Identifying which children will respond to therapy

From: Judy Kuster
Date: 10/6/99
Time: 8:37:39 PM
Remote Name:


Can you share some of the information you have learned about identifying which children will respond to therapy? And
what kind of therapy?

Re: Identifying which children will respond to therapy

From: Peter Howell
Date: 10/11/99
Time: 3:47:28 AM
Remote Name:


We have had two articles published recently in the Journal of Speech Language and Hearing Research (one in 1998 with
James Au-Yeung as senior author and one in 1999 with me as senior author). Both these articles explored the hypothesis
that stuttering starts as whole word repetitions, that usually occur on function words. This also happens in children's
normal nonfluencies and has been explained on the basis that it delays production of a subsequent word. Faced with the
intended utterance "I split", a child might have difficulty on the word "split" and, so, repeat the word "I" producing
something like "I, I, I split". In the second of the articles I mentioned, we have noted that this pattern changes with age
and a speaker who stutters advances producing dysfluencies like "I ssssplit". In our more recent work (not published as
yet), we have been looking at children followed up after they received treatment at the Michael Palin Centre or the City
University clinics we work with. These clinics offer a form of treatment tailored to the client rather than a defined
program. We have divided the follow-up children into those who have improved and those who have not. This division is
based on questionnaires given to the parent and child and a judgement by the researcher. Importantly, these decisions are
not based on speech assessment per se but reflect judgements about a child's socialization with family members, siblings,
peers etc. When the speech of these two groups is examined, interesting differences emerge. On first attendance at clinic,
the children who will be deemed "improved" at a later date show a higher proportion of function word repetitions ("I, I, I
split") whereas the non-improved group show a much lower proportion of this type of dysfluency. At follow-up, speech
dysfluencies drop to around the level of fluent controls. Perseverating in the function word repetition pattern, as occurs in
fluent children, appears to allow fluency to be regained.


From: Judy Kuster
Date: 10/6/99
Time: 8:38:53 PM
Remote Name:


You indicated that you have students from the US doing internships with you. Would they be getting any clinical therapy
hours in those internships? Are there ASHA-certified SLPs who might supervise those internships so they could be
counted as an internship site toward the hours that must be earned for ASHA certification? 

Re: Internships?

From: Peter Howell
Date: 10/11/99
Time: 3:48:16 AM
Remote Name:


Our group works in a psychology department and we rely on the clinics we work with for clinical therapy sessions.
Students doing internships do get clinical therapy hours but not with ASHA-certified SLPs as the UK has its own
professional body over-seeing its activities. It might be worth exploring whether the UK's college of Speech Therapists
could work with ASHA in order to enter into a reciprocal arrangement to give the treatment of stuttering a more
international basis (perhaps with greater research input from groups like ourselves).

fluency-shifted feedback

From: Meghan Culey
Date: 10/13/99
Time: 10:26:40 PM
Remote Name:


Hello, My name is Meghan and I am a graduate student at Minnesota State University, Mankato. I am not familiar with
the term 'fluency-shifted feedback' - you stated it is similar to DAF. Could you please explain this to me? Thank you.

Re: fluency-shifted feedback

From: Peter Howell
Date: 10/19/99
Time: 4:55:44 AM
Remote Name:


You must have meant "Frequency shifted feedback" refered to in the article. 

The initial reference to this can be found in: Howell, P., El-Yaniv, N. & Powell, D.J. (1987). Factors affecting fluency in
stutterers when speaking under altered auditory feedback. In H. Peters and W. Hulstijn (Eds.), Speech Motor Dynamics
in Stuttering, 361-369. Springer Press: New York. Joe Kalinowski and the group at East Carolina have done substantial
empirical investigations into it as well. The difference between FSF and DAF is that FSF has much less obvious effects
on speech rate (see my answer ro Gunars Neiders). Peter

Team approach

From: Ed Feuer
Date: 10/17/99
Time: 2:24:56 AM
Remote Name:


Do you work together with speech therapists in a coordinated team approach to treat stuttering in adults? The expertise that
psychologists could lend such areas as systematic desensitization would prove most valuable in stuttering therapy.
Professional jealousies in North America loom large in preventing speech therapists, psychologists and others working
together in such treatment team for adults. What has been the experience in the UK?  Ed Feuer

Re: Team approach

From: Peter Howell
Date: 10/19/99
Time: 4:51:46 AM
Remote Name:


Like every one in the world, we have to be careful when working with patients about covering ethical issues. Having said
that, the two principal clinics we work with are always happy to get involved in our research into therapies provided we
can satisfy them and ethic committees about the value of such investigations. Professional jealousies have never been a
problem for us. 

I should point out that we do our utmost to endeavour that all involved are kept abreast of what and why we are proposing
doing - from clients, their parents, therapists, researchers, ethics committees, other research groups and so on. This may
be the reason we have not encountered the jealousy problem. Our principal link man is Steve Davis and he'll be at the
ASHA convention in San Francisco and will be happy to advise on management of this aspect of our work so any readers
please use him! When we are in the process of setting up a therapeutic investigation, we try and take on as much
responsibility as we can so as not to burden the therapists but, as I've already said, we do consult them at all stages. We
often have to set up training materials and you can see full details of a current project with outlines for parents, project
description and training materials on the UCL speech group's web site. 

Finally, I'd just like to underline what you say about what contributions psychologists not specifically interested in
stuttering can make: In our department we have worked with School Psychologists concerning socialization issues, family
histories with people interested in the genetics of handedness, with experts of conditioning and our motor control group.
A wonderfully talented and generous mix of people who match in every regard our therapy colleagues. Peter Howell

Bone conduction sound-transmission question

From: Gunars K. Neiders
Date: 10/18/99
Time: 6:38:48 PM
Remote Name:



Did you publish the results of your bone conduction sound-transmission system study. If so could you cite the reference.
This would lay to rest Courtney Stromsta's hypothesis. 

What were some of the differences/similarities in your frequency-shifted feedback and delayed auditory feedback
experiments? Did you study the clients in laboratory setting only or did you also provide portable units that the subject
was able to carry around? If you provided portable units and the subject was flooded for a number of weeks with the
feedback every time he talked was there any change in the effectiveness of the device? 


Re: Bone conduction sound-transmission question

From: Peter Howell
Date: 10/19/99
Time: 4:54:10 AM
Remote Name:


On the first part of your question, yes we did publish our work on bone- conduction. You'll find some of it reported in: 

Howell, P. & Powell, D.J. (1984). Hearing your voice through bone and air: Implications for explanations of stuttering
behaviour from studies of normal speakers. Journal of Fluency Disorders, 9, 247-264. 

What Stevie Sackin and I are finding with frequency shifted feedback (FSF) is that mean speech rate is unaffected by this
alteration but the variability across different speech sections is reduced under FSF (relative to speech produced without an
alteration). DAF slows mean speech rate substantially. We have published work in: 

Howell, P., Au-Yeung, J., & Pilgrim, L. (1999). Utterance Rate and Linguistic Properties as Determinants of Speech
Dysfluency in Children Who Stutter: Journal of the Acoustical Society of America, 105, 481-490. 

that shows that local rate changes are all that are needed to improve fluency (though gross changes would improve fluency
too by rate slowing. 

Moving on to your other questions, we have only studied speakers in laboratory settings but Joe Kalinowski has started
to approximate natural situations using FSF - you might want to email him. He also works with people using portable
units so he is better able to answer those questions. Peter