Archive for July, 2009

Trusting the experiential common sense of stuttering

I had an exchange with my stuttering buddy Pam, who has recently experienced a relatively sudden evolution in overt stuttering behaviors.  New secondary stuttering behaviors include throat and laryngeal tension.  She told an SLP, who suggested she try (whole-body) relaxation techniques and laryngeal massage (i.e., massaging your neck).

Are any stutterers out there buying this?  I highly doubt it.  We know better.  And yes, the SLP was a fluent.  [A well-intended fluent that’s giving useless (if not harmful) treatment advice.]

In a sense, the sports analogy works here.  (It usually fails as it relates to stuttering, but it works here…)  If one develops some new ‘bad habits’ in their golf swing, will it help the golfer at all to massage their arm or trying whole body relaxation techniques?  No.  The problem isn’t tension in the arm, it’s the act of swinging itself.  Similarly, newly acquired secondary stuttering behaviors aren’t problems of “muscle tension” itself, but rather new and novel additions to the speech code.  Massaging the larynx won’t do anything–as any stutterer will intuitively know.  The act of speaking is what needs to be targeted–which is why negative practice and volitional stuttering are such great tools.

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When the ti-ger’s on the run…

I’ve been offline a bit over the summer, and haven’t been able to read up and reply to others as much as I’d like.  Recently, I got a comment by Pam, discussing the personal evolution of stuttering.  In essence (and I hope I’m getting this right), she feels as if her stuttering behaviors have changed, and that she is showing more stoppages (blocking / postural fixations) then ever before.  So what to make of it?

Well–I’ll state my safety disclaimer and say, “we’ve got no idea.”  But with that said, I think I may have an idea…

First off–our stuttering behaviors are only symptomatic of the pathology.  Our behaviors are not the pathology, but rather how the body tries to deal with the pathology (that is occuring at the neural level).  Stated differently, stuttering behaviors are symptoms; they are how the body is trying to behaviorally overcome neurological processing errors (which is the core pathology).  It’s my belief that the act of stuttering is the body trying to “jump-start” or “kick-start” the (stuck) system.  There’s a stop at the neurological level, and the body’s trying to force through it by priming itself with (motor) initiation behaviors.

That means that stuttering isn’t the pathology, but the body’s answer to the pathology.  And since it’s the body’s answer to the pathology, and it’s not a very efficient answer, these behaviors will evolve over time.  Older stuttering behaviors stop serving as effective primes out of the (neurological) stuttering moment, and the body hunts for newer/better behaviors.  As a result, the way we stuttered 5 years ago isn’t the way we stutter now, and it won’t be the way that we stutter in 5 years.

In any event, we’ve discussed (a theory on) why stuttering behaviors evolve.  But what do we do when our overt stuttered speaking behaviors evolve?  Well–we have to adapt.

Counter-intuitively, it could very well be that this sudden evolution in stuttering behaviors is a net positive.  First, the fact that we can tell there has been a change in stuttering behaviors indicates that we’re sensitive to it.  (In other words, we have desensitized ourselves to stuttering to some degree.)  Second, we may have our ti-ger on the run.  (Please read the ti-ger analogy if you haven’t already done so.)  Regarding our old stuttering behaviors, we’re either not doing them anymore or they have ceased to be effective.  At this point, the ti-ger is forced to show us a new trick; it’s behaving differently–and this can freak us out just a bit at first, because it feels like an adidtional loss of control  So what to do?  In essence, we’ve got to retrain the ti-ger.  He’s a wilily one, and isn’t easily domesticated.  Right now, the ti-ger is walking wherever he wants to go, and that’s not an acceptable way to live with it.  When we lose control, the ti-ger takes a swipe at us.  So pull out the choke chain and get to work.  There are any number of ways to try and tame this ti-ger, but my preferred method at this point is via volitional stuttering.  When we volitionally stutter, we’re tugging on the choke chain and directing the beast where to go, how to go, and when to go.  And we train this ti-ger to do what we want, when we want, how we want.  We’re not trying to make him go away, because I’m not sure that’s even possible.  We’re just domesticating the beast.  It will take both courage and practice, but the continued use of volitional stuttering gives us the ability to shape how the ti-ger behaves.

There are any number of online and print materials that provide step-by-step methods regarding how to employ the use of volitional stuttering to tame the tiger; this is just one.

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On stuttering patients’ opinions of Digital Speech Aids

It’s pretty interesting to see how the stuttering subculture (and the professional SLP subculture) have evolved.  When the SpeechEasy first came out, it was perceived (and touted by many) to represent an absolute evil.  And this initial reaction was pretty funny for me to witness; it reminded me of headless crowd of professionals all hustling and muttering the same thoughtless talking points.  (So much so that I wrote a paper about it.)  (And this wasn’t helped by the infamous Oprah appearance.)  But a strange thing happened over the next 5 years or so.  More and more stuttering consumers came out in favor of the device, and as such, so did many SLPs.  Now, the pendulum has begun to swing in reverse, as there is more and more data coming out touting the minimal therapeutic benefits of digital speech aids.

Which is why I find this article to be so interesting. The study is from Poland, and are thus beyond the American perspective.  In any event, their data suggests that stuttering clients (who wore DSAs for an average of 3 hours daily) seemed to appreciate the results.  Same phenomenon; same population; same treatment approach; diametrically opposed results.

