university that I worked, we had a partnership with the school of social work. We had interns in our clinic that provided all sorts of services that social workers provide. It was a wonderful operation. I wish I had looked back and checked to see if there were better outcomes for PWS. Sadly, I let that opportunity get away from me. In summary, some of us do work alone with PWS, but I bet there are a lot more working with other professionals in some fashion. I too would like to hear from others. Thanks Ed, John Tetnowski
From: John Paskievich
Ed I can appreciate why you continue to call for a muti-disciplinary approach for the treatment of stuttering. Stuttering can quickly develop from a speech disorder to a life disorder. Speech is what defines us most as human beings. Not being able to speak properly is, inevitably, to feel diminished as a human being. However noble your call for a multi-disciplinary approach may be, it is impractical for the reasons John Tetnowski outlined. Firstly, no private or public health system could afford to pay a team of psychologists, coaches, trainers etc to treat an individual stutterer. Even now good therapy from well trained pathologists is not readily available or easily affordable in North America. In other parts of the world treatment for stuttering is non-existent. Stuttering is simply not a health care priority. The same is true for learning disorders like dyslexia and ADHD. Secondly, most psychologists, coaches, trainers know next to nothing about stuttering. Teaching assertiveness training to a fluent person is entirely different from teaching it to someone who stutters. I can't imagine these professionals spending the time and effort to learn about stuttering to the same degree as a speech pathologist who specializes in stuttering. The best that any stutterer can do, right now, is to form their OWN personal team by doing a lot of reading, speaking with fellow stutterers and experienced speech pathologists, taking part in self help groups and conferences and exchanging thoughts on internet forums like this one. The stutterer, in other words, must become his or her own multi-disciplinary team.
From: Ed Feuer
To Prof. Tetnowski: Allow me to clarify what I mean by a multidisciplinary treatment team or to be more precise, a coordinated multidisciplinary treatment team. I do not mean referral AWAY. I do not mean an essentially meaningless "eclectic" approach claimed by sole SLP practitioners. I invite you to take down a volume from your bookshelf and turn to page 201 where the writer says: "We feel that stuttering needs a global therapy, a total push, if it is to yield to clinical intervention and that it must be attacked from every quarter and with every available weapon." I take very seriously those words written by Charles Van Riper in The Treatment of Stuttering. I wish every SLP with stuttering clients would do the same. You know, however, that in practice, the vast majority of such SLPs are not on the same page, in the same county or even in the same galaxy. Van Riper's stuttering modification therapy, which still makes best sense of anything out there, is simply too great a task for SLPs, alone. Lacking the knowledge and time, they have picked and chosen cafeteria style and the results should surprise no one. The reality is that stuttering therapy effective over the long term demands genuine and thorough systematic desensitization, healing and strengthening. If SLPs are honest -- and I implore them to be honest -- they will admit that is not being achieved in almost anything that passes for stuttering therapy today. Some SLPs know something about stuttering but they lack the tools. Other professionals, who have the tools, know nothing about stuttering. I'd like to see some of these people working together for the benefit of people who stutter. The SID-4 specialty certification is a step in the right direction but it should be seen only as a beginning. SLPs with such a specialty would make the best facilitators for what I advocate. My modest proposal would involve such SLP recruiting other professionals willing to use their skills to help achieve the goals of the stuttering-therapy model. Yes, cost is the objective issue but even before that obstacle is considered, the selfish impediment of �professional domain� as well as ego, fear of change, fear of rejection, comfortable inertia and to be candid, laziness, would all have to be overcome. But it all comes down to that item in the ASHA Code of Ethics about putting the needs of the client first. For elaboration, read my essay In The Year 2025, on Judy Kuster's Stuttering Home Page at: http://www.mankato.msus.edu/dept/comdis/kuster/TherapyWWW/In2025.html To John Paskievich: Yes, cost is the objective issue but imagine, if you will, what would happen if someone developed a highly effective but also highly expensive treatment of cancer or AIDS. Would the other practitioners tell their patients, "Yes, there is something much better but it's too expensive, so I'm going to keep giving you the old primitive stuff"? Or would those practitioners with integrity move heaven and earth to try to bring the cost down? I think you know the answer. And, yes, it's true that nobody dies from stuttering although the accumulated effects of decades of anxiety and misery probably serve to take a few or more years off a life. However, I ask you, John, should we be content to be forever relegated to treatment that is second-, third-, or fourth-rate and inadequate or worse? As for your suggestion that people who stutter should form their own multidisciplinary team, that, sadly, is what is necessary now. But it is a highly inefficient way of doing things. Knowledgeable SLPs could do a far, far better job of recruitment and the creation of a pool of necessary professionals from other disciplines -- IF THOSE SLPS WANTED TO. If..
From: John Tetnowski
Ed, I do hope that you realize that many of us (I might even say most of us) do have the best interest of the PWS at heart. In regards to your response, I REALLY think we are arguing for the same thing, i.e., providing everything that is needed for the PWS to be successful (I would also add, "and nothing else"). What I mean by that is, many people who stutter need a counselor, a coach, maybe an occupational therapist, maybe a psychiatrist....however, many do not. I think that the individual case and the skills of the individual clinician will make that decision for us. I hope you realize that we SLPs have been working in team settings for a long time and do not have a problem with it (as you seem to be insinuating.........and I am not being defensive, just truthful). Have you seen SLPs who work as part of a cleft palate team? I myself have worked on a rehabilitation team where the roles of PT, OT, SLP, social worker, etc. are quite fuzzy. We all worked together for the betterment of the patient. Does it work better? In some cases "yes", but in other cases it can be a waste of time and resources. I have been in situations (as part of a team) where I have been asked to do things that I am not trained to do. (e.g., stretching exercises as part of a PT regime.....I think the PT is much better equipped to do this than me, evn though they "showed me how to do it"). When I would say "no" to working with a patient because it was outside my expertise, I was looked at as a rebel..... or "not a team player". If everyone was well trained in all areas, this might work, but as the other John has said, try to find other professionals outside of SLP who are trained to work with PWS (especially if it is outside of a large urban area). If I can use his name, I think that Phil Schneider is better equipped to work as a counselor with a PWS than most other professional counselors. Van Riper probably was as well. I am just not convinced that every PWS needs a team. And I AM NOT LAZY, when I say that. I work very hard for my clients (and just to let you know, I see also them for FREE!). I make referrals and work with other professionals when needed......but I do not work with a team, just to say that I am working with a team. I DO think it would be interesting to see if a team approach is indeed more efficacious. I bet it would for some, but I bet it would make no difference for just as many. Remember, even Van Riper talked about subtypes of PWS. To be fair, I DO AGREE WITH YOU ON SOME ISSUES. I think specialty certification is a step in the right direction. I am looking forward to seeing the data however. Even though I am one of those BRS-FD, I really want to see the data that proves I get better outcomes than a non-specialist. I hope the data supports specialty recognition, but it is still not available. I ALSO AGREE with you on the point of putting together a list of other professionals who are qualified to help treat stuttering. The SFA maintains lists of qualified SLPs in each area. Maybe you can persuade them to put together lists of other professionals who are skilled with working with PWS. Personally, I would love to have access to that list for the people that I work with. It would be an incredibly valuable resource for the people who truly need an interdisciplinary team. Finally, I would like to know how YOU WOULD determine who really needs a complete team. Personally, I use a complete profile (I would be more than willing to send it to you if you would like....my e-mail is tetnowski@louisiana.edu). I wonder if you or others have an effective way of determining these needs of the clients. Finally, let me say that the tone of this response may seem defensive and confrontational. It's really not. I am intrigued and interested by your . I hope we can continue this discussion in a fruitful manner. One last point......I did try to read the reference that you gave me and the link is incorrect somehow. Can you give me the correct address so that I can read your paper.
From: Judy Kuster
John, When Mankato State turned to Minnesota State University, Mankato, they shut down the mankato.msus address. If you ever find an address that says that, substitute mnsu for mankato.msus and the URl should work. That happened 2 1/2 years ago and I've really never recovered! Anyway, the direct URL to the article Ed is referring to is https://web.mnsu.edu/comdis/kuster/TherapyWWW/In2025.html
From: John Tetnowski
Ed, I did read your article, again. I remember reading it last year as well. Truly, I do think that many of the things you are talking about do exist. The problem is that many of them exist in isolation. For example, I know that there are some great things going on with desensitization and feedback through advanced technologies in "virtual reality". There are active programs going on in stuttering research using VR at Hofstra University and with Shelley Brundage at George Washington University. Neither are propriatary in the least. These are at least two programs (among many, I believe) that are using and conducting research in a mutidisciplinary approach.
From: Ed Feuer
To Prof. Tetnowski, Lets cut to the chase here. There's a something particularly lamentable about stuttering that produces denial -- including denial on the part of practitioners. And unfortunately, the biggest elephant in the parlour, by far, is the refusal by many members of the profession to acknowledge the severe deficiencies in what passes for stuttering therapy these days. (Anyone who wants to discuss that situation can reach me at my e-mail address below.) I believe that the experience of the last 75 years has shown that the traditional Lone Ranger concept has failed. I also believe what is needed is thorough and genuine systematic desensitization, healing and strengthening and that it would take a coordinated multidisciplinary team approach to deliver that. So how do we get there from here? In my essay In the Year 2025 I say that progressive speech therapists could start with small steps, reaching out to collaborate with experts from other fields. But fluency disorder professors could help get things moving by developing joint practicums with, for example, psychology and counselling departments whereby grad students could share stuttering clients and lend their respective expertise using the speech therapy model in a collaborative treatment plan under supervision of their professors. Those professors would, of course, have to work together, communicate, liaise. Why is this not possible? I would ask all the professors here, including those who now regard this topic as unspeakable, to consider something George Bernard Shaw once wrote: "Some men see things as they are and say 'Why?' - I dream things that never were and say, 'Why not?'""
From: Judy Kuster
John, Your suggestion that the SFA might develop a team for referral of non-slps is interesting. I know some that I'd recommend for a team like that - Dennis Drayna, Gerald Maguire, and Nathan Lavid. Both Dennis and Nathan have written papers for previous ISAD online conferences. Dr. Lavid has written an excellent book "Understanding Stuttering." Two more team members, if they were still alive, both with PhD's in psychology (although many think they were SLPs) would be Joe Sheehan and Charles Van Riper.
From: John Paskievich
Ed As previously stated, I think that a multidisciplinary approach to the treatment stuttering has much to recommend it. Stuttering is so much more than a speech problem. It can negatively effect every aspect of a person's life from friendships and romance ti schooling and employment. Many stutterers lead circumscribed lives, fail to develop proper inter-personal skills and settle for second or third best. I believe that therapy for Post Traumatic Stress Disorder should be a vital component of speech therapy for stuttering. I feel that stutterers are traumatized in the full medical sense of the term, as traumatized as car crash victims or war survivors, perhaps even more so because stutterers are continuously forced back into traumatic situations whenever they must speak. It's more than interesting to know that up to one third of stutterers have experienced out of body experiences, a major symptom of trauma. Van Riper as a psychologist and stutterer knew how traumatic stuttering could be and that is why he placed such an emphasis on systematic desensitization and why he wanted, as you point out, to attack stuttering "from every quarter and with every single weapon." But the practical question remains; who will fund these weapons of mass destruction of stuttering when stuttering remains only a blip on the health care radar screen.
From: Ed Feuer
To John Paskievich: Yes, treatment for post-traumatic stress disorder is relevant in the treatment of stuttering. But treating PTSD is way beyond the pay grade of SLPs. And the people with expertise in treating PTSD know bupkes about stuttering. I'd like them to work together along with people with other relevant expertise, as needed, for the benefit of people who stutter. And when society finally gets serious about the treatment of stuttering, that is exactly what we will see.
From: maciste ABDOULLAH (Mauritania)
Has a gene been discovered yet that causes stuttering?
From: Barbara Amster
Dr. Dennis Drayna at the NIH is investigating that exact question. I suggest that you look at a review article of his work at the Stuttering Foundation of America website at http://www.stutteringhelp.org/Default.aspx?tabid=176
From: Judy Kuster
The SFA article that Barbara reports on his current and interesting research. Dr. Drayna also wrote a good article about his research on the 2005 ISAD online conference. The URL is http://www.mnsu.edu/comdis/isad8/papers/drayna8.html
From: maciste ABDOULLAH (Mauritania)
Is there any surgical operation that can help remedy stuttering?
From: Ken St. Louis
Dear Maciste, I hope I have the correct first name for you. Thanks for your question. Actually, there is no surgery that has been found useful for stuttering. More than 150 years ago, Dieffenbach carried out surgeries for stutterers in Germany where part of the tongue was taken out. Others over the years have cut the lingual frenum. We are quite sure that most stuttering originates from difficulties, not well understood, in the brain. And these difficulties likely have more to do with improper function of certain parts of the brain rather than abnormal brain tissue.
From: Jennifer Chestnut
I am a speech-language pathology graduate student and currently, in my graduate course we are discussing different therapy methods used to treat stuttering in children, such as the Lidcombe, Temple, and Shine programs. While I know that each individual that stutters is different, given a situation where both the child and parent(s) are motivated, which programs do you find the most successful and/or recommend?
