What is stuttering? - defining stuttering from the speaker's viewpoint

[ Contents | Search | Post | Reply | Next | Previous | Up ]

Re: From the listener's viewpoint -Comprehensive Reply

From: Mark Irwin
Date: 12 Oct 2008
Time: 01:20:34 -0500
Remote Name:


Hi Ed, From previous conferences I know you to be a forceful advocate for improved standards. My additional thoughts are these: As consumers we are right to challenge the effectiveness of the speech pathology profession in meeting the therapeutic needs of PWS. (Tammy Davidson Thompson in a presentation at the Oxford Dysfluency Conference this year entitled “In Search of Best Practice – Is current speech and language therapy meeting the psychosocial needs of adults who stutter”, showed that in a survey of approx 200 English SLTs (known as SLPs in USA and Australia) 84% use CBT techniques while only 49% had some exposure to CBT training!). You are right too in questioning the comprehensiveness and effectiveness of public awareness messages given about stuttering, but maybe this is because consumers like us have been ineffective in giving our messages to SLPs. Consumer advocacy plays an important role in directing the attention of professionals and the public. In my view SLPs, like the majority of people, are well meaning and considerate. They want to do a good job and promote their activities and skills widely. This online forum is one example of such promotion. The IFA Congress and the Oxford Dysfluency Conference are others. To a large extent they recognize that stuttering therapy is difficult. Unfortunately while most SLPs recognize their training to be inadequate, there are a few who think the reason for difficulty with therapy is that stuttering therapy IS difficult (not that the therapy they are providing is inadequate!). Instead they think this is the best treatment possible, it is better than giving treatment away to psychologists, no one else could do it better. This thinking is natural and therefore understandable. But in my view there are two other reasons for the problem in service delivery: 1) limited terminology (consider a profession trying to deal with coughing with no terms for differential diagnosis!) and 2) failure to recognize impact of social anxiety disorder (due to limited terminology and limitations in training.). SLPs are trained to manage the overt symptoms of the stuttering syndrome. Unfortunately our limited terminology means these overt symptoms are also known as stuttering. So under current terminology it could be said that SLPs are trained to manage stuttering. However it is clear from the history of this online conference that there are many pws who feel their lives have improved (less stuttering syndrome) even though their overt stuttering remains essentially the same (Pamela Mertz’s paper and responses are an example in this conference). And clearly it is this improvement in quality of life that is seen as more significant than the continued dysfluency. Also it is obvious from this conference that many SLPs seek to offer advice on dealing with the stuttering syndrome (eg acceptance of overt stuttering). Even the titles of some conferences give this message : Don’t Let the Stuttering Stop You, and this year’s Don’t Be Afraid of Stuttering. The problem is that this encourages many SLPs to think that, in offering similar advice, they are best dealing with their clients needs. (I know dental phobics need far more than advice to accept their anxiety and do relaxation exercises!) I support as you do, ASHA Div 4’s call for a multidiciplinarian approach. However it is paramount that diagnosis be made so that the need for a multidiciplinarian approach can be best determined. Self-report questionnaires that enable diagnosis of severity of Social Anxiety Disorder are available. Why aren’t they used? Because until recently SAD has been less well understood than stuttering. The challenges for revolutionaries are to provide reasons for change and power structures to affect it. I recognize your contribution to the reasons issue (your quote of Woody Starkweather last year made sense: “knowing nothing about stuttering they (inadequately trained SLPs) may presume they have enough expertise to treat it”). The ISA and NSA etc as consumer organizations are providing the power structures. The challenges for institutions include remaining open minded and providing forums for sharing of ideas. To a large extent the SLP profession has provided such forums. This conference is one. I hope, as I’m sure you do, they will be open minded to ways of improving quality of care and associated public awareness messages. Finally I see a link to Social Anxiety Disorder as a way forward. It is expected pws will have SAD because the measures for SAD involve analysis of speaking situations. (Walt Manning in another reply gave the nice analogy of someone who can’t swim being taken out to sea and then asked if they are nervous). However it needs to be pointed out that stuttering is also listed as a symptom of SAD leading to a horse/cart situation. This must be considered, firstly because SAD gives information to the therapist as to how the client thinks, feels and acts in relation to their stuttering; and secondly, because the existence of SAD provides established evidence based protocols for therapy viz medication, CBT, desensitization, counseling. I hope you, other consumer advocates and brave SLPs will join me on the Stuttered Speech Syndrome (stuttering and SAD) bandwagon. It needs a lot more revolutionaries (disciples of change!) like you to bang the drum. In my view it is only when this SSS Bandwagon has momentum that the questions of SLP training, enforcement of standards, and Public Awareness messages can best be considered. Are you on board and if not what do you need to get you there? Best wishes, Mark

Last changed: 10/12/08