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The role of eye-gaze diversion in the breakdown of communication

It’s refreshing to see a legitimately new research idea in press.  And if the idea is of good quality, I get all the more excited.  This research article measures the eye gaze of listeners as they are exposed to stuttering.  (In other words, special equipment recorded where the listeners were looking as they saw stuttered speech.)  Such an idea isn’t new; I remember having a conversation about this very research idea with one of the authors some 10 years ago–but it’s great to see that someone actually went out and did it.

There’s so much to like about this article.  First off, the breakdown of communication relative to stuttering is always blamed on the stutterer.  (The unconfident/diffident stutterer has bad eye contact because they’re nervous, which causes them to stutter.)  This study turns that assumption on its ear, and collects data on the fluent listener.  And what did they find?  Sure nuff, fluent listeners break eye contact when looking at stuttering.  So it appears as if no one is looking at anyone when stuttering is involved.  All parties are involved here…  (Looks like all could benefit from desensitization…)

This is where the authors and I differ.  They report that this break in eye contact is a response to the communication breakdown…  Nah.  Incomplete.  Innaccurate.  This break in eye contact *represents* a breakdown in communication.  They’re still under the mindset that ‘communication’ is the audible signal alone.  It’s not–the visual signal is an important part of communication, and when there is stuttering present, people are turning this modality off.

It’s a safe assumption to make that when listeners break eye contact, that can be a shameful realization for the speaker.  And that shame has consequences…

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Episode 38 of the Stuttering.Me micropodcast is up

Being broke, poor, and having peace. Learning lessons from the Millionaire Mind and applying them to life with stuttering.

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The interpretation of therapy results fails when the treatment teaches to the test

I’m really at a loss if I should keep pointing out the cargo-cult pseudoscience in the field of SLP.  But alas, here’s another example–including many of the same researchers on this little gem.  This study is measures the effects of syllable-timed speech to treat preschool children who stutter.  In English–this means…”Does talking like a slow monosyllabic robot cure kids from stuttering?”  The abstract says “yes, but it takes 6 visits.”  I couldn’t bring myself to read the article.  Sorry.

What’s the flaw?  The kids are being taught to the test.  Talk in such an unnatural way that overt stuttering is impossible.  Measure that the kid isn’t overtly stuttering.  (Profit!)  Assume that this unnatural “fluency” will result in a life-long recovery from stuttering.  So gang….are we buying this?  Make a kid talk like a robot and assume stuttering is cured?

No–I’m not saying that direct pediatric stuttering therapy is bad… not by a long shot.  But this research group has to recognize that they can’t quantify the stuttering phenomenon.  And their attempts to quantify the disorder results in them fooling themselves into success that they’re likely not really having.

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A perfect example of how flawed thinking results in flawed (and useless) data

This article is both rich and ripe with fodder.  I hardly know where to begin, but let’s trudge through this together.  The title: “The relationship between mental health disorders and treatment outcomes among adults who stutter.”  Again, let’s look at the assumptions the authors are making.  Do we see articles on mental health disorders and the treatment of cerebral palsy?  Do we see articles on mental health disorders and heart disease?  Liver malfunction?  No, you don’t; “that’s silly” is what you’re probably thinking.  But this is an anchor to the negative stuttering stereotype: unexplained phenomenon below the neckline is usually viewed as physical or medical.  Unexplained phenomenon occurring above the neckline (such as stuttering, cluttering, Tourette’s, etc) is generally not viewed as “medical”, but rather a character flaw (or character weakness) of the person.  This prejudice is encapsulated in the title.

So let’s look at the article’s premise.  The authors cite that only 1/3 of those that go through stuttering treatment have any real kind of lasting result.  And they’re trying to figure out what makes this 1/3 ‘successful’, and the other 2/3’s failures.  So they make the assumption that only those without mental disorders can retain therapeutic success post-treatment.

Let’s delve into this a little further.  What they’re implying is that stuttering children and adults have mental health disorders.  Ipso facto, it’s our fault.  If we were strong enough not to have these mental health disorders, then we could make stuttering therapy work for us.  It’s the old (bad) SLP playbook: “If first you don’t succeed, blame the client.”

But back to the study…The authors are predicting that only those without mental health disorders will retain therapeutic success.  Stutterers that fail to succeed have mental health disorders.  And what do you think they found?  Data that supports their prejudicial assertion.

Now–how is this utterly and fatally flawed?  It’s flawed in the hearts of the “researchers”.  They’re pairing the cause of stuttering and the failure of stuttering treatment with psychological disorders.  These are the predjucial glasses that they wear.  And if you look for something, predjicially, you’ll be sure to find it.  This is a perfect example of both: (a) pseudoscience, and (b) cargo-cult science.  The authors fail to even respect or recognize that the cause of stuttering and failures in stuttering treatment are entirely beyond the realm of psychological or mental health disorders.  But let me invalidate their entire study with one or two sentences.  Those participants that scored as having a mental health disorders were more severe from the start; the stuttering ti-ger has been kicking their ass for an undocumented period of time, and this is being revealed in their psychological metric.

Looks like I just found yet-another crappy research article to use as an example in my classes.  Keep it coming folks–this material helps my students become better and more critical scientific thinkers…

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