From: Lynne Shields
Jennifer, I truly do not recommend one program over another. As you said, every child who stutters is an individual, with their own personality, strengths and weaknesses, and preferences. I like to help each child take the time to explore their stuttering, what happens to them when they stutter, how that is different from when they are fluent, how it feels to get stuck, etc. Then, we try out some different ways of talking that help them learn to vary their speech and manage their stuttering. I try to engage the child in the process and give them the choice about the techniques or "speech tools" that work best for them, and help them use those tools in a variety of situations of their own choosing. I rarely use a single program for a particular child. I haven't found any 'one size fits all' programs.
From: Brian Humphrey
Jennifer, My approach is to try to understand the attitudes, behaviors, and thinking of each person who stutters and tailor my treatment plans to the needs of each individual. It is like having a variety of different needles and threads in one's sewing kit. Fluency shaping and stuttering modification approaches are each effective with some, but not all, clients. Delayed auditory feedback and/or frequency altered feedback may work well with some clients but not others. Age of the client and treatment history are additional factors that may suggest trying one approach over another. With adult clients, I like to demonstrate and have them try a few treatment approaches and agree with me on which to focus on first. For example, I am thinking of a client who chose to use fluency shaping approaches when I discussed and demonstrated treatment approaches with him. Later, after making some progress but reaching a plateau, we switched to stuttering modification approaches to make further gains. We need to remember the ABC's of stuttering: affect, behavior, and cognitive factors. Only part of the stuttering problem is the stuttering behavior itself. When that particular client started working with me, he was most concerned about his stuttering behaviors. Later, he recognized and was more willing to work on his feelings and attitudes related to stuttering as well. When he did, his communication effectiveness improved.
From: Brandye Johnson
What are some good strategies/techniques to teach children (ages 7-12) how to cope with their disfluency in society, school, home, etc.?
From: Charlie Osborne
Brandye: There are many resources that are available with the information you seek. One of my favorites is the following: Reardon, N. A. & Yaruss, J.S. (2004). The source for stuttering: Ages 7-18. East Moline, IL: LinguiSystems.
From: A Better Resource...
As a parent of a CWS, I would suggest contacting some of the professionals in the FRIENDS Organization. They were most helpful to my husband and I in figuring out what options might be best to use with our son. My husband and I have come to believe those who stutter know better than those who do not...
From: John Tetnowski
There are lots of good resources out there. We are in the process of getting a children and teens group going in Lafayette, Louisiana, but tehy are not yet established. Last week we had two teens and one child come to our NSA group's "bring a friend meeting" (in honor of ISAD). After the meeting I thought, "I really wish we could have done more for those kids and teens". Within just a few days, however, I have been contacted by the clinicians of two of the three teens and kids who attended the group. The were something like this, "What did you do at that meeting?......it's like they are new kids!" and "they are so motivated now". I was surprised because I didn't think that our group really met their needs. I guess I was wrong (again). Talking with anyone who stutters seems to be a great idea. I thought a teen group was needed for teens, and that a kids group was needed for kids. I guess I was wrong (still again). Therefore, I will agree with your . One of the best things for kids who stutter is to meet someone else who stutters. A note for all of us SLP: after every self-help or support group that I attend, I thank all of the attendees for helping me learn more about stuttering. I encourage all SLPs to attend a group this month themselves. You never know what you'll learn!
From: Dick Mallard
Brandye, you asked a good question. I had a newspaper reporter ask me one time what I learned in childhood that helped me "overcome" stuttering as an adult. I did not have therapy until I was age 22 and in graduate school. The best foundation I received as a child is that my parents insisted that stuttering not be used as an excuse for anything. If I had to give a report in school, I had to "do the best you can, even if you can't say a word, and we will be proud of you." Not giving the report was not an option! My parents also insisted on me having good manners and social skills. I had to look at people when I talked to them, speak where others could hear me, shake hands like I meant it, and demonstrate respect and manners with all, especially individuals older than me and women. Having good social skills and knowing that you can interact socially and deal with others appropriately are tremendous foundations on which to build good communication skills and speech control. When I did get help for my speech, the communication environment was not a threat to me because I felt I was socially competent and that I had confidence in myself as an individual. By the way, my wife of 42 years still appreciates that I open doors for her!
From: Stacy
I have recently read that classroom modifications should be considered when working with CWS (e.g., not having to speak in front of the class). However, you stated that doing such things in school helped you once you received therapy. Is this something that needs to be dealt with on an individual basis, or do you think modifications, in general, should not be made since they may interfere with social/pragmatic skills?
From: Dick Mallard
Stacy, I am not in favor of promoting avoidance for anyone who stutters. Stuttering is a problem that needs to be solved by the person who has the problem. Professional guidance is needed sometimes as the individual seeks to deal with and eventually solve his/her problem. Of course, individual differences and circumstances must be taken into account. This is why I favor a problem solving approach to treatment. When an individual learns to make decisions and then deal with the consequences of those decisions, progress can be made. Our job as professionals is to present the variables that need to be considered and then assist the person in making the proper decision that will be in the person's best long-term interest. The problem comes when the individual cannot see long-term benefits and makes a decision that satisfies an immediate need. The example you gave is perfect. It is not in the child's best long-term interest to not speak in class but he/she may decide to take that route due to present fears. We cannot force someone to make the correct decisions for long-term success. We can, however, present options and then be ready to assist the person in dealing with consequences.
From: Drew Stewart
In 2005 I heard Dr S. Block speak on Exposure Therapy. I decided to take that approach in regard to my mod-severe stutter. I joined Toastmasters Int here in N.Z. It has worked wonders, & my Iceberg is melting, but there is still a lot of work still to be done. I still find talking 1/1 can be difficult at times. I am now scared of a major relapse. My question is: How do I overcome that feeling". I am 56 yrs of age & have stuttered all of my life.
From: William Rosenthal
Hello Drew, I will take a crack at this. First, there is never a guarantee that relapse will not occur. Having said that, in my experience, it is less likely in a situation like yours, where you have obviously taken the initiative and done a great deal on your own. There is also some confusion about relapse. It must be distinguished from a 'recurrence of old symptoms'. Relapse takes you back to square one. It is like having to begin all over again. The recurrence of old symptoms is different because you have the tools to deal with it. If you find that you are 'slipping', you need to take stock of what is going on, reestablish the framework that was working for you. This latter thing is common in treatment, or usually after treatment, but it is not the same as relapse. You might consider converting your concern about this to increased vigilance. Put some dates on the calendar to periodically take stock of where you are and what if anything you need to do to keep on track. Sounds like you are doing a good job for yourself. Keep it up and good luck!
From: Shelley Brundage
hi Drew: I liked Bill's comments on relapse and thought I would add a comment on another aspect of your post. One of the mechanisms underlying why exposure therapy "works" (in psychological disorders anyway) is habituation. That is, over time, with repeated (controlled) exposure to fearful situations (such as giving a speech to a large audience), one's "fear structure" for that situation changes (habituates) and becomes reduced in its magnitude. So, how to "keep that feeling" going? I think you are doing it--keep going to Toastmasters, keep talking to folks 1:1, etc. You've actually done a very difficult task (on you own deciding to attend Toastmasters and then actually doing so!) and you should feel good about that. You may be interested in some work that we're doing in my lab here at George Washington University--see link titled Virtual Reality and Stuttering...we are using virtual reality environments in which PWS can practice reducing stuttering and related behaviors in safe, controlled environments that can be changed over time.
From: Amos Lukong, Douala
Can any one tell me if singing can help in controlling stuttering. I met with a classmate of mine some months ago and discovered that her stuttering has greatly improved as compared to some 7 years ago when she and I were classmates in the primary school and both of us had serious problems with oral work in Class. She informed me that she joined a choir group in her church and this has helped her stuttering a lot.
From: Dale Williams
Amos, People have tried singing therapies with stuttering, although they are rare. The idea behind them is that singing increases the available airstream for speech and improves the coordination of air and voice. If you can get a copy of Richard Ham's book ('Clinical Management of Stuttering'), he explains it better than I do.
From: Lynne Shields
Amos, While it is often true that a stutterer can sing fluently, I do not know of any evidence that singing therapy has any reliable affect on stuttering during speaking. Your former classmate reports that her stuttering improved after she joined a choir at church. I wonder what other factors may have changed in her life that may have contributed to the improvement in her stuttering. For example, singing with the group may have increased her comfort level in being with others and performing before an audience. When one's comfort level in speaking increases, this may lead to a reduction in the tension associated with stuttering, which could contribute to improved fluency. There may be other ways in which she has begun to manage her speech that improved her speech, as well.
From: Sarah Shumway
I am a graduate student in Speech and Language Pathology and am very intrigued by this thread. I recently evaluated an advanced PWS with severe blocking, prolongations, and secondary characteristics. However, he reported that when he sang in his band, he was fluent. Is it possible that singing therapy would help with rate control and easy onset if used like melodic intonation therapy for aphasia? Is there research in this area?
From: Vasu Parameswaran
This is NOT a rhetorical question but a genuine one and if you could at least point me in a general direction, that would be great: Is there a comprehensive theory, or at least any ongoing work towards building a theory, that explains stuttering? By comprehensive, I mean that it must explain at least the following mysteries and then some: 1. Stuttering is almost absent when the stutterer speaks when alone. 2. Stuttering is almost absent when the stutterer sings. 3. Stuttering is almost absent when the stutterer choral-reads. 4. Stuttering is almost absent when the stutterer assumes a foreign accent or mimics somebody else. It seems like a lot of research effort has been (and is) spent in data gathering: doing surveys and the like of stutterers vs non-stutterers. But has there been any effort to "make sense" of the large amount of data collected so far and to build a theory? I know that the "diagnosogenic" theory has been discredited but Johnson at least tried and failed. What about later theories like Sheehan's "role-conflict" theory for stuttering? Has that been discredited?
From: Greg Snyder
Your question really does necessitate a discussion on what constitutes a true scientific theory. (As opposed to a pseudoscientific theory, many of which have made their way into the field of SLP.) While there are many characteristics of a "true science" theory, there are a few core components: (1) A true theory can be directly tested and falsified; (2) A true theory makes predictions. Those predictions are then directly tested. (As opposed to many a stuttering perspective that simply "explains" aspects of stuttering after the fact.) (3) A "true science" theory is not held in great regard as its sole job is to attempt to account for reality and be tested. It is continually tested; active attempts are made to falsify it. If it is falsified by a study with sound methodology and internal validity, then the defunct theory gets abandoned. In other words a true science theory places more emphasis on the data, rather than the theory itself. Any theory that falls short in any of these 3 areas is, by default, pseudoscientific. Pseudoscientific theories hold no true scientific value. Instead, I would argue that they are a significant detriment to our field and to people who stutter. I've got to run to church at this point, but I'll come back at a later time and time to address your question in a more specific fashion. (But before the question could be addressed, a "true science" theory had to be operationally defined.)
From: Vasu Parameswaran
Hi Greg, thanks for your response and this discussion. This discussion overlaps significantly with our discussion on your article on stuttering in sign language! Interesting (and useful) that you laid out the requirements of a scientific theory before getting into the details of your forthcoming answer (which I will await). Anyway, I could not resist noting here, based on your response, that one of the clearest accounts of the scientific process I have read anywhere, is given by Wendell Johnson in his book "People in Quandaries" - not sure if you've read it. In that book, he hypothesized that there is a reversal of the order of abstraction, in effect, making a stutterer "project" his concept of stuttering from the word-level to the physical-level. Based on this theory, he predicted that there would be no stuttering to be found among American Indians, given that they do not have a word for it (this we know turned out to be false and Johnson was a little too premature in his Eureka). Nevertheless, I would claim that his intention was to stick to the scientific method although he faltered in the application of it. Similarly, Sheehan posited his approach-avoidance and role-conflict theory for stuttering. A central tenet of the theory was that embracing the "stutterer" role begets more fluency while embracing the "fluent" role begets more stuttering. One can argue that a "prediction" made by this theory is that voluntary stuttering should reduce real stuttering. This is certainly true. His theoretical framework also suggested the therapeutic approach of embracing the role of a stutterer, stuttering as openly as possible (Incidentally, I have personally done both of these and benefitted immensely in more earned fluency, better conditioning to pull out of stutters and less fear). Anyway, I am not sure what he did in his later years - did he improve on this theory? did he find flaws in it requiring a revision of the theory? Did others build on it, or find it no longer credible, or is it just that it fell out of "fashion" to think about role-conflict and approach avoidance? These were some of my related questions. Anyway, I will await a more detailed response from yourself (and others of course).
