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From: Greg Snyder
Date: 02 Oct 2006
Time: 15:01:30 -0500
Remote Name: 130.74.194.57
Hi Julie, A couple of rambling thoughts… First, I expect that many are not being exposed to the concept of stuttered sign, or “stuttering” in other expressive modalities; I know that I wasn’t. And in a sense, this reality may reflect the field of SLP viewing stuttering solely as a “speech” disorder. And regarding your specific question on assessment and treatment, I think the existence of stuttering in sign and other expressive modalities should change everything, but will change nothing. Please allow me to elaborate… If the stuttering phenomenon does exist in other modalities within expressive communication, stuttering ceases to be a “speech disorder.” As such, the field of SLP really needs to take stock in what we believe (or think we know), as well as our roles in the perceived treatment or management of the phenomenon. Let’s look at the reality of the situation. We’ve been treating childhood stuttered speech for decades, yet there have been no significant changes in the incidence or prevalence of stuttered speech. It’s even debatable if treatment outperforms spontaneous recovery. In spite of this, there are people in Australia claiming outstanding results relative to the treatment and eradication of stuttered speech in children. So far, such results are not replicated in other clinics. We’ve got people in Virginia claiming their treatment has a 90% success rate of the participants who complete their program, yet the prevalence of stuttered speech in the US (or Virginia) remains unchanged. In 2002, JFD actually published an article bluntly stating that a factor contributing to relapse after "successful" stuttering treatment is the client's difficulty in adjusting to a new role as a fluent speaker! (Rather than admit that the treatment may not be successful, the authors would rather blame the client for failure!) In 2006, the SLP magazine “Advance” published an article suggesting that the children who do not spontaneously recover from stuttered speech fail to do so because they are “perfectionistic”! (I’m not even sure where to start with this… other than to suggest that it is not science.) Let me come about this from a different perspective. As early as 1928, there was a scientific and medical stuttering model proposed by Orton & Travis. But as with many things within medical science, there were no easy answers, explanations or cures. Around that same time, there was a competing theory that took an easier route—blaming the psychology of the stutterer. (Ever notice that when there are no easy explanations to account for someone’s deviant behavior, people almost invariably point to psychology first and foremost?) The field of SLP apparently chose the easier, and arguably pseudoscientific, route—subsequently establishing the foundation of stuttering research and treatment on the premise that people stutter because they’re nervous (i.e., speech-based anxiety tension). Can you imagine such a theory applied in modern medicine? Parkinson’s disease? Dysphagia? Aphasia? Are people that continue to have cancer after treatment blamed for failing to accept their cancer-free selves? Similarly absurd statements can be made relative to a speech-motor perspective, but I’ll save your time. In a time where we’re sending robots to explore Mars and people can receive “virtual physicals” with full body fMRI scans, it amazes me that people still continue to choose the belief that stuttering stems from speech-related anxiety tension or that it is the result of a learned behavioral speech incoordination. It’s the thoughtless acceptance of research paradigms gone awry. The point is this: The field of SLP had a chance to establish stuttering as a legitimate medical phenomenon, but we chose a different (and conceptually easier) course that has result in stagnant, antiquated and pseudoscientific stuttering perspectives that continue to plague us to this very day. If we continue down the path in which we came, we’re likely to replicate similar results. And since we haven’t changed course after 70+ years to recognize the insanity, I doubt we’ll start now. In short—if stuttering is a phenomenon that extends itself to all expressive communication modalities, then everything we think we know about stuttering (as a speech disorder) needs to be reassessed—because it is likely wrong. Most every etiological theory that has been established (and is supposedly the basis for our evidence-based-treatments) may be invalid. If people are willing to accept the notion that the stuttering phenomenon extends to all expressive communication modalities, then it will shine a light on our decades of professional inadequacies—and that will be a bitter pill to swallow for many a SLP and stuttering researcher. Secondly, if we cease to believe that stuttering is a behavioral speech disorder, then it really does impact the perceived efficaciousness of any treatment an SLP can provide. While we may be able to help people feel better about themselves and guide them into becoming effective communicators regardless of stuttered speech, the actual eradication of stuttered speech is likely beyond our scope of influence. The answer to the stuttering phenomenon likely lies within a harder science, such as genetics or other neurological based treatments, such as deep brain stimulation or pharmaceuticals. So in short—if stuttering is accepted as a phenomenon representing natural reflexive attempts at self-correction and self-initiation of gestures relative to expressive communication, then it will likely nullify the bulk of our previous efforts as a field. We will look our clients in the eye and tell them that we don’t know what stuttering is, but we can help them live and cope with the pathology. Everything we thought we knew, we will accept that we do not know. But no other profession is likely to step forward and address a population in need, so I hope we will continue to do so—using our best evidence-based-research and treatments in the managements and coping strategies that we provide. However, the likelihood of this paradigmatic shift occurring is minimal. One paradigm cannot be abandoned until another takes its place. It’s almost as if people prefer to live in a pseudo-reality that ignores nature’s reality, rather than to accept nature’s harsh truths. Subsequently, the field of SLP will likely continue on its path to nowhere, changing very little in the process. Until then, claims of uber-successful treatments and cures, as well as beliefs that stutterers are essentially to blame for their own pathology will not only continue—but probably propagate. And it is because of this, that I predict a (true) cure will come from outside the field of SLP. Please don’t shoot the messenger.