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Interesting Observation in SLP Research

I was pleased to see that researchers who are collecting data on specific language impairments are intentionally excluding children with any history of stuttering (even if there’s spontaneous recovery) from their trials.  This may be anecdotal and have no real validity whatsoever, but my language skills pretty much stink…  (And yes, there is a lot of data linking relative delays in language proficiency with stuttering.) Anyway–I find this to be interesting research, not because of the way it’s presented, but because of how the data can be interpreted. More and more, I am under the belief (perhaps illusion) that stuttered speech is nothing more than a reflexive behavior that the body uses to deal with the stuttering phenomenon (which is best represented as a neurological state). So we produce stuttering behaviors to kick-start (or get out of) our stuttered neural state. This leads me to believe that stuttering has 2 components; the stuttered neural state, and a reflexive behavioral compensation to the stuttered neural state. (So why kids can have 1 without the other, and why some kids/adults have to have them both…fascinates me.  My gut is that it reflects the location of the neural error in the language formulation/production process.)

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  1. May 19th, 2009 at 12:54 | #1

    A bit off-topic for the beginning of your post, but … Stuttering starts with a reaction to a loss of speech control, but the loss of speech control may itself be partially caused by a reaction and a resulting emotion. It may simply be a temporary disconnection in response to a reaction. I agree with you that more advanced stuttering (which could begin only minutes after stuttering starts in youngsters) involves a neurological brain state that is highly complex. But I think there’s a difference between the origin of stuttering and the continued presentation of the behavior. I think the strength of the underlying disconnection has something to do with your question at the end of your post: why some kids have a more intense feeling that they are stutterers and some have more overt reactive behaviors. And, of course, some have both. The differences would be in the intensity of the “brain maps” that individuals create from their awareness of the underlying emotions. Hope this makes at least a little bit of sense.

    [Reply]

    Greg @ Stuttering.me Reply:

    Hey Darell! I appreciate your comment, and always enjoy reading them.

    I think your perspective may have validity for us persistent developmental types–but what about adult/acquired stuttering? Such as from drugs, focal neural insults, or Parkinson’s patients taking L-Dopa? Then, the ‘reaction to a resulting emotion’ perspective tends to break down, wouldn’t it?

    Further, if one buys into your ideas, then they’d be stuck into believing Bloodstein’s distraction hypothesis relative to how/why Choral Speech (etc) enhances fluency. (Or maybe you’ve come up with a better mousetrap and I’m just too slow to figure it out.)

    In any event, you know the data as well as I do… and (pediatric) emotional reactiveness is associated with therapeutic success. Whether this relationship is causal (doubt it) or just part of the phenomenon (with an unknown intervening variable) remains to be seen 🙂

    [Reply]

    Darrell Dodge Reply:

    Thanks, Greg. In my experience, acquired stuttering presents very differently than the developmental variety. It’s more steady/persistent through the utterance and is more difficult to modify. My sense is it may be more associated with a timing or sensory/feedback issue. The old Market study identified stimulus of the thalamus as a therapeutic fix in some cases and implicated the corpus callosum as well, if I remember correctly. There are emotions & reported feelings, but they also present differently — at least in adults.

    With DAF, I’m more ready to buy into the Alm (via Goldberg) dual pre-motor hypothesis. When DAF/AAF or choral speech is present, there’s an immediate quieting of reactivity, virtually within seconds. I think it’s a more sophisticated type of distraction than Bloodstein was referring to, however, possibly providing an indication of all the things that are going on beneath the level of awareness. I think this points out the important role of auditory feedback in stuttering. The amygdala is relentlessly monitoring the auditory channel for threats associated with negative outcomes. When choral speech or another voice is present, the task changes dramatically and loss of speech control while being the center of attention becomes a non-issue. Also, there is a more deliberate skill-type quality to speaking in unison with someone — more like tracing. That may immediately cancel the threat situation and the reactions and conditioning that go with it. The mirror neurons are engaged and the external pre-motor loop is more active, by-passing the internal loop than seems more vulnerable to disruptions by the PAG and other structures associated with reactivity. Of course, for stutterers who have not worked on the fear issue, (i.e., many people who turn to DAF devices) the reactivity can re-express at the least breakdown of trust in the device, with devastating effects.

    Emotional reactivity seems like more of a phase with many preschoolers. I’ve seen kiddos I was worried about gradually (or even suddenly) turn things around when confidence in their speech increased. I’ve seen others who seemed more steady keep stuttering. Maybe there was more of a weakness in the underlying speech-language system in those cases (?) Not all reactions can be seen as reactivity. Stuttering itself may be the expression of the emotion in those cases. Or maybe the feeling state (which is private and can’t be seen) is more important for some children. Very young children are in a virtual state of chaos vis-a-vis developmental changes, emotions, and awareness and I wonder if we’ll ever be able to figure it out. Let’s hope.

    – Darrell

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