From: Greg Snyder
Hi Vasu. You raise a lot of valid questions, and I'll try to address them as well as I can within the limitations of this medium. First off, you wrote in regards to WJ: [Nevertheless, I would claim that his intention was to stick to the scientific method although he faltered in the application of it.] This may or may not be true; I will never know his personal intentions and motivations. But I will suggest that he fell into a trap by not strictly adhering to the scientific method. In short, his gross errors were twofold. First, he was trying to apply deductive thought in science; and this simply doesn't work very well. The end result is essentially a house of cards. He created his central tenet, and then went forth trying to prove said tenet. This really goofs up experimenter bias, and doesn't really keep us honest in the process. Secondly, he attempted to use corroborative evidence to �prove� his central tenet, rather than direct measures of his stated hypothesis. This is also a scientific no-no, and one which is (or at least should be) taught in any graduate level science class. Further, if one looks at perhaps his only real attempt to �prove� his belief (i.e., the Monster Study), it was horribly designed. Data gathered from that study would really be hard to interpret due to problems with internal validity. It does honestly befuddle me why such scientists didn�t measure psychological attributes before stuttering surfaced, so that one could use a simple statistical regression to predict stuttering--rather than trying to use corroborative evidence to prove your deductive belief post-hoc. You also wrote relative to Sheehan: [Similarly, Sheehan posited his approach-avoidance and role-conflict theory for stuttering.] You know, I do carry a soft spot for Sheehan, as he (in my estimation) was the most scientific of the largely pseudoscientific psychological stuttering theorists. If you follow Sheehan's thought, and actually step into his logic--it really does make sense. However, Sheehan fell into some of the same traps that WJ did. For example, he wrote: [In psychological and speech laboratories we've uncovered evidence that stuttering is a conflict, a special kind of conflict between going forward and holding back - an "approach-avoidance" conflict. You want to speak but are torn by a competing urge to hold back because of fear.] This is a deductive hypothesis that cannot be tested. It is based on corroborative evidence (i.e., the phenomenon that when people try to stutter less, they often stutter more). Sheehan had very cleverly discovered a terrific phenomenon, which held a lot of clinical promise. But just because we've discovered a phenomenon, that does not give us the right to solely interpret in a fashion that we want to believe. Sheehan was using corroborative evidence to support a central hypothesis (or theory) that was not directly testable. Further, I could provide other explanations accounting for the phenomenon that have just as much (or more) validity as Sheehan's. Opinions are like _____; we've all gone one, and they all tend to stink. (Salmelin's 1998 article, if I recall correctly, documented changes in neural processing relative to when a stutterer tried to stutter less or more. So by allowing the stuttered brain to work the way it wants to--i.e., stop trying to stutter less and just accept the stuttering as it comes--this may allow for more efficient neural processing of speech.) So in short--One can discover and use the positive effects of a phenomenon, but that doesn't mean that your explanation of it holds any true merit. A perfect example of this is Freud; he made a lot of astute observations, but his explanations were a little screwy. Ok, this is to be continued. I've got to get to work! But yes, there may be an emerging perspective on stuttering that seems to handle the stuttering phenomenon pretty well, including its existence in other expressive modalities. I'll have to attack this in the future.
From: Vasu Parameswaran
Hi Greg I agree with most of what you write and I think it is about time for a concerted effort for a true theory. I also think that there is enough raw material out there: Irrespective of whether one is in agreement on the theories of Johnson/Sheehan (Van Riper probably didn't fuss much about theories and got down to clinical business) it is undeniable that the three were virtually fluent speakers, each having taken a slightly different route. And there are scores who have gone thru their therapies and other kinds. So I think that at least clinically, a lot of the pieces of the puzzle are there. And given that today there are tools for brain studies as well, there will be ways to test theories. The Salmelin article you mention sounds very interesting and something that should be built on. And on a side-note, my soft corner is for WJ. If you read the chapter on stuttering in his PQ book, you will find that he advocated eliminating artificial devices (tricks) for false fluency, stuttering openly, voluntary stuttering, desensitization etc, tools that are in use today and the others. And for him to put forth these tools in that era (1930s and 40s I think) it was truly innovative, and I believe he laid the foundation for many others to build on.
From: Greg Snyder
Hi Vasu. You wrote: [it is undeniable that the three (JS/WJ/CVR) were virtually fluent speakers.] I've never had the honor of meeting any of them before their passing, but one can still hear them online if the right website is searched. While the speech sample that I've heard was small, I would classify it was a well-controlled stutter; to call them virtually fluent, at least in the small recordings that I've heard, would be a stretch. Undoubtedly, all three contributed to the field, for better or worse; their contributions did help many. But as for your original question, I do believe that the emerging neurophysiological model does hold promise. The variability of stuttering has really been tough for theorists to account (which may have been enticing for those in the psychological milieu), but a proposed neuro-etiology can likely handle the variable nature of stuttering. Singing uses an entirely different neural processing pattern and neural pathways, thereby bypassing any proposed neurophysiological flaw. Choral speech provides speech feedback in the form of exogenous gestural initiation, thereby utilizing an alternate premotor pathway that bypasses the stuttered neural flaw. Utilizing a foreign accent also produces gross changes in speech-related neural activity, and relies heavily on sensory feedback. However, as this novel form of speech becomes more habituated, it will become integrated into the speech gesture itself, thus losing its fluency enhancing effect. (As does any other secondary stuttering behavior; which serves as a novel alteration to the speech gesture, thereby likely utilizing an alternate neural pathway or processing pattern.) The thing is. what I have just described is a gross over-simplification of a perspective probably best explained by Per Alm; although others, such as myself, have arrived upon the same general conclusion. While many aspects of this perspective have yet to be tested, they are testable, especially with the inclusion of current and future neural imaging techniques looming on the horizon. fRMI and MEG are our friends. If I'm not mistaken, Per Alm has his dissertation published on line, and can be accessed for free. If you're asking for a modern theory on the etiology and behavioral aspects of stuttering that follows the merits of true science, it would be a good place to start. Hope this helps,
From: Ken St. Louis
Hi Vasu, I have recently become very intrigued with Per Alm's model of stuttering that postulates that we function with two pathways involving the basal gangial as we plan and carry out movements. According to his model, which I don't pretend to understand well, the stutterer has problems with the "medial" system (pathway) but not with the "lateral" system. The lateral system is typically active in such activities as singing, speaking in a nonpropositional way, speaking while simultaneously hearing oneself under DAF, and so on. The medial system is most active in propositional tasks and those that require internally generated timing. What I like about Alm's model is that I can envision a neural "switch" that can go back and forth at predictable and unpredictable times, resulting in stuttering or lack of stuttering. It fits my own experience, i.e., when I went through a period of several months when I could be a stutterer or not simply if I intended either role. More relevant, it fits what I have seen many times clinically, people who can seem to learn to control a "switch" that allows them to bypass their old stuttering "mode" and thereby helps them be fluent versus people who cannot seem to do that consistently or at all. Of course, some aspects of his model may be a stretch (e.g., the connection between stuttering and dystonia) but others have some potentially testable hypotheses (e.g., the different densities of dopamine receptors in the putamen for males and females during the time when stuttering typically begins). Greg may find this all too pseudoscientific. I'll wait and see. 😄
From: Greg Snyder
Actually, this is where I was going in my (long) series of responses. And in all honestly, the dual premotor hypothesis was lifted from Goldberg & Bloom's article from 1990. I wrote about this extensively in my own dissertation, I just never published it. It's really great to see it in print and gaining momentum. It, in my eyes, is the only scientifically valid perspective out there. But again--that's just my opinion... :)
From: Shelley Brundage
hi Vasu: You may also want to take a look at the work of Anne Smith and her colleagues. Their research is well done and sheds light on what is going on in children who stutter versus those who do not. These comparisons in turn could lead to the development of a theory of stuttering onset and maintenance.
From: Gunars
y'all, Motivational interviewing, often used in the framework of addiction, may be another framework from which to examine stuttering. It is based on defining Stages of Change: 1) Precontemplative, where a person has no intentions of changing, 2) Contemplative, when a person is thinking about change, 3) Determination, the stage where a person decides to change, 4) Action, the stage where with or without a therapists help the person does things to change, 5) Maintenance, where client continues activities to stabilize his change, and 6) Relapse, where a person goes back to his or her original state. I add another state, the 7) ACTION/THERAPY FAILURE stage. I hypothesize that most of the people who have adult perseverative stuttering syndrome are in the 7) action/therapy failure stage which is an insidious form of 1) precontemplative stage. Am I right? If I am right how can we move them out of these stage?
From: William Rosenthal
Gunars, I think that it is helpful to think about stuttering as a two component process. The first component consists of motor speech behaviors, the second of psychodynamic features that influence the course of treatment. You can think of these as two, orthogonal normal distributions. If a person is high on the psychodynamic distribution, psychotherapy will be an essential part of treatment. If they are high on the organic distribution, then speech management/modification will be more effective. You can play around with various positions on these distributions and see that for some people, both approaches are essential, if for example they are high on both distributions. I think your 6) and 7) could result from either an intractable organic loading, or severe psychodynamic impasse. Many treatment approaches emphasize intervention along only one of the dimensions. It may be either the wrong dimension for a particular individual, or it may be inadequate because both dimensions must be attended to. What do you think?
From: Gunars
Bill, A very interesting and possibly promising hypothesis. I will have to give it some thought...I am not so sure about the orthgonality, i.e. lack of correlation...Even though one might be dominant, I think they might feed into each other.
From: Gabrielle
I am currently enrolled in a stuttering class and I think it is fascinating. Although I'm learning of the reaction, treatment, and theories for stuttering in the U.S., I am very curious as to how other people who stutter from different countries around the world, are viewed and treated. I realize this is a very broad question however, if you could give me a general consensus to how major countries deal with, or how they view stuttering, it would be greatly appreciated.
From: Judy Kuster
A good place to start will be reading several of the short papers from several African nations that are a part of this conference.
From: Judy Butler
Would someone please direct me to evidenced based practice information regarding increasing the fluency of a school age child's apraxic speech? The more I read about apraxia, the more I see some similarities with stuttering/cluttering, as a recent SID 4 article by David Darly described. What do we know about speech naturalness in stuttering therapy that I could generalize to apraxia?
From: John Tetnowski
Judy, Great question. I see so much more interest these days in stuttering and concomitant disorders (whether it be apraxia, ADHD, ASD, etc.). Your reference to cluttering has not gone by without notice. Specifically, I would refer you to several articles in the 1996 issue of JFD dedicated to cluttering. That issue and some of the following articles are related to the issue of treatment success. Brady, J. P. (1993). Treatment of Cluttering, New England Journal of Medicine, 329, (11), 813-814. Craig, A. (1996). Long-term effects of intensive treatment for a client with both a cluttering and stuttering disorder. Journal of Fluency Disorders, 21, 329-336. Daly, D. (1992). Helping the clutterer: Therapy considerations, in F. Myers and K St. Louis (eds) Cluttering: A Clinical Perspective, Leicester, England: FAR Communications. pp. 107-124) (Reissued in 1996 by Singular, San Diego, CA.) Dewar, A., Dewar, A.D. & Barnes, H.E. (1976). Automatic triggering of auditory feedback masking in stammering and cluttering, British Journal of Disorders of Communication, 11, (1), 19-26. Langevin, M. & Boberg, E. (1996). Results of intensive stuttering therapy with adults who clutter and stutter. Journal of Fluency Disorders, 21, 315-328. Marriner, N.A., & Sanson-Fisher, R.W. (1977). A behavioral approach to cluttering: A case study. Australian Journal of Human Communication Disorders 5, 134-141. St. Louis, K.O. & Myers, F.L. (1995). Clinical management of cluttering. Language, Speech, and Hearing Services in the Schools, 26, 187-194. On a personal level, however, I will mention something specific about cluttering and apraxia. I am beginning to think more and more that cluttering is a symptom, not a diagnosis. It seems to me like we can say, "that was cluttering", as judged by rapid and/or irregular rate. This can take place with "linguistic" nonfluencies (i.e. non-stuttering disfluencies), as well as stuttering like disfluencies. As a matter of fact, we are starting to see that there may actually be a preponderance of non-stuttering disfluencies where cluttering occurs. Very often, this cluttering can sound much like apraxia (whatever that sounds like!.....but remember, one of the hallmarks apraxia is inconsistency of error patterns!) Thanks for the great . John Tetnowski ("a cluttering specialist wanna-be")
From: Alyssa Krebs, College Misericordia
I read recently about the concordance rate of identical twins who stutter. I also read that many people feel that this rate could be tested if identical twins were separated and raised in different environments. Based on your studies and research do you feel that stuttering has a higher genetic component? Or do you believe that its onset has more to do with environmental issues?
From: Dale Williams
Good question, Alyssa. And one for which there isn�t an easy answer. In many ways, the nature-nurture separation is a false one. For one thing, our genetics determine in large part how we react to environmental influences. I suppose that�s another way of saying that it all eventually goes back to genetics. Still, it seems plausible to me that a child could be genetically susceptible to stuttering and yet, because the environmental agents were conducive to fluency, the child never developed it (stuttering). In fact, early intervention is, generally speaking, based on this idea. A lot of gray areas here.
From: Nan Ratner
I just finished writing something about this issue (but it won't appear until next year), and would like to chip in. It is not at all uncommon for "identical twins" to be discordant for many known genetic conditions. In part, this is because "environment" means something different to geneticists than SLPs. It is usually taken to be pre-natal, natal and ante-natal environment, although it can include the kinds of things we view as environment, which tend to be more synonymous with "nurture." For example, there are some fascinating data to suggest that identical twins may experience pre-natal uterine conditions that create inverse patterns of cerebral dominance and handedness; multiple births are also highly susceptible to brain injury and other risks that could cause a condition to emerge in one twin, and not the other. Finally, until recently, identical twins were defined by appearance, not DNA. I still can't tell the Olsen twins apart, but they are apparently NOT monozygotic by their own press releases.
