Research on stuttering is showing promise in the areas of genetics, pharmaceuticals and assistive devices. At the same time, leading speech-language pathologists are evolving more strategies for client-centered fluency therapy, according to presenters at a research symposium July 9 at the National Stuttering Association’s national conference in Scottsdale, AZ,
With permission of the presenters and Tammy Flores, the Director of the National Stuttering Association the session was video taped and edited onto DVD by Tom Kuster, Professor of Communication at Bethany Lutheran College. This information was put online by Judy Kuster, chair of the Education and Resources committee of Division 4, Fluency Disorders of ASHA, and Professor of Communication Disorders at MSU, Mankato. The video can be used for NSA meetings, for those who teach about stuttering, and for those who want tolearn more about stuttering. The DVD is divided into each speaker’s presentation and each section can easily be used for an NSA meeting or a class on stuttering, with discussion following.
The following copyrighted DVD is available to order. Click here to order from Judy Kuster. The information will also be linked to Stuttering Home Page. The cost for each video is $10 ($5 for the materials, mailer, and postage, $2.50 for producing and copying the DVD, and $2.50 will be sent to the NSA.)
Larry Molt, Ph.D., CCC-SLP/A, BRFS, Associate Professor in Communication Sciences and Disorders at Auburn University in Alabama and Director of the university’s Neuroprocesses Research Laboratory. Dr. Molt’s topic was assistive devices used to enhance fluency.
Dennis Drayna, Ph.D. is a Senior Investigator and Section Chief at theNational Institute of Deafness and Other Communication Disorders. Dr. Drayna’s topic focused on the genetic aspects of stuttering.
Vivian Sisskin, MS, CCC/SLP, BRS-FD, is a clinical instructor in the Department of Hearing and Speech Sciences at the University of Maryland. Ms. Sisskin focused on stuttering and concomitant disorders.
Gerald Maguire, MD, Associate Professor of Clinical Psychiatry and the Kirkup Endowed Chair in Stuttering Treatment in the Department of Psychiatry and Senior Associate Dean for Educational Affairs at the University ofCalifornia, Irvine (UCI) School of Medicine. Dr. Maguire’s topic was an update on potential pharmacological treatments.
Walt Manning, Ph.D., CCC/SLP, BRFS, Professor and Associate Dean in the School of Audiology and Speech-Language Pathology at the University of Memphis. Dr. Manning provided insight into behavioral therapy for stuttering.
following summary provided by Jim McClure
NSA Research Symposium:
Refining Therapy Techniques and Seeking New Answers
Reporting on a long-term study of the SpeechEasy assistive device, Dr. Molt said that 77% of users achieved at least a 20% reduction in disfluency, but that fluency gains diminished over three years for a significant number of subjects. Regardless of fluency, however, many subjects perceived themselves as better communicators. The SpeechEasy study measured use of the device alone, but the device’s manufacturer now recommends that people who stutter undergo speech therapy in addition to using the device.
Dr. Molt, who directs Auburn University’s Neuroprocesses Research Laboratory, noted that new, low-cost software for cell phones, PDAs and MP3 players allows users to experience delayed auditory feedback when wearing an earbud or Bluetooth headset. Outcome measures for these devices have yet to be reported in the literature.
About half of stuttering is genetic in origin, according to Dennis Drayna, who heads genetic studies on stuttering as a Senior Investigator and Section Chief at the National Institute on Deafness and Other Communication Disorders.
Genetic studies of people with family histories of stuttering show ample evidence of a genetic link with stuttering. “If it’s genetic, we can identify the gene,” Dr. Drayna said, “and that can get us to the cells and molecules that the pharmaceutical industry works with.”
At the same time, genes do not entirely control stuttering in anyone, according to Dr. Drayna. Therapy can largely eliminate stuttering for some people, but their genes do not change.
Stuttering and Co-existing Disorders
Not all disfluency in early childhood is stuttering, according to Vivian Sisskin, and may be related to other disorders. Stuttering-like disfluencies include part-word repetition, whole-word repetition, prolongations and silent blocks. Other disfluencies include interjection or fillers, revision, phrase repetition and multisyllabic word repetition: which often are seen as coping mechanisms in older children and adults who stutter.
Ms. Sisskin identified three patterns of disfluency in young children: persistent developmental stuttering, language-based disfluency and atypical disfluency. She noted that while it’s impossible to predict which children who stutter will recover on their own, recovery is influenced by family history, gender and age when stuttering begins. If a child is still stuttering two years after onset, spontaneous recovery is less likely.
Some disfluencies may be a result of other disorders that may be either related to stuttering or coexisting with stuttering. These include language disorders, cluttering, developmental apraxia of speech and autism spectrum disorders. Ms. Sisskin said clinicians can tailor speech therapy to work with these other disorders and help the individual achieve better communication.
Trials of a prescription medication for stuttering show promise, Dr. Maguire said, but further research is needed before such drugs become available to the public. He is the lead investigator in studies of the medication Pagoclone for stuttering.
In a trial of 130 individuals, Pagoclone reduced stuttering in 55% of subjects, and also reduced anxiety. Further trials are scheduled. Dr. Maguire noted that trials so far have tested only the effect of the drug. He suggested that in the future, medication combined with speech therapy may be even more effective.
In a question-and-answer session, Dr. Maguire emphasized that Pagoclone is not approved for children. Some drugs, such as Zoloft, and other drugs that work with the neurotransmitter dopamine, can exacerbate stuttering, but may leave undesirable side effects. He suggested children who stutter and have significant anxiety problems should see a child psychologist as well as a speech-language pathologist.
Factors in Therapy Effectiveness
The relationship between client and clinician is just as important as and maybe even more important to therapy success than the specific therapy method used, according to Dr. Manning. Research on therapy effectiveness in psychotherapy indicates that regardless of the approach used, the working alliance between client and clinician, and the quality of the therapist, are common factors in therapy success. Dr. Manning sees similar findings emerging in fluency therapy.
Dr. Manning defines effectiveness as an alliance in which the client and clinician share a similar view of the therapy process and objectives, and the client feels empowered to act autonomously work toward cognitive change. His goals for change are to increase fluency, improve communication and develop greater autonomy.
He suggests that people who stutter, with the help of their clinicians, move toward rather than away from the problem, assume responsibility for taking action, restructure the cognitive view of the self and the problem, and recruit the support of others. Support groups are one of the factors in long-term success, Dr. Manning said. He advises SLPs to attend at least one NSA conference.
A video recording of the symposium is available from the Stuttering Home Page.