CONTENTS This is a threaded discussion page for the International Stuttering Awareness Day Online Conference paper, Is There Anything New In Stuttering Or Are You Still Doing The Same Old Things, by Walter Manning. The presenter of this paper, Is There Anything New In Stuttering Or Are You Still Doing The Same Old Things has consented to have a personal email address posted here if you wish raise further questions and/or comments. Walter Manning - email@example.com Old whine and new battles ;-) From: Gunars K. Neiders, Ph.D. Date: 10/14/98 Time: 6:13:43 PM Remote Name: 188.8.131.52 Comments Proffesor Manning, Thank you for your survey of the field article. The comments and questions are from somebody who thirty years ago gave up constant following of the evolution of stuttering therapy literature because it did not appear to hold any real promise for chronic stuttering syndrome (Cooper's definition). As a part time psychologist I tried to find the answers in the area of psychology and recently (about a year ago) re-entered the fray because through rational emotive behavior therapy I made order of magnitude improvements both in cognititions, affects, and behaviors that resulted in significant Quality of Life (WHOQOL, 1995 and Yaruss, 1998). From the outsiders view the things that are different in the field, ranked in importance as seen by me are: 1. Serious attempt to document treatment outcomes. I particularly like the Dr.J. Scott Yaruss model. 2. The Capacities and Demands model especially as explained by Dr.Woody Starkweather. 3. Incipient understanding of the role of cognitive and affective aspets of treatment. Here I would like to see more discussion and research in comparing, contrasting, synthesizing various counselling approaches such as rational emotive behavioral therapy, gestalt and its experiential offspring, group dynamics a la esalen institute, ... 4. Utilizing of computer resources where we all owe a debt to Judy Kuster and the triad of list-server owners Drs. Mowrer, Starkweather, and Quesal, as well as a horde of other website providers. 5. Coming of age of National Stuttering Project. We owe a debt to John Albach and the "democratic forces" ;-)! Some things that were and still are important include: 1) Stuttering Foundation of America, and 2) the perpetual optimism that the sciences will provide us all the answers tomorrow (if not sooner!) (I am as yet not convinced of that within the next 30 years MRI, PET, or genetical studies will provide us with meaningful insights to develop new treatment plans.) One statement which is discouraging to me but was encouraging to you is the anti psychological air as indicated in your quote "Findings such as these tend to provide additional evidence to counter the notion that people stutter because they are neurotic, have a personality disorder, or, as some would have had us believe, have an unusual relationship with one or more of their sphincters." I think that this type of prejudice against ALL psychology tends to throw the baby out with the bath water. There is more to psychology than the discredited theories of Freud and his followers. THE question which I pose to you is: Granted that there is no evidence that some complex has caused us to stutter, do you really think that proper application of a cognitive behavioral therapy, such as Rational Emotive Behavioral Therapy would not aid in the stuttering therapy process in working through problems due to self-deafeating cognitions/beliefs and help the client to work through his inappropriately negative emotions considering his stuttering such as guilt and shame? Re: Old whine and new battles ;-) From: Walt Manning Date: 10/14/98 Time: 6:14:09 PM Remote Name: 184.108.40.206 Comments Gunars- I'll respond to your question first, then comment a little about what you perceived as an anti-psychology comment. About all I can say to your question about REBT is that I have no doubt that this, and other similar approaches, would be likely to be a great help to an adolescent or adult who stutters. What you tell yourself about the experience of stuttering (or another experience for that matter) determines much of the handicap. So any clinician or counseling strategy that helps the person to reinterpret the experience in a better manner is likely to help. And REBT is one of my favorites. Regarding the perceived anti-psychology (sphincter) comment...What I meant was that the newest neurophysiological data points more and more to possible CNS involvement, although no one knows what this really means. I meant that these data seem counter to the idea that stuttering arises from a deep-seated emotional problem as the Freudian types suggested a few decades ago. Still, of course, there are LOTS of psychological stuff going on in the stuttering experience. It's just that (developmental) stuttering is not likely