From: curious
I have a question for all the experts out there. I am currently providing speech therapy for a young female, a first grader. Her predominate dysfluncy is blocking and it is severe. She is also severely language delayed. Right now I am focusing on her language skills at this time and working in easy-on-set, sliding and light contact. You see when she is successful in her language activities and in reading her fluency increases greatly. Is this a good start? Are there any resources book etc. you think would be helpful in therapy?
From: Ken St. Louis
Dear Curious, Yes, I would say you are off to a good start. Your first-grader obviously is getting some success from the reading / language activities and accompanying fluency shaping targets. The success you are seeing in terms of reduced blocking and/or stuttering might be a function of several things. First, it could be from the fluency shaping targets (easy-on-set, sliding, and light contact. [Note: the sliding may be a stuttering modification strategy; I don't know without a description.] Second, reduced frequency or severity of stuttering often occurs from structured activities, i.e., the reading and language activities. Third, improvement could have resulted from your child simply liking and feeling more and more comfortable in the therapy setting (related to adaptation and desensitization). My guess is that it is from the second and third reasons I mentioned, but I really cannot know. This is a good start, but don't fall into the trap of thinking that just because your child can be fluent with you in this structured setting, she will be able to transfer it outside. No need to rush, but at some point, you should being to build in some transfer activities.
From: Yemi Akintunde
Could anyone explain to me why exactly! We stutterers don't stutter when we sing and we speak to ourselves or pets. I don't understand that part very well i think this could help in some kinds of stuttering treatments too. Isn't it mystery?
From: Ken St. Louis
Dear Yemi, Please see the thread above entitled Singing as Therapy for Stuttering as well as my post Re: References/Pointers to Theories of Stuttering Ken St. Louis 09 Oct 2006. There are lots of reasons that singing and talking to one's pets are different from meaningful conversation.
From: Sensi
Thank you for your post Dr. St. Louis. As a stutterer I have found that most and biggest of differences and reasons between singing, talking to myself, talking with an animal VS conversation with another person are in the stutterer's head!
From: Veronica
thanks for the opportunity to ask a question. I am a PWS but my question is about my daughter aged 8, she has stuttered since she was about 3 and has been in speech therapy on and off since then, she has learned techniques to help her speak more easily e.g sliding, keeping eye contact etc. Most of the time she does not use the techniques she knows becasue she prefers to just speak and not think about how she sounds. She is aware THAT she stutters but I get the feeling she is not aware WHEN she stutters. Does this make sense or am I reading the situation wrong?
From: John Tetnowski
Veronica, That's really a great question. I know a little about that issue because I have an 8 year old daughter myself (and I may know a little about stuttering as well). At 8 years old, I would simply ask her. I have seen many PWS in my life who tell me that they really wanted to talk about stuttering when they were really young, but their parents just avoided the topic. They talked about how uncomfortable it was for them to see the discomfort on their parents' faces, but they knew that they could not talk about it. I suggest keeping an open dialogue with your daughter. If she doesn't want to talk about it now, she may want to next week, or next month, or next year.....or maybe never. However, she should be aware that you know about it and are more than willing to talk about stuttering with her. I think that it may take the fear out of her life....no matter what the effects of stuttering therapy may be. I think you have a wonderful opportunity to open that dialogue now. Maybe even reading this thread of postings with her could open the dialogue. I am sure she would love to see how much interest you have in every little part of her life...even the parts that may be difficult to talk about now. Good luck. I bet that your daughter will appreciate the openness.
From: Judy Kuster
The SFA movie, Stuttering: For Kids, By Kids is an excellent way to open discussion about stuttering with children. The movie is actually freely available online from the SFA, and is part of the online conference this year. You can watch it, linked here and see if you feel it is appropriate for your daughter at this time.
From: Dick Mallard
I would like to follow-up on what John said. One of the most memorable moments in our family stuttering program came one day when the parents and child had to talk about what the child did when stuttering. As I went from family to family, I noticed one dad had tears in his eyes. He said to me, "I can't imagine what my son must think. This is the first time in his 12 years that we have ever talked about his speech. He must think he has a disorder that is so terrible that it cannot be discussed. He has asked for help many times in his own way but we did not respond. We have a lot of ground to make up." I will never forget the depth of his emotion. He would encourage others to talk to children about stuttering or any other issue that is on their minds.
From: Barbara Mathers-Schmidt
Veronica, You've raised some interesting, and important, questions. I am wondering if you've ever had the opportunity to discuss this with your daughter's speech-language pathologist (SLP). The SLP may be able to share observations about whether your daughter seems aware of stuttering when she stutters. Your daughter also may be able to fill you in on this. In general, very young children often are not aware of their stuttering in the early stages of stuttering development. Usually as they get older (certainly by age 8) they have the self-awareness skills to be aware of such behaviors. Even so, it is common for individuals who stutter to not notice, or at least not be bothered by, mild stuttering behaviors in the midst of a conversation. In a sense, they seem to get accustomed to stuttering and might not notice it (and associated behaviors) unless it interferes with the communication effort. Furthermore, many times a child who stutters just wants to get the message out, and not deal with the stuttering. You make two observations that (if accurate) are really quite positive, in terms of your daughter's self-image as a communicator: 1) You note that "she prefers to just speak" and 2) "she prefers to not think about how she sounds." It is great that she seems to want to talk with friends and family. It will be important to stay tuned into whether she is ever reluctant to talk or seems frustrated or embarrassed when she stutters, so that she can receive the support she needs. Her teachers and SLP might be able to shed some light on this. I'll stop here, because I believe I've responded to the main question you've posed. Do you have other concerns you'd like to discuss? If you want to think about this some more, with input from panel members, you might describe your daughter's stuttering severity, and the nature of the stuttering behaviors, and how other people react when she stutters. Is she currently participating in speech therapy?
From: Veronica
John, Judy & Barbara, thank you for your comments regarding my daughter's awareness of her stuttering. I have always been open with her and others about her stammering and encouraged her to be the same. In fact I was a lot more open about her stutter than I was about my own until I decided if I was to ask her to be open and honest then I needed to do the same and so I began to deal with my own covert stammer about 18 months ago. I have watched the 'Stuttering for kids by kids' with Bevin (and have posted a comment on it in this online conference) and she and I have found it useful. She has shown it to her Grandmother, Dad and brother as a way of speaking about her stutter with her family members. I have used Sheehan's iceberg with her to talk about her feelings about stammering and we have done this a number of times in the past 6 months so I can gauge where she is with regards to her feelings. I have told her about this online conference and have shown her some of the posts. It is a good idea to speak to her SLP about her awareness and I plan to. As a stuttering parent of a stuttering child I sometimes wonder am I the best person to support her and help her deal with her stammer, given that I have my own issues to deal with, she once commented to me that it was okay for her to stammer but it made her sad when I stammered. Has anyone got any views/thoughts/ experience on the impact on a stuttering child of having a stuttering parent?
From: Dick Mallard
Veronica, we have had several families in our program where one parent stuttered as well as the child. I will not treat children without family involvement. I believe you having the problem gives you certain insights that will be helpful. There have been times when both the parent and child received treatment together. In one case the child made such good progress she was able to help her father! Seeing the entire family as a unit where all can know and understand the variables that need to be managed is so efficient and rewarding. Good luck to both of you.
From: Barbara Amster
Veronica, I think that by just living your life and being her mother, she is able to see that stuttering is only one part of you and that it can be managed and examined. It is also wonderful that you are open about your stuttering and giving her the opportunity to talk about her feelings. Yes, it's certainly challenging to stutter but it sounds like you are giving her a lot of support.
From: Jeff Cowen
As a graduate student studying speech-language pathology, I am currently enrolled in Fluency class and am enjoying reading the wealth of knowledge available on this website! As a parent I can relate to your concern about your daughter, however, I can't completely understand your situation since I am not a PWS. I commend you for your openness and eagerness to keep learning about your daughter's stuttering as well as the relationship that the two of you have.
From: NA MarceljanssensME
I am 61 years old and I have Parkinson's from my 45th year on. I never stuttered before and now I developed a stuttering behavior after a Deep Brain Stimulation in the STN (Sub Thalamicus Nucleus) Is this a well-known phenomenon and how can this be treated you think ? At the same time, I have a very sore throat and my voice sounds very rough!
From: Lynne Shields
I do not have an answer for you--maybe someone else will give you more information. There is a short piece from 1999 at: http://www.mnsu.edu/comdis/kuster/related/parkinson.htmlon the topic of stuttering and Parkinson's disease. Stuttering is often listed as a potential symptom of Parkinson's disease, so I do not know what the connection might be between the treatment you had and the stuttering. There is some helpful information on the Stuttering Foundation of America website on neurogenic stuttering (stuttering caused by damage to the brain later in life) at: http://www.stutteringhelp.org/Default.aspx?tabid=81 With regard to your hoarse voice and sore throat, you may want to see an ear, nose and throat physician about this, as this problem is not necessarily connected to the stuttering. I wish you the best.
From: Greg Snyder
Hi Marcel. I wanted to take a minute to reply to your post. First off, stuttered speech is not an uncommon byproduct relative to the treatment of Parkinson's. The uses of Levodopa (L-DOPA), or other drugs, have been documented to bring about stuttered speech. To be honest, you are the first case in which I have heard that stuttered speech is brought about secondary to DBS. However, this makes intuitive sense if one follows a neurological stuttering model. In short, speech-related neurolingustic processing (within the Basal Ganglia) has been affected and stuttered speech surfaces as a consequence (or even compensatory strategy) to these processing errors. These errors in speech-related neurolingustic processing can be brought about by tinkering with how the basal ganglia functions via: dopaminergic activity associated with Parkinson's management, as well as methodologies such as DBS that use electrical stimulation to inhibit affected cellular activity. (Point being, the onset of stuttering in cases such as yours seems to be associated with us tinkering around with how the basal ganglia functions.) Subsequently, I would suspect that (in time) the cessation of DBS would result in a decrease (or perhaps cessation) of your stuttered speech. This, however, may be antithetical to why DBS was implanted in the first place! Subsequently, I suspect that the use of speech feedback would likely be one of the better choices in decreasing stuttering frequency, and improve overall �fluency.� If you are interested in this type of treatment, I would contact Paul Blanchet from the State University of New York at Fredonia; he researches stuttering, as well as the use of speech feedback in those with Parkinson's. Relative to your sore throat and rough voice, we would need more information before tacking that question with any kind of validity!
From: Shelley Brundage
Hello: I shared your post with one of my colleagues who does research on speech disorders in Parkinson's disease. Dr. Geralyn Schulz is an internationally-recognized researcher in the area of speech and Parkinson's disease. Here is what she wrote in response to your post: Many persons with Parkinson's disease (PD) have various voice and speech difficulties including a soft voice that others cannot hear, a monotone voice that lacks the typical variations in pitch and intonation, a harsh or rough vocal quality, imprecise articulation which can make you sound as if you have slurred speech, and either a slowed speaking rate or a faster than usual speaking rate. Deep brain stimulation (DBS) has been proven to be very beneficial for the motor problems of persons with PD. However, voice and speech functions often get worse following DBS, particularly if you have bilateral stimulators implanted, that is one stimulator on each side of the brain. Most times people with PD who have a faster than typical speaking rate also have imprecise articulation and the combination that results can sound like stuttering. It is not the same kind of stuttering exactly that happens in people who have a fluency disorder in the absence of PD but it can sound very similar. Many of the voice and speech problems that persons with PD have can be helped by receiving speech therapy. There are many different types of speech therapy that you could receive but one form in particular is called the �Lee Silverman Voice Treatment� (LSVT�) and it has been proven to be very effective in helping alleviate the many voice and speech difficulties (and even some swallowing problems as well) in persons with PD. Studies are underway right now to determine whether LSVT� would benefit those who have had DBS but since it has helped so many who have not had DBS there is a good chance that it could be helpful for those who have had the DBS.
From: Melissa Gorecki
I am a student from Michigan and we are currently learning about stuttering in my Fluency Disorders class. I have a question. What is the percentage of clients that have had a stutter reoccur? Once a client has had stuttering therapy, what is the probability that you will see them again for more therapy?
From: Lynne Shields
I don't have any data to answer your question. When children start in therapy at younger ages, there is a higher likelihood that they will not need additional therapy later on. Some of this may be due to early intervention, while for others the reason may be that they either recovered on their own, or did not truly have a stuttering problem. For children who begin therapy at later ages, the likelihood of continuing to stutter to some extent is higher. Some of these individuals may return additional therapy for their stuttering later in life. I also see a fair number of people in their late 20's and early 30's who had therapy as children, but who now have an interest in continuing to modify their stuttering. Hope this gives you at least something of an answer to your question.
From: Charlton V. Knowles
I have had therapy for the past thirty years, with intervals of approximately seven years, and invariably, I was always very successful in treatment. My problem has been my difficulty in maintaining the necessary motivation needed to sustain the fluency I acquired in treatment. Short of becoming a Speech & Language professional, how does one maintain that "fire" after formal therapy? Understand that I am living in The Bahamas and self help groups are non existent.
