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From: Ken St. Louis
Date: 03 Oct 2007
Time: 13:28:41 -0500
Remote Name: 157.182.15.19
Hi Ed, That's a tough question, "What do we disagree about?" It's a good question though, because it identifies issues that are currently in debate. Let me mention a few areas of disagreement that I have observed in the past few years, as well as some areas of agreement. A. With the recent revival of "operant" approaches to stuttering as a result of the the documented use and success of the Lidcombe Program for preschoolers who stutter, there is an issue of the extent to which we (1) should accept any stuttering in the speech of children and (2) should be concerned about desensitization to stuttering in this group. Other, perhaps more traditional, approaches to stuttering for very young stutterers often use a combination of parent counseling and fluency shaping or stuttering modification. These, of course, would accept some forms of stuttering or speech that is not perfectly normal. B. A similar issue has to do with evidence-based practice. If a particular approach is supported by the lion's share of experimental evidence, does if follow that other approaches for which there is less published evidence should not be used? Many years ago, I coauthored a chapter on stuttering therapy, and we concluded that the EVIDENCE suggested that fluency shaping approaches were more effective than other approaches. One reason for that, however, was that some of the more traditional approaches, e.g., the Van Riper stuttering modification approach, was popular when studies looking at efficacy were not being carried out with the same rigor that were characteristic of some of the fluency shaping studies. Now, I'm not at all sure that I would make the same conclusion. C. The issue of whether or not to carry out desensitization activities with stutterer seems to be less of an issue than in the past decade or two. Now, regardless of the approach to therapy, many clinicians seem to have concluded that desensitization is important. One reason for this seems to be that negative and unhelpful emotions did not seem to disappear with quickly achieved fluency and often came back to interfere with long-term gains. D. How to measure stuttering has been--and continues to be--a challenge for clinicians and researchers. We typically agree that we need more than frequency measures (i.e., %SS or SS/M), but there is not uniformity of opinion as to what other measures should or must be included. So there's a start. Hope it answers a bit of your question. Ken