caused by the psychological stuff. Re: Old whine and new battles ;-) From: Gunnars Date: 10/14/98 Time: 6:14:38 PM Remote Name: 220.127.116.11 Comments Professor Manning, If we assume that the model of stuttering, that it consists of three processes, the Original Onset, the Cementing Period, and the Propagation Process (which the adolescents and adults are in), your answers make sense. Tools like REBT would be used in the Propagating Period to reframe the stuttering, and, hence, to make it easier for the sufferer to both cope with his stuttering and to work more effectively and efficiently on his speech therapy. If furthermore, we stipulate that there is a strong inborn commponent of stuttering, the theory that stuttering evolves would be valid, and then the Original Onset would be invisible to us because it would depend on the family Threshold for recognition of stuttering. Only after the threshold of stuttering is reached, would the professionals be called in. The Cementing Phase is the interesting one. In Quantum Physics we have a duality model of light: sometimes it acts like a wave and sometimes it acts like a particle. Do you think that it is possible that both the demand/capabilites AND genetic predisposition both contribute to what I call the Original Onset? Or does the demands/capability model only play a role in the Cementing Phase? Which writings reflect your most recent thoughts on stuttering therapy, as contrasted to its causes? Thank you for your responses, in advance. Re: Old whine and new battles ;-) From: Walt Manning Date: 10/14/98 Time: 6:15:06 PM Remote Name: 18.104.22.168 Comments I responded earlier to your comments but apparently failed to post it correctly. I agree that many factors go into onset and development, including the two you mention. I really like the work of Anne Smith/Ellen Kelly and their development of a multifactoral-dynamic model of onset. I believe it's the best thing I've read about onset in a long while. The edited texts of Curlee and Siegel provide some good chapters, particularly on brain imaging and genetics. Finally, the work of Woody Starkweather and his application of Gestalt treatment to those who stutter should yield good results also. I hope I have responded to your comments. Re: Old whine and new battles ;-) From: Les Anderson Date: 10/14/98 Time: 6:16:08 PM Remote Name: 22.214.171.124 Comments Gentlemen, I really enjoyed your viewpoints on the psychological aspects of stuttering. I stuttered very severely for fifty years then, in 1990, I attended an intensive clinic, The Institute For Stuttering Treatment and Research in Edmonton, Alberta. For five long years I struggled to maintain the fluency that I gained through the use of fluency skills. There were many days that I became completely exasperated with the seemingly uselessness of these skills to help me realize any sort of fluency. I don't know why, but almost overnight, my attitude towards my stutter and myself took a dramatic turn. I just gave up the notion of trying to be 100% fluent and adopted the attitude that if all people could see in me was my stutter then they had a greater problem than I. If everything I did was judged by my speech then they were missing out on what I had to offer. In simple language, I just didn't give a darn anymore. This attitude has done more for my fluency than the previous five years of struggling with the fluency skills. By no means am I saying that I don't need the skills; however, my psychological attitude towards my stutter and myself has really turned my life around. Yes, I truly believe that psychology plays a major role in the treatment of stuttering. Les Anderson President, British Columbia Assoc. of People Who Stutter New approach From: Ed Feuer Date: 10/14/98 Time: 6:16:54 PM Remote Name: 126.96.36.199 Comments There can be a new approach, but speech therapists must recognize their field does not hold all the answers to treating stuttering in adults. Treatment, if it is to be effective, must deal with the client as a whole person and helps him or her overcome lifelong conditioned responses. Simplistic tongue jockey, token therapy approaches are doomed to failure if the bruised psyches and emotional scar tissue created by stuttering are not healed. Stuttering is a life impediment, not only a speech impediment, and as such, its treatment calls for more expertise than possessed by SLPs alone. That is why I advocate an ongoing approach which recognizes that seriously dealing with stuttering means you have to deal with the whole person Ñ an approach in which the SLP acts as facilitator in a collaborative team. To help make the effort concerning the proper speech mechanics effective, the person who stutters, depending on individual needs, would also work with treatment team experts in such areas as desensitization to fears, assertiveness