From: John Tetnowski
First of all Charlton, if you're offering to bring someone to the Bahamas to help.......I am the person to volunteer. I'll tell you where to send my ticket. Just kidding! I think that many of us have looked at stuttering and stuttering intervention over the years as a disorder or "illness" that can be "cured" or fixed. We treat it in the medical model as a disease. Go to a speech pathologist and they will "fix it ". I am starting to see stuttering intervention/recovery/rehabilitation more in the concept of self-help or self-improvement. Even though there is likely an organic cause for stuttering, it can potentially be treated or controlled as a matter of self-improvement. Let me give you an example of what I mean. If I wanted to lose a few pounds, I know how to do so. Simply eat less, eat healthier, and exercise more (I am assuming that there is no organic cause for my extra weight). I can lose weight, and I do lose weight every time something important comes up. In other words, I lose weight before every family reunion, before every high school reunion, and any time that I will be getting together with people I haven't seen for a long time. As soon as that event is over, I am back to unhealthy eating and less exercise. The only way that I will get a lifetime of "skinniness" is when I decide to make the change for a lifetime. I will only be thin when I commit to making that change for life. It's wonderful to hear on how "good I look" (liars!) when I travel to one of these events. But as soon as I get back home, I reward myself with a pizza or a gallon of ice cream (for working so hard to lose the weight...and being successful at it). I know how much better I looked and fealt, but it wasn't a lifetime change....it was just a diet. I am hoping that someday I can make the change to a lifetime of improved healthiness, not just a few weeks or months of change. I know how to do it. The COST is just too high. I think that stuttering can be similar to this analogy. It is quite possible to get fluency for special events in your life....like when you need to go to the prom, or when you need to interview for a job, or when you need to say your wedding vows. If you do not want to make the change in life style, it's easy to fall back and require another "diet" of speech therapy in a few years. The successful person is the one who realizes that this is a lifelong self-improvement program. It requires self-control (at the restaurant/in speaking situations) and may require a little extra practice (at the gym/or self practice with a tape recorder, etc.). If we want to maintain change, for the sake of self-improvement, it is a lifetime commitment. Just as I am genetically wired to carry a few extra pounds, many of you may be wired to have a few extra dysfluencies. Let me add, this is not a critique. I choose to live with a few extra pounds......you may choose to live with a few extra dysfluencies. There is nothing wrong with either one of our choices. But they are OUR choices. When I choose to maintain self-control, and improve myself (not 'CURE" myself), is the time when I will become successful. I hope this makes some sense to you. Please let me know if this helps you think about stuttering and fluency in a slightly differnt manner. I look forward to your response. Good luck! By the way, I think that maintaining contact with self-help groups (where they are available) are a great help to PWS. It is always easier to diet and exercise for me when someone else is doing it with me.
From: Charlton V. Knowles
Dear John, Unfortunately, Walt Manning has put in his request to relocate to Nassau first, should the opportunity arise. But you are next in queue. I can understand why weight control may be a problem for you, all that good Cajun cooking in Louisiana! I'll have far worse difficulty controlling my eating than controlling stuttering. Anyhow, thanks a million for the insightful response to my letter. I have been thinking and re-reading your response and the analogy is quite relevant. Losing and maintaining weight lost similar to "fluency" maintenance both require changes in behavioural patterns. However, I think "fluency" maintenance is a bit more difficult. All the emotional and cognitive factors that play into stuttering/"fluency" suggest that it requires total commitment most of the time. I like to draw the analogy between proficiency in playing tennis (I am an avid player) and stuttering control. To get results the objective is commitment, practice, with a view to "controlling" your behaviour. The "successful" tennis player or PWS is one who is able to control behaviour more often than not. The difference between a pro tennis player and myself is that he can anticipate his stroke (use of technique) well in advance of hitting the ball at a higher percentage of time than I can. I react to the ball more often than the pro, who interacts with the ball. So his preparation hence ability to control the ball is at a higher percentage. Successful Stuttering modification requires the same or similar degree of anticipation. The bottom line is that in both behaviours, one has to be in tune to the behaviour. In short they have to monitor very well. I am past the stage of expecting perfect fluency just as I am past the stage in tennis of expecting to have control over every stroke in tennis. What bothers me is when I know I can do better than what I am doing either in modifying my speech or playing tennis at certain points in time. The variability in my game and in my modification of stuttering is my source of frustration at times. I am also aware that things happen in the course of a day, week, month, etc. that makes monitoring more difficult than other times. But I think like you pointed out, how much are you willing to pay, to achieve the results you desire. What sacrifices are you willing to make in spite of these interferences to stay on course? There is no doubt in my mind that I am willing to make "realistic" life/behavioural changes to be more proficient at stuttering control. My commitment to re enter therapy so many times over the years, I think supports that, and following every treatment I come back to Nassau with more knowledge about the idiosyncrasies and mysteries of stuttering. I think your suggestion as well as Judith's and Walt's to form a self help group in Nassau is another step in learning to manage my stuttering. Incidentally, your communication with me has refired me up again and I am doing much better than last week.
From: Judy Kuster
Starting a support group in the Bahamas might be something to consider. You mention that you have had therapy several times. Perhaps you received therapy in the Bahamas. If so, perhaps the speech clinician that you saw knows of other stutterers that might want to form a small support group. I checked the ASHA directory which lists two ASHA-certified speech therapists in the Bahamas. If you want contact information, email me privately (kuster@mnsu.edu). A support group can be as few as 2 people;-) Our support group in Minnesota has 3-6 members, three that are always there. We meet once a month for 2 hours. There is a lot of information about starting support groups you might find helpful - "How to start and run a self-help group" (http://www.stutter.ca/runself.html "101 Things to do at self-help group meetings" (http://www.nsastutter.org/search/dsp_results.php?tbl=subcategory&mixid=233). The International Stuttering Association (http://www.stutterISA.org/ is committed to help spread support groups around the world. There is even a paper on this online conference that talks about how to get involved with the ISA.
From: Charlton V. Knowles
Dear Judy, Thanks a million for your immediate response. And particular thanks for the information on self help and starting self help groups. In previous years, I did have contact with the local Speech/Language Therapy Department in Nassau, but over the years, I think I have outgrown them in knowledge about stuttering and it's treatment. However, it is not necessary to form a self help group with a certified therapist to oversee it's operation. I have in previous years formed groups in Nassau and Montreal and did so as recent as a few years ago. I think my foot dragging at this time is due more to taking on more work to my already hectic schedule. I own and operate four fast service restaurants in Nassau and my decision now is - do I want to do additional therapeutic stuff outside of daily practise to enhance my ability to maintain fluency or build the business? It has been five months since formal therapy with Walt Manning and I am at the point where I DO need to create an environment that motivates me to focus more on stuttering modification and maintenance, equal to or greater than developing my businesses. I think the bottom line is doing whatever I have to do to keep the focus on practising and working on the techniques consistent with good speech.
From: Dick Mallard
Charlton, we were together at Hollins College in 1976. I was one of the clinicians in training during your course. How are you? Great to hear from you. Maybe your difficulties arise from you trying to be fluent. Have you ever thought about trying to control stuttering rather than not stuttering? Let me know what you think. Again, good to touch base with you.
From: Charlton V. Knowles
Dear Richard, Boy that's been a long time. Forgive me, but I don't remember you. I remember Ross, Kathrine and Ron Webster. Congratulations on going onto higher studies after that point. I think in every PWS there is a certain acquired desire to never...ever.. stutter again. This is probably confirmed every time the PWS does so well in formal therapy only to return to their home environment and the disfluencies pop back in again. When this happens, the feeling of despair and failure prevents the person from considering any other possibilities and alternatives at that time. To answer your question, I think I am experienced enough in the nature of stuttering and its treatment to realistically not expect to be fluent. My difficulty is staying in touch with my stuttering behaviour to modify it when it occurs. It is evident to me that I have to monitor as well as I can all of the time, in spite of any external interferences. My work is quite high pressured and is wrought with time pressures. I'm in the restaurant business, so you can imagine the potential for disfluent and uncontrol speech. But I think I can learn to manage the speech in spite of these environmental stresses. Thanks for the response.
From: Dick Mallard
Charlton, I was learning to teach Precision Fluency Shaping when we were at Hollins. Katherine was my instructor. If you were one of her clients, then we worked together. You used the tennis example during your conversation with John. The good player has to anticipate what is going to happen and react accordingly. Is that what you try to do with your stuttering? Recall from Hollins that you were taught "targets" that if used correctly would lead to fluency. Is that still your goal?
From: Charlton V. Knowles
Dear Richard, Yea, essentially I try to use a combination of the PFS technique except not on the first sound but the first syllable and move slowly through the rest of the word. Its more the Hugo Gregory technique than webster. But in essence they are all so similar. I do have a lot of successes in the course of a day, it would be nice to have the same success in high speech stress situations as I do in low stress speech situations.
From: Dick Mallard
Charlton, it seems to me that what is lacking in your therapy history is the ability to control the moment of stuttering. Many clinicians fail to understand the value of what Charles Van Riper taught in his MIDVAS sequence. Being able to control stuttering instead of avoiding stuttering by using some fluency technique frees one from worry and fretting about the problem. I wish you every success.
From: Charlton V. Knowles
Dear Dick, Thanks for the response. I am coming to the conclusion that there are three fundamental components that I struggle with and somehow need to overcome that will enable me to have better and more importantly, CONSISTENCY in speaking better; (1) maintaining a high level of motivation to monitor and modify, (2) not reacting so profoundly with anxiety and fear when I anticipate a moment of stuttering and (3)trusting that the modification techniques that I have at my deposal, whether they are easy relaxed approach/ smooth movement, sliding through the word or Precision fluency shaping, will do the job. I suspect that most, if not all PWS have similar anxieties when they anticipate stuttering on a sound, or word, the thing is I don't know if mine is at a greater degree. I am in contact with Walt Manning, who I had therapy with in May, and my speech clears up virtually immediately when I keep moving forward in my communication and not retreat or back up, which is the core of my stuttering pattern. When I go into those higher hierarchy situations( I don't avoid very many situations) I really have to force myself to move forward, its like pushing against a brick wall. I would suspect that it is so difficult because I am still not sufficiently desensitized to the moment of stuttering. But does one ever become desensitized? Your would be really appreciated.
From: Dick Mallard
Charlton, to answer your question, yes, people do become desensitized to stuttering to the point that the problem is not a major factor in their decision making process each day. You have been working on this problem long enough to realize that trying to be fluent is not all that it is made out to be. I would certainly like to continue this dialogue with you. I do wish you the very best. I hope we can meet personally (again) sometime in the near future.
From: Moussa DAO Burkina faso
Some days ago a parent sent with her daughter. she was so afraid by a sheep than she starts to stutter. She didn't stutter before this event. her stuttering worsens. in her family nobody stutter. in such situation what to do ? what could provoke such stuttering?
From: Dick Mallard
In the U.S., this girl would be a good candidate for a stuttering evaluation and stuttering treatment. Events that bring on the beginning of stuttering can be very different. They are not considered to be basic causes of stuttering.
From: Stephanie Huber (Student)
I am currently enrolled in a stuttering class where I learned that the likelihood of boys beginning to stutter is greater than that of girls. I learned that this may be because of a genetic predisposition for stuttering and/or that boys tend to develop slower than girls with regard to language acquisition. Are there any ideas out there that would support theses theories and why there is a greater occurrence of boys who stutter than girls?
From: Nan Ratner
The simplest answer is that this gender imbalance is seen for other communication (speech-language) disorders (Specific Language Impairment, dyslexia), and may reflect male disadvantage with language tasks during early childhood (most of your language tests have separate norms for boys and girls to reflect this). In addition, the gender imbalance is somewhat lessened if you collect data close to onset as Yairi and colleagues have: it appears that girls' stronger language skills may enable them to recover more often than boys do. And please, I do not want to get into Larry Summers-type discussions about gender and innate ability. I am just reporting the available facts relevant to early childhood pacing of skills.
From: Ellen-Marie Silverman
Hello, Stephanie, I'm not sure I am a qualified responder in this forum since I currently am not a professor and haven't been since 1986, but I am someone currently and actively involved in matters concerning stuttering problems. I chimed in here to add to Ms. Ratner's response that seems to be a variable in whatever ratio imbalance there may be between males and females regarding the incidence of stuttering problems. In 1980, an undergraduate student of mine, Katie Van Opens, and I published a paper in Language, Speech, and Hearing Services in the Schools (one of the journals ASHA publishes), entitled "An Investigation of Sex Bians in Classroom Teachers Speech and Language Referrals" Language, Speech, and Hearing Services in the Schools, 11, 169-174). We compared the responses of classroom teachers in several midwest, suburban public school systems to written descriptions of a child's speech, language, voice, and stuttering problem, where one description identified the child as female and an indentical one for each problem identified the child as male. For only stuttering, was there a statistically significant difference between responses based on the gender of the fictional child. More of the teachers were likely to refer the boy with the stuttering problem we described than the girl for speech-language services. To me, this suggests that these teachers may have thought the social, economic, and other consequences of a having a stuttering problem were greater for males than females. So, while it may be fruitful to look within individuals, i.e., genetics, neuro-functioning, etc., for an explanation of a gender difference in stuttering problems, I, as have others before me, think we also need to explore cultural and societal, as well as familial, influences on the development of stuttering problems. I think you asked a key question, and I hope I have given you some information to help you find your (and, maybe, our) answers.
