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From: Greg Snyder
Date: 21 Oct 2006
Time: 19:30:32 -0500
Remote Name: 24.74.142.133
Hi Gretchen. Let me try to attack these questions. [1. Why, exactly, do you believe that the future of stuttering treatment will not be behavioral? Would you mind elaborating on that--and maybe hazarding a few predictions about the direction(s) that stuttering treatment might take in the future?] It’s just been my experience that when we don’t know much about a disorder, we try to treat it as best we can. And since stuttered speech presents itself as a deviant behavior, it has largely been confused as a behavioral disorder. Subsequently, the treatments have been largely behavioral. We’ve tried this for some 70+ years, and I’m not too terribly proud of the results, considering that open-heart surgery is now common, and only requires about a 96 hour hospital stay. Stuttering therapy can go on for years, without significant improvement at actually removing the core behaviors. As such, I just don’t see any quantum leaps of behavioral-based stuttered speech treatment efficacy lurking just around the corner. Subsequently, my vote is to leave the behavioral paradigm where it’s at for now, as that’s not the path toward “curing” the pathology. We can continue to provide it, but let’s sink our efforts into other research areas, such as prosthetics, drugs, and genetics. These treatment venues may provide a more direct route toward (or bypass around) the actual core pathology, and subsequently provide better results. … … … … You also wrote: [A key differentiating factor in separating PWS from the non-problematically disfluent seems to be--] I’m not sure I buy into this perspective. The person with normal linguistic nonfluencies doesn’t have the reflexive response toward secondary stuttering behaviors. As such, I’ve never bought into the DYSfluent DISfluent continuum. It always smelled of a politically correct shallow explanation of a pathology in which we do not understand. But I digress. Your question was: [do the stuttered signers you've met/interviewed/heard of exhibit this same (or similar) level of self-consciousness and distress that is so often characteristic of PWS?] Well, I’ve only met 1 in person! Stuttering in sign, while present, is very (very) rare. And since the student would only “stutter” in sign while in SIMCOM, it wasn’t much of a problem relative to the deaf community (which uses sign as THE primary mode of communication.) But relative to his speech, I suspect that he dealt with many of the same issues that others with stuttered speech face. I also know (second hand) of a guy who demonstrated stuttered signing; and his stuttered sign behaviors actually become incorporated into his name sign. So while I can’t confirm his emotions about it, I suspect that a fair amount of fibbing and mockery went on. … … … … You went onto ask: [Is it not possible that part of "stuttered" signing might be due to the fact (if indeed it is a fact; I have no idea, as you can doubtless tell) that signing is just plain more DIFFICULT, motorically speaking, than oral-vocal speech?] The motoric acts of speech are exceedingly complex, and is associated with a large number of neural innervations. I would be tempted to bet that motoric complexity has little to do with the stuttering phenomenon. … … … … … [CLUTTERED sign HAS been clearly identified and/or operationally defined?] To the best of my knowledge, cluttered sign has yet to be formally identified. Now go forth and start researching. … … … …. … [If stuttering may turn out to emerge as the effect of "neural processing errors" occurring "at a central level," how might one account for stutterers who are "cured" dramatically through speech therapy?] I’m not going to pretend to have all the answers. Many children spontaneously recover from stuttering both with and without treatment, and many do question the actual efficacy of pediatric stuttering therapy. And while I’ve met a few adults that do an exceedingly good job at controlling stuttered speech, the core pathology remains. Their dedication and volitional control of speech through behavioral treatments is very noteworthy, and an accomplishment that very few seem to be able to match.