training, anti-procrastination techniques, interpersonal communnications, psychology and psychotherapy, acting and drama, anxiety and stress management, and and human performance. All members of the team would be in close liaison regarding the needs and progress of the client. Fluency disorder professors could help get this concept off the ground by developing joint practicums with, for example, psychology and counselling departments whereby grad students could share stuttering clients and lend their respective expertise in a collaborative treatment plan. But that's not the way the profession does things. Precisely Ñ and therein lies the problem with respect to the treatment of stuttering in adults. Ñ Ed Feuer Re: New approach From: Walt Manning Date: 10/14/98 Time: 6:17:19 PM Remote Name: 188.8.131.52 Comments Ed- I guess your view of the field is different from mine. Is there anything new? From: Jeff in Iowa Date: 10/14/98 Time: 6:18:01 PM Remote Name: 184.108.40.206 Comments Very interesting article. I agree that Conture, Yairi, and others have given us much more information to use on which to base remediational programs. The questions, however, is whether, in practice, we do anything differently. I work in the schools, and it all comes down to your training. Pull-out therapy, for example, is still the "norm," even though we know it doesn't work! Our knowledge has expanded probably four-fold since the late 1980's, as estimated in Futurist magazine. I'm sure this applies to stuttering also. Maybe our treatment techniques are still valid? Thanks for provoking a lively discussion. Specialty recognition From: Judy Kuster Date: 10/14/98 Time: 6:18:47 PM Remote Name: 220.127.116.11 Comments Walt, thanks for an interesting article! You mention that one area where improvement is to be expected relates to the creation of the commission to regulate specialty recognition. Do you have any information about what the guidelines for Specialty Recognition are going to be? Re: Specialty recognition From: Andy Floyd Date: 10/14/98 Time: 11:05:39 PM Remote Name: 18.104.22.168 Comments Hi Judy! According to the August 1998, SID-4 newsletter, "the criteria for inclusion in this inaugural cadre are: (1)The applicant holds the ASHA Certificate of Clinical Competence in Speech-Language pathology. (2) The applicant has completed a minimum of 5 years of post-clinical fellowship year professional experience, (3) The applicant demonstrates sustained interest in, and experience with, fluency disorders, possesses knowledge about the nature of fluency problems and the research base for that knowledge, and has experience in the evaluation and treatment of individuals with fluency disorders. (4) The applicant has participated, within the preceeding 3-year period, in continuing education activities in the areas relating to fluency disorders." "Recognition as a fluency specialist in the inaugural cadre of fluency specialists requires a majority vote of the members of the Specialty Commission on Fluency Disorders." 3 letters of recommendation are required. In the future, after the initial cadre, candidates will be required to have a mentor. "The commission will identify mentors from among the inaugural cadre of fluency specialists and will assist applicants in locating mentors." TECHNOLOGY From: Harsha Kathard Date: 10/15/98 Time: 3:31:24 AM Remote Name: 22.214.171.124 Comments Dear Walt Thank oy for an interesting article- did you get feedack about the application of technology to the treatment of stuttering?- If so which devices were found to be useful ? Also, did practitionerscomment on alternative methodologies eg.hypnosis? Re: TECHNOLOGY From: Walt Manning Date: 10/15/98 Time: 9:54:18 AM Remote Name: 126.96.36.199 Comments First of all, thanks to Andy Floyd for responding to Judy's query about the process of obtaining specialty recognition. The commission was recently elected and we are about to get underway in calling for applicants to the inaugural cadre of recognized fluency specialists. I suspect that we will have large numbers that will take some time to process. I'll know more following a Division 4 steering committee conference call tomorrow (Friday the 16th). Secondly, to Harsha, I'm not sure what you mean by "application of technology". If you mean devices such as frequency or time altered feedback devices, I did not. These devices, in one form or another, have been around for a good while and, I suppose, were not considered to be new. No comments on such things as hypnosis, also not particularly new. In some, very rare, cases, masking and altered feedback devices may be helpful for some people. However, I'd rather see people modify their fluency without using them as a crutch. In additon, cosmetically, they can look rather strange, eliciting, I suspect, even more negative reaction than the stuttering events. I guess I view these devices as an expensive and generally unnecessary ways to chase the fluency god. Now THAT should elicit some reaction from a few people reading through these high-tech conference notes. dopamine From: "Sheryl Sawaski"