From: Tony Stewart, UK
Hello I've stuttered from a young age, and have tried several forms of therapy (the most recent was 12 years ago). All have helped, but relapse has always eventually occured. At the time, it was expected that adult stutterers could expect to relapse in virtually all cases. I am now 45 years old, and a health professional. Working at a fairly high level and lecturing frequently, I'm becoming ever more frustrated with my dysfluency. I have no fear of public speaking, and find the stutter mostly as an inconvenience. My questions are: Is it worth my seeking therapy again? If so, is there any particular kind I should try? Is relapse still inevitable? Thanks very much for your time.
From: Dick Mallard
Tony, what kind of therapy have you had?
From: Tony
Hello Dick - thanks for responding so quickly! Chronologically, have received the following: - Psychiatrist (1960s) - 1:1 speech therapy at school (1960/70s) - Fluency workshop in Burton on Trent (Franklin Brook) - 2 weeks, 1976 - Hypnotherapy by general practitioner - 3 sessions 1993 (after first session, was totally fluent for 1 week; subseqent sessions were less successful) - 1:1 speech therapy with input into stammering group, 1993 (little success).
From: Dick Mallard
Do I understand that all of your therapy has been directed to helping you not stutter? That is, the emphasis has been do this or do that so stuttering will not occur?
From: Tony
I think so - the aim always seemed to be to reduce or eliminate the stutter. No-one actually said they thought they could completely cure it, but that was many years ago. I've maintained 'radio silence' since then, and am just beginning to wonder if there are any new or improved methods which may help.
From: Dick Mallard
Tony, it seems that you need to stop trying to be fluent and learn to control stuttering. I always go back to the procedures I learned in my initial therapy emphasizing a Van Riper approach. Learning to control the moment of stuttering rather than avoid the problem gives one great confidence and improved speech control. I wish you the best.
From: Tony
Thanks for this, Dick - I will look further into this.
From: Sally Clark
Why do you think the 1:1 speech therapy with input into stammering group resulted in little success? As a graduate student in speech-language pathology, it is always helpful to know what "works" for some people and what doesn't. Also, what type of treatment (speech therapy or otherwise) did you find to be most helpful with your stuttering when it occurred? Thanks.
From: Tony
Hi Sally Thank you for your questions. The 1:1 sessions were OK, but I found the particular therapist fairly uninspiring. The group sessions were a disaster - a combination of collective story telling, but nothing at all inspirational (probably depends on the personalities in the group). Four of the group sessions were dominated by one former stutterer who had received some intensive therapy somewhere, was determined to tell us all about it, and wanted to carry on for several more weeks (the other therapists eventually stopped him). He had done well, and was terribly enthusiastic, but no-one tried to capture his experience and consider how we might put it to practical use. Afraid I gave up in the end. Two things produced results. Firstly, a 2 week stuttering course introduced slack syllabics, breathing techniques and made us go out into the towm to deliberately stutter as severely as we could to strangers. Sounds horrible, but it completely stopped me from being scared of stuttering. The second was a course of three hypnotherapy sessions, given privately by my family doctor. He concentrated on my self-confidence, and I came out of the first session feeling 9 feet tall (really). My stutter disapeared for around 1 week, but the other 2 sessions never achieved the same success.
From: John Tetnowski
Tony, I hope you don't mind, but this is cut and pasted from a comment that I made the other day and is appropriate to this discussion as well. I think that many of us have looked at stuttering and stuttering intervention over the years as a disorder or "illness" that can be "cured" or fixed. We treat it in the medical model as a disease. Go to a speech pathologist (or some other professional) and they will "fix it ". I am starting to see stuttering intervention/recovery/rehabilitation more in the concept of self-help or self-improvement. Even though there is likely an organic cause for stuttering, it can potentially be treated or controlled as a matter of self-improvement. Let me give you an example of what I mean. If I wanted to lose a few pounds, I know how to do so. Simply eat less, eat healthier, and exercise more (I am assuming that there is no organic cause for my extra weight). I can lose weight, and I do lose weight every time something important comes up. In other words, I lose weight before every family reunion, before every high school reunion, and any time that I will be getting together with people I haven't seen for a long time. As soon as that event is over, I am back to unhealthy eating and less exercise. The only way that I will get a lifetime of "skinniness" is when I decide to make the change for a lifetime. I will only be thin when I commit to making that change for life. It's wonderful to hear on how "good I look" (liars!) when I travel to one of these events. But as soon as I get back home, I reward myself with a pizza or a gallon of ice cream (for working so hard to lose the weight...and being successful at it). I know how much better I looked and fealt, but it wasn't a lifetime change....it was just a diet. I am hoping that someday I can make the change to a lifetime of improved healthiness, not just a few weeks or months of change. I know how to do it. The COST is just too high. I think that stuttering can be similar to this analogy. It is quite possible to get fluency for special events in your life....like when you need to go to the prom, or when you need to interview for a job, or when you need to say your wedding vows. If you do not want to make the change in life style, it's easy to fall back and require another "diet" of speech therapy in a few years. The successful person is the one who realizes that this is a lifelong self-improvement program. It requires self-control (at the restaurant/in speaking situations) and may require a little extra practice (at the gym/or self practice with a tape recorder, etc.). If we want to maintain change, for the sake of self-improvement, it is a lifetime commitment. Just as I am genetically wired to carry a few extra pounds, many of you may be wired to have a few extra dysfluencies. Let me add, this is not a critique. I choose to live with a few extra pounds......you may choose to live with a few extra dysfluencies. There is nothing wrong with either one of our choices. But they are OUR choices. When I choose to maintain self-control, and improve myself (not 'CURE" myself), then and only then will I become successful. (By the way, I can measure success in whatever way I measure my own success....this may mean perfect fluency, but it also may mean "coping with disfluency".....it is a personal choice). I hope this makes some sense to you. Please let me know if this helps you think about stuttering and fluency in a slightly differnt manner. I look forward to your response. Good luck! I also think that maintaining contact with a self-help group is a great way to continue taht lifetime of change. Just as it is easier for me to go to the gym with someone else, that accountability to another person or group can help through the difficult or less motivating times.
From: Tony Stewart
Hello John Thanks for this - very interesting indeed. You are right - can put myself into "non-stuttering" mode at any time, saying anything I like, and modulating my voice how I wish. But - it's difficult to think hard on my feet AND speak fluently at the same time. A bit like my PC having insufficient RAM and crashing as a result. Put me into a radio studio and I will not stutter either(auditory delay?). I'm always really busy, and do not spend time actively thinking about my stutter or how I can improve it. Involvement in this conference has caused me to suddenly become reflective, however. One thing I have just remembered is that when I tried hypnotherapy, my GP (family doctor) concentrated on improving my self-confidence. At the first session this worked miraculously, and I left the surgery feeling literally 9 feet tall. The effect wore off after a few days, and was not as pronounced on subsequent sessions. It does, however, occur that I seriously lack self-confidence. When I think about it, have done many things - become a health professional, consultant, professor, written 3 well-reviewed textbooks, published research and developed & led a very well regarded Masters course - all in spite of having a stutter (sorry - I'm getting too full of myself here). Yet I honestly cannot regard myself as "successful". Well, not for more than a couple of seconds. If one of my children did this, I would be immensely proud of them, and would definitely regard them as being massively successful! So perhaps finding a way of feeling better about myself, combined with some more therapy might help - though I suspect this would not be a once-and-for-all cure. Does this sound like a useful approach?
From: John Tetnowski
Tony, I agree with you. I think feeling better about yourself is indeed a great way to go.....however, I see little reason for you to need much of it (confidence, self-esteem, etc.). You are not "full of yourself". You have had a successful career and should be proud of it. I know I would be proud if my daughter achieved your level of success. However, people like us, have incredibly high expectations for ourselves. I think discussing this with people who are close to you is a great exercise that can really help. Since we were talking about children, let me give you an example from my life. When my daughter was born, I reacted in a way that I thought was appropriate. After all, I had seen my father and other males in my life react the same way. My personal reaction to being a father was to WORK MORE! After several months of this, my wife complained to me that I was never home. I remember telling her, "What else do you want me to do? I am working three jobs to make sure that you and our daughter have enough money to have all the things that we want!" Her response was, "We don't want your money.....all we want is you!". Unfortunately, for people like us, we can never be GOOD ENOUGH. However, honest and opened-discussions with people around us may be the key to being satisfied. When you say you want to be better with your stuttering and its symptoms....I might ask you why? And for whom? You may have already answered part of the question already. Just knowing that you (and I know myself, as well) have incredibly high expectations of yourself may be a step in the right direction. Looking at the world in this fashion MAY help. I am not going to ask you to change your life goals or your expectations. However, take the time to write down what you really want as your goals for your speech. You may have already met your goals. But putting them in writing may get them "closer for you to grasp". Good luck! (but you probably don't need luck....your talent will probably carry you!)
From: Tony
Thanks for your very generous and helpful , John. I shall definitely try out your suggestions.
From: Charlton V. Knowles
Dear Tony, What part of the UK you're from? I recently spend two weeks there, during that heat wave in July and drove from London to St. Andrew's via the west coast of England. Beautiful country, never drank so much beer. Your current position in life vis - a- vis stuttering is so similar to mine. In my own right I have I think achieved great success in life, not only in business but as a person. I have a great deal to be proud of and the feed back coming from my family, friends, child, wife and my peers in business confirms this. Every person I come into contact with interacts with me the same way they would interact I think with any other person who did not stutter. They see AROUND my stuttering and to them, my stuttering doesn't define me. My wife often asks me, do I think I will ever leave stuttering alone and just live my life? Very good question. I think how you feel, based on your to John and the others, is similar to my thinking; which is I have been able to be quite fluent in formal therapy and immediately after, using techniques, only to see the level of modified speech dwindle. The control of stuttering in therapy was so liberating and words just flowed, only to have to go back to choppy speech. That for me is what I find so difficult to accept. I reason that if i am able to have such a high degree of fluency in therapy, i should be able to maintain that, post- therapy in my home environment. Furthermore, I reason that I have been "successful" in virtually every other areas of my life, then I should be able to be "successful" in controlling my stuttering more consistly than I am able to do just now. This is the part a non stutterer doesn't understand. And perhaps only a few Therapist who do. I don't know if you would agree with me in part or in full, but your comments would be welcomed.
From: Bertha
I have a 5 year old soon who stutters since 2 years ago. Many people have told me that stuttering is caused by anxiety disorders, but I think its the opposite. Stuttering causes the anxiety) What does the new theories or researches say about it?
From: Ken St. Louis
Dear Bertha, Your intuition is more correct. Although we cannot absolutely rule out anxiety as a possible cause for stuttering, it appears to be very rare as the original cause. And yes, most anxiety that stutterers experience results from their stuttering. Henry Freund articulated that very well for older stutterers. Your son presents with a common pattern. For example, three years of age is the typical age that stuttering begins. We know now that there are genetic factors that can play a role in the onset of stuttering, although apparently not in all cases. Most authorities suspect that the problem in stuttering is a neurologically based problem affecting the coordination of muscles and structures used in speaking.
From: Bertha
Thanks, Dr Ken for your answer, I live in Yucatan Mexico, and I have taken my soon to many specialists (most of them Psychologists), and everyone said that the origin of the stuttering its anxiety, I have read a lot about it, many articles in the internet and books, and i disagree whit that opinion. So, What is the procedure for a good diagnosis for him stuttering. Which specialists have to do the evaluations and give him the treatment?
From: Judy Kuster
Bertha, the SFA website has two people in Mexico who are speech therapists who specialize in treating stuttering. You can find them at http://www.stuttersfa.org/Default.aspx?tabid=308Perhaps you are near them or they will be able to refer you to someone who is. There are other speech therapists in Mexico that are certified by the American Speech-Language and Hearing Association. If you email me (judith.kuster@mnsu.edu) , I will send you their names and contact information.
From: Gunars
Dear Bertha, As a 69 year old student in psychology who has stuttered all of my life, I want to tell you my side. It does not matter what came first, stuttering or anxiety. In the end it helps to reduce any source of "speech anxiety". When the child speaks: 1) pay full attention to the child, 2) do not expect or demand that the child will talk more fluently, 3) love him or her without judging his or her speech, 4) take time to just be with him or her (be as relaxed as you can when interacting with him or her), 5) accept him or her as he or she is (stuttering did not stop Winston Churchill from being a great statesman, stuttering did not stop Charles Darwin to become a leading scientist to understand how species evolved, stutterin did not stop Sir Branson to become a billionaire, etc... Dear Bertha, have patience and be assured that it is not your fault that the child stutters. Even though I grew up in an environment where discipline was thought to be important, I believe that for a child who stutters it is important to have parents who are not so disciple oriented. In plain English, let your child do things that other children should not do. Pay attention to him or her when they talk or try to talk. Mask everything else out. Have hope for yourself and your child. Have hope.
From: Sara
I am currently treating a client who is 47 and has never before received speech therapy. We have had 2 sessions and i am beginning to see a lack of motivation. She has not completed homework and it appears she is depending on me to "fix" the problem. Has anyone had this type of experience? What has helped motivate the client and aided them in realizing their roles and responsibilities for success.
