What clinicians should know!

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Re: Stuttering severity, anxiety management, evidence base

From: Mark Irwin
Date: 05 Oct 2008
Time: 22:14:20 -0500
Remote Name: 203.192.86.115

Comments

Sue, (Re Your suggestion our discussion be continued via email). I am sorry if my questions are upsetting you. However I make no apologies for asking them. I am making a concerted effort on behalf of consumers to assist the process of improved therapeutic outcomes and increased public awareness. As Judy Kuster, provider of this wonderful online forum for open debates/questions, said last year: “Disagreements and challenges can lead to new discoveries”. So I would very much like to continue discussing this with you publicly. You make the comments that “My view is that fluency shaping should be the treatment of choice (because that is what I believe the evidence indicates)when the adult wants to work specifically on their speech (fluency)”. Can I ask When would an adult pws consulting a SLP not want to work specifically on their speech? This is inspite of what you mention as the importance of consideration of anxiety. I am sure you would agree pws cannot all be expected to diagnose the extent of their anxiety in relation to stuttering/speaking. Am I right that a diagnostic process is needed? Hence my other question What process do you use?. It would seem none. I understand you may feel you are an experienced clinician and can make accurate assessments based on your experience, but this does not help pws when they consult an inexperienced clinician. You also make the point in regards to clinicians “they need to know what the current thinking is about what is evidence-based best practice for the treatment and management of stuttering across the lifespan” AND “there is evidence to suggest that Prolonged (or Smooth Speech) should be the treatment of choice for adults who stutter”. Based on these statements I feel my question on evidence base is reasonable. I repeat it What is the evidence that fluency shaping works better than other modalities for those who have stuttering related anxiety? I believe there is none, as the evidence base to which you refer measures stuttering only in terms of % syllables stuttered. (no mention of covert stuttering or objective measures of anxiety). Is that correct? I agree with you when you say “we need to determine how each individual who stutters feels about the problem and importantly, what the impact is for them”. Can I ask again How do you measure this feeling and impact? Sue this questioning is not meant as a personal attack on you, and I do not want to be dismissed as a clinician-hating pws, someone only recounting a personal viewpoint, or a timewaster. As your bio says “For the past 25 years she has taught at the university educating undergraduate and graduate students in the area of stuttering”. Also I know you give frequent presentations internationally (most recently at the Oxford Dysfluency Conference) and are a long time member of the Australian Speak Easy Asoociation’s national council. Because of your position of influence I believe it is important your thinking is crystal clear on this subject. If my questioning has caused you to reconsider your views can I suggest linking stuttering to social anxiety disorder is a way forward. In any case I hope you will answer my questions publicly. Kind regards, Mark (mirwin@cobweb.com.au)


Last changed: 10/05/08