Date: 10/16/98 Time: 3:19:17 PM Remote Name: 188.8.131.52 Comments I am interested in learning more about the study of dopamine levels and the possibilities of using medication to control stuttering. Has there been any more research done in this area, and to what degree has this helped people who stutter? Sheryl Re: dopamine From: Judy Kuster Date: 10/16/98 Time: 4:45:24 PM Remote Name: 184.108.40.206 Comments Sherry, You might also want to read Larry Molt's paper in this conference, A Perspective On Neuropharmacological Agents And Stuttering: Are There Implications For A Cause As Well As A Cure? http://www.mnsu.edu/comdis/isad/papers/molt.html Re: dopamine From: Walt Manning Date: 10/19/98 Time: 10:17:17 AM Remote Name: 220.127.116.11 Comments Sheryl- Yes, there has been some research on dopoamine-related medication. The one that I am most familiar with is the work by Gerald Mcguire, et al and the use of Risperidone. A well-known SLP was involved in the study (Glendon Riley) and if you email me personally I will provide you with his email address and some references. The study showed a decrease in stuttering severity (% SS, Duration, % time stuttered, SSI-3)for the 16 experimental subjects v a control group. Thanks From: Chuck Goldman Date: 10/17/98 Time: 5:20:13 PM Remote Name: 18.104.22.168 Comments Thanks for presenting such a concise summary of where we are in stuttering today. Ideas are often recycled and in the process improved. Oliver Bloodstein often refers to the stuttering schools that were prevalent in the earlier part of the century. It's nice to know that the self-help groups of today are the new improved version. Our learning curve is not steep but it is growing. Re: Thanks From: Walt Manning Date: 10/19/98 Time: 10:22:18 AM Remote Name: 22.214.171.124 Comments Chuck- Yes the curve is shallow but, I agree, still moving upward. Since writing the conference paper I've had other thoughts about "new" stuff, based, in part, on reactions to the paper. Which is one the the reasons I wrote it. There truly are several new things going on and our knowledge continues to increase. I suspect that we will have several significan breakthrough events taking place within the next 10-20 years that help us to understand considerably more about the etiology of stuttering. I also think that the quality of service will continue to improve based on the advocacy of the self-help groups and the work of the ASHA Special Interest Division to develop speciality recognition. Advances in Stuutering From: Valerie Johnston Date: 10/18/98 Time: 11:47:17 AM Remote Name: 126.96.36.199 Comments Dr. Manning, Thank you for your analysis of the advancements that have taken place in the field of stuttering during the past 30 years. I frequently am asked this question, too. And, quite frankly, I have not taken time to think about how to provide an answer that is concise and well-organized. Your article is going to help me do this. Valerie Johnston SID-4 professional issues From: Ed Feuer Date: 10/20/98 Time: 2:11:43 AM Remote Name: 188.8.131.52 Comments On ASHA's SID-4 site, there is reference to a list of "professional issues." These include "sponsorship of discussion of controversial issues" and "multidisciplinary interaction." What discussion of controversial issues have the SID-4 people sponsored and what does SID-4 mean by "multidisciplinary interaction"? Ñ Ed Feuer firstname.lastname@example.org Re: SID-4 professional issues From: Walt Manning Date: 10/20/98 Time: 4:00:21 PM Remote Name: 184.108.40.206 Comments Ed- Sometimes virtually everything we discuss turns out to be controversial. We have had a number of controverisal topics at our annual Division Leadership conferences for the past five years so that's probably the best example of that. I'm talking about how to develop the criteria for speciality recognition, mentoring, & determining treatment outcomes. Your other question having to do with multidisciplinary interaction - a hot button for you I know - has been done by having a variety of people from other professional areas speak at these conferences and be involved in presentations sponsored by ASHA and the Division - neurologists, psychologists, counselors, etc. In addition, many of us in the field of communication disorders read widely in many other fields since human communication ranges across so many areas. I'm not certain what you are asking so I'm not sure if I have answered your question. SID-4 professional issues From: Ed Feuer Date: 10/21/98 Time: 12:18:11 PM Remote Name: 220.127.116.11 Comments Walt, I have to be somewhat skeptical about the "sponsorship of controversial