From: Greg Snyder
Hi sara. Stuttering management is certainly very difficult, as there are many variables (other than speech) involved. My initial thought is that while it is very easy to blame the client for a lack of therapeutic progress, it is something in which i ultimately do not condone. There are simply too many variables in play, such as an unknown etiology, inefficient therapies, and a lifetime of living with the negative social consequences of stuttering for me to feel comfortable placing any blame on the clients. Ultimately, the therapeutic path is chosen by the client, and it may be the professional's responsibility to elucidate these (realistic) objectives and provide a framework in which they can be achieved. But in order to really provide a useful perspective, it would be helpful to know your current treatment objectives, as well as what the client wants to get out of treatment. For example: often times, the stuttering iceberg (hicks, 2003) provides a substantial barrier towards dealing with the actual speech itself (hicks, 2005). Ultimately, i try to give my clients as honest an assessment as possible, create an informed consumer, help the client clarify their own (realistic) treatment objectives, and then work with the client on their path toward reaching their objectives. But again, the more information you provide us, the more pertinent a response we can provide.
From: Lynne Shields
Just to add to the good reply from Greg Snyder, I am interested to know whether or not this client is a partner with you in deciding what techniques to try, and when and how to practice these outside of therapy. She may be unmotivated, though I would be surprised to find that to be the case for an adult who has sought out therapy. There may very well be something else going on. For example, she may find the assignments you have given to her to be too difficult or too fearful. She may not see the value of the techniques, either because she does not understand them or because they are truly not valuable to her. It may help to talk openly with her about her goals, and be sure that you are addressing the issues that are important to her. This may help both of you work together to address her concerns. Hope this is helpful.
From: Barbara Mathers-Schmidt
Hi Sara, I am so impressed that this woman who has stuttered since childhood is seeking help at age 47! In my experience, it is critical to explore and support whatever motivated this individual to seek help at this time. Somehow she has managed to cope with stuttering on her own for many years, and shifting to a new perspective and mode of dealing with this is huge. I agree that it is important to ask her about her expectations of therapy, and then provide education and clarification around our current understanding of stuttering and the nature and course of stuttering therapy. And of course, she needs your support in taking the steps toward self-observation and self-monitoring and disciplined practice. This isn't easy for any of us! You mention that you've only had two sessions with her. It may be that after she has more time to realize that this is not a case of "getting cured by the therapist" she will be more inclined to participate in the therapy. I'll check back to see if you respond with additional information or more questions.
From: Sara
Thanks to Greg, Lynne and Barbara for your great responses. Let me start by clarifying that it was not my intention to place blame on my client, I just want to optimize her commitment to therapy. I'll try to answer some of your questions as best I can. Lynne, you wondered if fear might be keeping her from completing assignments; thus far, her task has been to report on incidents of stuttering (setting, people, topic, words, etc.), so I think it would be unlikely that fear was keeping her from completing the assignment. Barbara asked about motivation for seeking therapy at this time; this was discussed at her initial evaluation and in both sessions, and her motivation seems to be primarily job-related. We have discussed the course of therapy (expectations, outcomes, treatment options, roles of client and clinician, etc.), and she appears to understand. Greg, you asked about our treatment objectives; the plan is to follow a general Van Riper approach, beginning with identification of her primary and secondary behaviors (hence the HW assignment). As therapy progresses, the client will be increasingly involved in selection of targets, etc. Any additional feedback is greatly appreciated.
From: Lynne Shields
Sara, You stated that "thus far, her task has been to report on incidents of stuttering". Some additional questions for you related to this are: 1) does she see this assignment as being important to the process of therapy?, 2)is the problem possibly that she gets so busy at work/home that she doesn't remember to pay attention to the occurrence of stuttering, or, 3) could her fear of stuttering be preventing her from approaching even this task? These are just what ran through my mind as I read your most recent posting. Possibly, as Barbara suggests, therapy is just so new that she is getting her bearings. Or, maybe more talk needs to happen to make this assignment do-able and meaningful to her. Or, perhaps it can be reworked so that it is easier and more do-able for her. For example, if she tells you that she gets so busy, she forgets, perhaps you two can arrange a time or two each day when you will call her on the phone and ask her to recall one or two situations so far that day where she stuttered, and then she can jot that down in her notebook or planner as you speak with one another. She could also find another person she trusts to do this with her. I'm just brainstorming here, so this may all be irrelevant to your situation with this client. I can tell that you are concerned about her and want to find ways to make therapy successful for her. I find that taking a problem-solving approach with a client can help facilitate therapy, because both you and the client are engaged in working out the kinks until you both arrive at a mutually agreed upon set of activities/methods/etc. that will provide the client with ways to actively and successfully manage their stuttering.
From: Barbara Mathers-Schmidt
Hi Sara- It sounds to me like you are starting out the way many of us would--having the client identify stuttering (when she stutters, what she does when she stutters, nature of the communication situation). One more thing to add to Lynne's thoughts-- perhaps your client also needs more practice with identification before she does this on her own. You might consider practicing more with her in private and then more public settings, to make sure that she actually can identify and analyze her stuttering. I also often get the client to establish practice assignments/targets with me, so the client will buy into it. And...I may suggest just tuning into this self-observation at particular times or in particular communication situations so that the task does not seem overwhelming (and so the client is more likely to remember). Best wishes to you in your work. Thank you for prompting this discussion!
From: Ellen-Marie Silverman
Hello, Sara. I think you have received considerable advice to help you work with the client you wrote about, and what that boils down to is so important, and that is the focus of therapy. Our focus can be primarily on fixing the problem or addressing the needs of the client. While it may seem that these are one and the same, actually they are not. From my experience, unless a client, child or adult, feels known by the therapist and feels engaged in the process of directed change, their commitment is not sufficient to establish the change they may want. When the therapist focuses on fixing the problem, the client tends to feel unrecognized as an individual, left out so to speak while the therapist seeks victory over "the problem." So, the therapist's job is first and foremost to connect with the client so as to establish a team mate, together with whom, and only together with whom, meaningful change will be accomplished.
From: Greg Snyder
[So, the therapist's job is first and foremost to connect with the client so as to establish a team mate, together with whom, and only together with whom, meaningful change will be accomplished. Ellen-Marie Silverman, ISAD, 2006]. What an incredibly profound statement. Thanks so much for your contribution; I'll be including this in my clinical coursework for years to come.
From: Ellen-Marie Silverman
Greg, thank you. You honor me. Ellen-Marie
From: Nalini Harikumar
I am a SLP student and have an adult client who has his good and bad days. Apart from his disfluency problem he is in a situation where coming for therapy might be the only place where he can get some positive reinforcement for all his hard work in implementing the strategies he has learned. My client has days where he refuses to actively participate in the therapy session and others where he is self motivated to apply all strategies and work toward a goal. I think it is hard for an adult to be self motivated when the progress is slow.
From: Greg Snyder
Hi Sara. Even at our best, our existing stuttering treatments provide (IMHO) marginal results. Even a recent survey of over 1,000 people who stutter revealed that the preferred stuttering "treatment" was self acceptance. I cant fathom that type of response in the medical model. (You must learn to accept your kidney stone!) Subsequently, stuttering treatment a pretty complex balancing act of any number of issues. If one reads Bloodstein, he evaluates some 450 different treatments, most of which provided at least somewhat positive results. This even caused him to pontificate that any treatment could be made up at a moment's notice, and produce equivalent efficacy to the real "scientific" treatments used by professionals. This is a pretty damning statement, as it suggests that the act of therapy (and perhaps the therapist) may have more impact on the success of therapy, rather than what is done within therapy (i.e., the treatment itself). As such, this is an uphill battle for any SLP to face. Providing efficacious stuttering treatment is difficult! So to try to respond to your therapeutic situation, I think one would optimize a clients commitment to therapy by targeting issues in which the client values. If the client doesn't value the short-term therapeutic targets established by your or Dr. Van Riper, then they will not get done. And this is likely to be so, because the client may not recognize or feel that these targets will significantly change or improve their quality of life. The client has hope for improvement, but they may feel (or know) that therapy objective X isn't going to take them there. This isn't the client's fault, as the current paradigm of stuttering treatment cannot remove the pathology, but rather aims to limit the scope in which the pathology affects the person. So as a person who stutters myself, as well as a stuttering researcher and clinician, I wonder what good reporting incidents of stuttering actually provides? Without a pertinent context in which the client identifies, this exercise may seem fruitless to the client. Subsequently, it may not get done. Especially when there isn't a clear connection between this activity and whatever "job-related" issue that drove her to seek treatment in the first place. I guess the point in which I am trying to establish (and admittedly poorly so) would be to suggest that following someone else's pre-existing stuttering treatment protocol is not the path that I would choose. It may have worked for Dr. Van Riper, but it may not work for me (as the therapist). I will happily and readily admit that there are many a therapist that are orders of magnitude better than I, but my little experience thus far has taught me that successful stuttering therapy is when I help the client achieve their goals- -rather than the client following a prescribed protocol that may or may not be in alignment with their values, short term objectives or long-term objectives. Finally, I will suggest that the idiosyncratic nature of stuttering treatment may suggest that not all SLPs (regardless of their proficiency) are appropriate for all stuttering clients. And if there is a stuttering client and an SLP that cannot (for whatever reason) find that common ground or establish that collaborative team effort, then a referral to another SLP qualified to provide stuttering therapy may be the best course of action.
From: Fiona
Do you have an opinion as to whether stuttering is more linked to genetics or is molded by the environment?
From: Ken St. Louis
Dear Fiona, Personally, I would come down in the middle somewhere, perhaps more on the side of genetics. Clearly one's heredity influences the likelihood he or she will stutter. Take a look at the thread above under "Gene for stuttering? maciste ABDOULLAH (Mauritania) 06 Oct 2006." For example, it is true that if one identical twin stutters, the other is likely to stutter as well. Clearly, too, the environment plays a role. For the identical twin research I just mentioned, sometimes one will stutter and the other will not. This suggests that there must be more than common genetic makeup going on here. More to the point, there are many, many stutterers for whom no stuttering relatives are reported.
From: Nan Ratner
With all due respect, we need to be careful about how we use the term environment; in genetics, it is not just "childrearing" or "societal attitudes", which is how it is interpreted in stuttering. It can be as basic as the different uterine and birth conditions twins experience, which is why virtually all undoubtedly genetic conditions show SOME degree of discordance in identical twins. I really think we need to be careful how we use this term in fluency disorders, because environment has become very much more synonymous with the issue of parenting and listener responses than it is in any other field.
From: Sarah, OK
I was watching a television program in which an 18 or 19 year old boy who had a fairly severe stutter was given a device to wear in his ear. When he wore this, he no longer had a stutter. His speech wasn't as smooth as normal fluent speech, it seemed slower and more thoughtful, but the stutter was gone. The difference was amazing. How does this work?
From: Brian Humphrey
There have been a number of altered auditory feedback devices for use by people who stutter. Some of these produce delayed auditory feedback (DAF), some produce frequency altered feedback (FAF), and some can produce both. Delayed suditory feedback sounds like an echo of your own voice coming back to your ear. Some cell phone circuit malfunctions give us unwelcome delayed auditory feedback. Frequency altered feedback sends your speaking voice through an earphone at a different pitch. It can make your voice sound like Mickey Mouse if the pitch gets raised, or like Darth Vader if the pitch gets lowered. We are not quite sure how altered auditory feedback produces gains in fluency, but we know that the auditory system has an influence on fluency. Improvements from delayed auditory feedback or frequency altered feedback seem to be like the improvements noted during choral speaking: speaking along with altered auditory feedback may be like speaking along with a voice that is not your own. If you have a computer with headphones and a microphone connected, you may try DAF and FAF on your own computer. AT http://www.artefactsoft.com you may try their DAF/FAF Assistant program. It is inexpensive to purchase. Altered auditory feedback is a recurring topic in the ISAD online conferences. For more information, "A Brief Historical Review or Assistive Devices for Treating Stuttering", by Dr. Larry Molt, provides a good description of the various assistive devices used to alleviate stuttering over the years, including altered auditory feedback devices. This article can be found in the 8th Annual Stuttering Awareness Day Online Conference.
From: Judy Butler's boys club
We're 3 boys in the 6th grade. We have some questions for you. 1. how does stuttering start because I wasn't born with stuttering? 2. how do people destroy stuttering? 3. What's the best way to make people aware of stuttering? thank you, Boys Club
From: Lynne Shields
Hi boys, You have asked some very good questions. I certainly do not have all of the answers, but I'll make a few after each of them: "1. how does stuttering start because I wasn't born with stuttering?" I don't think we know for sure exactly how or why stuttering starts, but you are right when you say you were not born stuttering. Of course, you weren't born talking either. I am curious to know what you think about how stuttering started for you. "2. how do people destroy stuttering?" Wow. Another good question. I think the answer may be different for each person who stutters. What do you do to manage your stuttering? "3. What's the best way to make people aware of stuttering?" I'll bet you boys know some good ways to make people aware of stuttering. Have any of you given a talk to your class to teach them about what stuttering is and how to do it? That would be one way to increase awareness of stuttering. I think this conference is another good way to do that. The Stuttering Foundation of America, NSA and FRIENDS all have lots of good information that you, your parents and your speech teacher can use to teach about stuttering, too. Anything positive that lets people know what stuttering is, how it feels, and what to do to be the best listener they can is what I would call a good way to educate others. And one other way that I like alot: developing snappy comebacks for when people tease you about stuttering. That can help other people know how their unkind remarks come across! I'm glad you boys have a group and can help each other out. Good luck learning about stuttering and teaching others about it. Thanks for posting your questions.
