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 - wmanning@memphis.edu 

Old whine and new battles ;-)

From: Gunars K. Neiders, Ph.D.
Date: 10/14/98
Time: 6:13:43 PM
Remote Name: 134.29.30.79

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: 134.29.30.79

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: 134.29.30.79

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: 134.29.30.79

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: 134.29.30.79

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: 134.29.30.79

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  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  and therein lies the problem with respect
to the treatment of stuttering in adults.  Ed Feuer

Re: New approach

From: Walt Manning
Date: 10/14/98
Time: 6:17:19 PM
Remote Name: 134.29.30.79

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: 134.29.30.79

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: 134.29.30.79

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: 208.166.66.153

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: 192.96.21.51

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: 141.225.97.53

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: 137.28.10.68

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: 134.29.30.79

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: 141.225.97.53

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: 152.163.213.198

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: 141.225.97.53

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: 209.30.57.189

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: 207.161.63.121

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"? 
Ed Feuer edfeuer@escape.mb.ca


Re: SID-4 professional issues

From: Walt Manning
Date: 10/20/98
Time: 4:00:21 PM
Remote Name: 141.225.97.53

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: 207.161.138.11

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  instead of simply rejecting the concept as a threat to SID-4.  Ed Feuer
edfeuer@escape.ca

Re: SID-4 professional issues

From: Walt Manning
Date: 10/22/98
Time: 1:52:34 PM
Remote Name: 141.225.224.85

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: 208.156.162.62

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: 141.225.224.85

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: 208.213.100.109

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: 141.225.224.85

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.