issues" because of the actions of two SID-4 board people who operate stuttering newsgroups. One fellow imposed a gag order on discussion of the coordinated multidisciplinary team approach and his buddy booted me off completely. As for "multidisciplinary interaction," I would hope that the division would give full consideration to the merits of a collaborative team approach in which SLPs and others with relative expertise, as needed, work together in treating stuttering in adults Ñ instead of simply rejecting the concept as a threat to SID-4. Ñ Ed Feuer email@example.com Re: SID-4 professional issues From: Walt Manning Date: 10/22/98 Time: 1:52:34 PM Remote Name: 18.104.22.168 Comments Ed- As I said in a previous post,I think most competent SLPs who work with individuals who stutter take a multifactorial and multidisciplinary approach. But, in fact, this therapy is not rocket science. A good clinician is able to help most regular people who stutter without getting other professionals much involved. In the cases where other professionals are needed, and I've had some,a referral and a team approach (obviously) makes the most sense. I don't believe that the SID steering committee or the individuals you refer to believe that this (or any other) issue is some form of "threat". I also don't believe they are particularly paranoid about such issues. Increased Technology From: Kara Campbell and Michelle Roberts Date: 10/21/98 Time: 6:01:29 PM Remote Name: 22.214.171.124 Comments Dear Walt, First of all, We would like to say that your article was very interesting. As graduate students, we also have the priveledge of reading your book, Clinical Decision Making in the Deagnosis and Treatment of Fluency Disorders, and we have really enjoyed it. It is very informative and will be a useful tool for us and others as we become future SLP's. Regarding increased technology in stuttering, you stated that "the internet increased the availability of information about stuttering that is, at the very least, erroneous and, at the most, unethical." We are curious as to why this availability of information would be considered unethical and were hoping you could clarify that for us? Thank you Re: Increased Technology From: Walt Manning Date: 10/22/98 Time: 2:01:52 PM Remote Name: 126.96.36.199 Comments Kara & Michelle- Thank you for your comments about my text. Sometimes all I notice are the typos and things I'd like to change and update....which I will in an eventual revision. About the internet sources...it's just that there is some real junk in stuttering, as there is in any topic area. The unethical parts (IMHO) are the programs that make outlandish claims of success, offer to conduct therapy by mail or the internet, etc. Where testimonials are provided (about cars, religion, or treatment for stuttering) I quickly become suspicious. I'd love to go into more detail here about my criticism, but risk being sued by certain people... another sign that a program really isn't all it's cracked up to be. Role of parents and families From: Carolyn Hochanadel Date: 10/22/98 Time: 1:17:49 PM Remote Name: 188.8.131.52 Comments The role of the parents regarding cause of stuttering and it's continuation is not a new topic. As a speech-language pathologist and a parent of a child who stutters (he is 4 yrs. old), entering the world of stuttering as a parent was more difficult than as a therapist. What is new in our field is the importance placed on the parent's role to assist the therapy process as an equal and valuable member of the team. To be treated as a person who will help my child rather than looked at as what was I doing wrong in my interactions with him, was a wonderful relief for me and encouraged me to be involved in his sessions with his speech therapy. Peter Ramig's support of parent involvement in therapy has such a possitive approach to it and a new twist to the parent/child relationship. Do you also see this as a "new" change or an old idea revisited? Re: Role of parents and families From: Walt Manning Date: 10/22/98 Time: 2:09:47 PM Remote Name: 184.108.40.206 Comments Carolyn- I certainly agree with you. The emphasis in the past few decades is more on having the parents do what they can to help rather than blaming them (even indirectly) for possibly causing the problem. Guilt and shame is the last thing parents need. I don't know of any enlightened SLPs who take that approach...although, of course, many are still out there. As Peter or Bill Murphy often say "Stuttering is nobody's fault"...a wonderful message. Parent involvement in a positive way along with more direct treatment procedures, even at a very young age, have done much to help. As you know, there are those cases where parents can't or won't become involved. It's still possible to help the young children, but (again, as you know)much more of a challenge.