From: Emily
I am a speech/language pathology graduate student who has a particular interest in animal assisted therapy. I have read (and been taught in my classes) that the use of animals in stuttering therapy can be beneficial in reducing stress and increasing positive feedback for PWS. I wanted to know if anyone has any insight or encounters with this type of therapy. Any information or opinion from anyone is appreciated.
From: Lauren G- SLP Grad Student
Hi, Do you have any advice for a SLP in the school setting to try and incorporate the child's teacher more in the therapy process?
From: Lynne Shields
Lauren, Thanks for your question. Developing and maintaining good communication between the child who stutters, the classroom teacher and the SLP is the key to including the teacher. When I work with school age children, I ask them what they want their teacher to know about stuttering and the best way to teach their teacher. Helping the child advocate for themselves at school is so important, with as much support as they need at first, and gradually letting the child take charge. If they can learn to talk to their teacher about any concerns, be they stuttering or other things, that child is learning to advocate for him or herself. A teacher who is educated about stuttering, in general, and about the particular child's concerns, can be a much better parnter with that child in the efforts to help the child cope with stuttering. There are good materials available on the Stuttering Homepage that can be used to help children educate their teachers, and for SLPs to use to begin educating everyone at their school about stuttering. Best wishes to you as you complete your studies.
From: Brandye Johnson
What are some strategies/techniques an SLP can use when collaborating with classroom teachers? How can you get them to incorporate what is being done in the therapy sessions with the child into their classroom setting?
From: Lynne Shields
Brandye, Working with the student and teacher together to brainstorm how the student can be helped in the classroom seems to work the best, in my experience. Maybe you can talk with your student and ask how they would like to involve their teacher. Then, you might want to find a time when you, the student and the teacher can meet to talk about how to do this. There are materials from SFA and NSA designed for teachers, to help educate them about stuttering. Doing this one-on-one with a teacher, or educating teachers at an inservice are ways to begin engaging teachers. Best regards, Lynne
From: SS
I like the idea of doing transactional analysis to figure out the source of my negative feelings about stuttering. Do most therapists that do TA also deal with stuttering behaviors directly or (alternatively) are there speech therapists that practice TA? Does practicing TA require any qualifications or credentials?
From: William Rosenthal
Hi there. Part of the answer to your question is easy. There are not too many transactional analysts who are trained in stuttering treatment, and there are very few speech-language pathologists and fluency specialists who are trained in TA. Depending on where you live, it may be possible to find some therapists who are willing to work cooperatively with you. If you can identify some issues that you think may be interfering with your stuttering treatment, a TA therapist may be able to help out and your work with the fluency specialist may be more effective. TA is often used by persons who are certified or licensed by other professions, such as psychology, social work, counseling, and speech pathology. The International Transactional Analysis Association (ITAA) does provide, however, an independent clinical certification program. That organization can verify the certification status of various professionals.
From: Meghan - NAU Grad Student
I am a first year SLP grad student. This past week, I observed an evaluation of a second grader who stutters in both Spanish (native language) and English. As a Spanish speaker myself, would you suggest that therapy first be addressed in his native language (which is the only language spoken at home) or his second language?
From: Amanda
I am a second year grad student and I also have worked with a child who is bilingual and stutters. This particular child did not stutter in spanish (his primary language) and only stuttered in English. We began in Spanish by reducing his rate and just slowing him down. We also suspected that the stuttering may have something to do with language learning. After about 1.5 semesters he got the idea of talking slower (I think Spanish is spoken about 4 times faster than English) and then we transitioned to English. I had to have an interpreter with me because I do not speak Spanish, but that didn't seem to hinder any of our efforts.
From: A.E. McClendon
I have been doing my graduate research on bilingual children with fluency disorders and the research I have found so far indicates that therapy should first be addressed in the child's native language.
From: Nan Ratner
There is virtually no published literature on this topic, so think about documenting it for possible publication, or collecting cases if you are in an environment that sees numerous cases like this (we here at Maryland are very interested in collecting bilingual stutterers' profiles in their two languages, so feel free to contact after the conference if you have possible clients for this study). However, I would think that therapy might have to address BOTH languages eventually, if cognitive and affective stressors differ WHEN the person uses the two languages - it shouldn't be an issue of the structure or the rate of the language itself. BTW, there are not data, to my knowledge that suggest dramatic rate differences among spoken languages, as suggested in the prior post. Even here in the States, we would get sampling error if NY/New Englanders such as myself were compared to stereotypical Southern women. 😄
From: Lynne Shields
I have worked with two bilingual children who stutter and two adults. All four cases were different, so I think it is important to remember that there is not one correct way to manage stuttering for this population. One of my child clients was actually a teen. He stuttered much more in his native language; he also stuttered in English. It turned out that the difference for him was that his father made him nervous and did not deal with the stuttering in a way that allowed his teenaged son to feel comfortable with stuttering, hence the increased stuttering in the first language, and primarily when talking with his father. The second child was 5 years old and stuttered pretty equally in his primary language and both of his second languages. One of my adult clients stuttered in both languages, but stuttered more in English. She decided, and I was inclined to agree, that this was because she had a more restricted vocabulary in English and tended to manage her stuttering by substituting words. This is an area, as Nan mentioned, that needs much further study.
From: Maria Ladenheim
How does early stuttering differ from normal disfluency?
From: Charlie Osborne
There are distinct differences between early stuttering and the disfluencies observed in many children as they develop language. Rather than list them here, let me suggest that you go the Stuttering Foundation of America's homepage at www.stuttersfa.org . They have an excellent brochure that describes early stuttering and normal disfluencies, If you think your child is stuttering. You may also want to check out another brochure they have available titled 7 ways to help the child who is stuttering if you believe that your child is stuttering. I would also suggest that you contact a speech-language pathologist in your area that specializes in working with children who stutter and perhaps set up a diagnostic appointment. S/he will be able to help provide you with more information specific to your child. If you're not sure how to find a SLP, the SFA website has a referral list of SLPs specializing in stuttering state-by-state.
From: Kym
What are your thoughts about pegacolon? I had heard both negatives and positives about it.
From: Nan Ratner
It's actually Pagaclone, by Indevus Pharmaceuticals. I understand peer-reviewed publication of their study results are to come shortly, but conference presentations suggest it can be beneficial in reducing stuttering for some folks. Stay tuned - I am sure when the study is released it will be broadly covered by the press.
From: KLamb
What do you do when you have a parent who is constantly making negative comments about their 12 year old daughter's stuttering, in front of the child? I have tried giving the mother info about stuttering, explaining that it is not her daughter's fault, etc, but none of it seems to get through to her. My heart is breaking for this little girl. Any suggestions?
From: William Rosenthal
Hi there. I hope that you will not mind if I steal a bit from another response that I gave on the forum for a similar problem. The situation that you are describing is not easy. The parents need to be responsive and willing to consider changing their behavior. I think that they may need some critical information. They need to understand and accept the principle that when their child stutters, it is not an option that is under his control. Punishing that does not make sense, in the same way that punishing someone for breathing does not make sense. They may need something positive to do, like praising the kid for fluency, and doing whatever controls that you are teaching him. Try emphasizing a change in their behavior, rather than a change in attitude or beliefs. It is much better to approach these parents as allies rather than as adversaries, and I would not give them anything more to read. Rather, get one or both in the therapy room and teach them the kind of responses that you want them to make. Stay positive, not punitive. Still, if you do your best and you are not able to bring them around, you need to let go and move on. We all need to learn that we can't win them all.
From: Ashley
I was wondering if you are happy with your decision of choosing a field in Speech and Language Pathology and what was your deciding factor and experiences thus far?
From: Charlie Osborne
An excellent question! I probably don't have enough space to list all of the reasons I became an SLP. I will share some of what I have learned from students-in-training to become SLPs. Probably one of the most common reasons I have heard from students is that they would like to help people. Our field allows us to get to know individuals on a very personal level and, if we do our jobs right, to observe these individuals make positive changes in their communication abilities. Being able to be a part of helping a person make these changes is highly rewarding. Other students have indicated their attraction to the medical and scientific aspects of the field. As a SLP you have many opportunities to learn about current research, often research that has a strong medical theme, for example the brain studies that are being conducted comparing people who stutter to people who don't. Another exciting area of current study is regarding evidence-based practice. There are diverse opinions within our narrow field of stuttering, from people who are passionate regarding their beliefs. This makes for interesting reading and interesting discussion! Another exciting aspect to being a clinical SLP is that you are able to apply much of your own creativity into your therapy. Each client is an opportunity for you to learn and to continue to craft and hone your clinical interaction skills. Personally, I have been a practicing clinician for going on a quarter of a century and can honestly state that I have never, ever been bored. With all of the advances taking place in technology and in scientific thought, I suspect that my remaining years in practice will be even more interesting than my previous ones. If you are in the process of deciding whether or not to choose the field of speech-language pathology as a career I would suggest that you contact one or more of the SLPs who work in your area and ask if you might be able to job shadow with them. Another suggestion would be that you continue to participate in event s such as this one!
From: Sarah (student)
Hello. This is somewhat of a broad question, but I was wondering why you chose to go into the speech-language pathology profession? Many people don't want to take more than 4 or 5 years of college unless they are inspired by something. Did anything particular inspire you about this field?
From: Lynne Shields
Sarah, I suspect that there are a wide variety of reasons why any of us entered our respective professions. My story is perhaps not terribly inspirational, but here it is nevertheless. I went to college thinking I wanted to be a teacher of the deaf. As a teenager, I used to babysit for a family who had a deaf child and I suspect that this was my only, and probably relatively weak, reason for choosing such a major. As I remember, I lasted about two weeks into my freshman year in that field. I visited the lab school on the campus where I was enrolled, and after observing for awhile, realized that a classmroom setting really was not a good match for me. In fact, I recall a feeling akin to my stomach dropping on realizing that I had not really thought out my choice at all. I trudged over to the department office to give them the news that I was not going to pursue deaf education after all. As I stood outside the office of the chairperson, awaiting my turn, I perused the various pieces of literature on the bulletin board. A brochure about speech-language pathology caught my eye, and I remember thinking, 'now that is something that I would like to do'. I proceeded to transfer to another university after my freshman year. Luckily for me, I loved the major once I began the coursework and never entertained the idea of switching majors after than. You could certainly make the case that I changed focus rather than entirely changing fields--both deaf education and speech-language pathology deal with disorders of human communication. But, I'm not entirely sure that I chose the field after a significant amount of studied thought. A chance reading of a brochure, and the field found me; it happened to be a good fit. I wish you the best in your studies.
From: Charissa, NAU Grad Student
In one of the biographies of PWS, a woman mentioned that she received Botox injections that helped temporarily reduce her stuttering. I was wondering if anyone knew how or why that procedure works?
From: Greg Snyder
Hi Charissa. Botox was briefly used as a stuttering treatment, similar to that of an adductor-type spasmodic dysphonia. Theory being that people who stutter do so secondary to motor-speech incoordination. Blocking is caused by hyperactivation of the (adductor) laryngeal muscles. If one could use BOTOX to decrease the activation strength of these muscles of adduction, stuttering would decrease or cease. However, there's a few significant flaws here. First and foremost, any time you novelize speech, you will enhance fluency. Certainly, a BOTOX injection into laryngeal adductor muscles would alter normal speech production. Secondly, the notion that stuttering is somehow causally related to speech-motor incoordination has been debunked (in my opinion) in 1994. So the theory in which the practice was based became obsolete even before BOTOX was used. I've spoken with a few clients that have tried this, and none have reported significant efficacy from it. Further, the side effects (i.e., temporary reduction in vocal quality) was something that they could do without.
From: K Ellison
I have an adolescent client with a mild-moderate fluency disorder. It has been a bit of a battle trying to get him to participate in therapy. I was wondering if anyone had any ideas that would motivate him to want to participate.
From: Rachel
Try a reward system. During the therapy session, set aside some time to let him do something he likes (videogames, computer time, etc), so that he has something to work towards.
From: Lynne Shields
I suspect that the only way to motivate your client is to address issues that are of importance to him. His agenda may not be yours, so it might be a good idea to spend time talking with him about his speech to find out what, if anything, about his speech bothers him. I have found it helpful to watch the teen DVD from Stuttering Foundation of America with teens, and use it as a springboard for discussion. The Power Game (I don't think I have the name quite right--it's at work) has good questions to use in discussing stuttering with adolescents, too. The key is to gain his respect by respecting him as a person and finding out what is important to him. Best wishes in working with him.
From: Ken St. Louis
I would suggest considering the idea of having your youngster visit a self-help group run by adults. Somewhat surprisingly, this often has a strong motivating effect on young people who stutter. Maybe it has to do with the fact that they can see that stuttering need not be a terrible detriment to living a full life, something that they may not be so sure about.
From: Judy Kuster
Date: 22 Oct 2006
The live, threaded discussion part of the 2006 ISAD online conference is now closed. The conference paper and responses made here during the conference will remain online. Thank you for stopping by. Judy Kuster