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Getting to the heart of the problem – why stuttered speech happens

September 5, 2011 By Leave a Comment

Now that summer (at least over here in the the northern hemisphere) is over, life is getting back to normal and I want to get back to my efforts to explore the validity of my theory about stuttering. Central to this theory is my belief that there is interaction between speech planning, beliefs, emotions, and the pre-motor and motor programs involved in speech execution. Speaking is meant to happen automatically, but when there is over control of planning words and how to say them, the result might be feelings of anxiety, as well as the wrong signals being sent to the mouth and vocal folds that need to keep vibrating if the speech is going to flow.

Now the question is can this hypothesis be validated through research? Not being a researcher myself, I was very excited to attend a lecture at the NSA Applied Research Symposium by Dr. Jennifer Kleinow of LaSalle University. Kleinow’ et al.’s research related to Smith and Kelly’s Multi-factorial Model of Stuttering, a model that I have referenced many times. The study she presented was designed to see if something in the internal monitoring system of people who stutter is different than in people who speak fluently. What Dr. Kleinow and her colleagues found is that stutterers showed heightened peaks in looking for errors, regardless of whether an error was actually committed. This supports the vicious cycle hypothesis that says stuttering results from over-monitoring the speech plan.

In addition, Kleinow explained that the part of the brain that tells you to stop and start all over might be the anterior cingulate caudate (ACC). This area is a kind of switchboard between the premotor, linguistic, cognitive, limbic system. It is active during speech production, apparently overactive in some people who stutter.

So here we have some support that stuttering is not just a linear problem of blocks, rate of speech, breathing or voice production. It is most likely a problem of system function and is effected, at least in part, by over control of speech planning. There may be other areas of control as well, but this study related to the monitoring of phonological errors before they happen. It is my hope that learning about this connection might encourage those of you who stutter to be aware that planning what you are going to say gets in the way of what you want – the ability to speak without effort.

Filed Under: dynamic stuttering therapy, fluent speech, nature of stuttering

Mapping a Plan for the Future

July 31, 2011 By Leave a Comment

levelt stuttering modelEarlier this month I attended the Applied Research Symposium: Mapping a Plan for the Future, sponsored by the National Stuttering Association. The purpose of this seminar was not only to advance our understanding of stuttering but also to see how we can apply the findings to treatment for people who stutter. I was happy to have the chance to participate in a dialogue with researchers in the field. It was also very important for me to see if their findings fit into the Dahm Theory. The presentations touched on many aspects of stuttering, including the psychological processes of non-linguistic and language processing, and error-monitoring and motor control. I found it very encouraging that these topics touched upon the factors that I discuss in my model.

Our first speaker was Dr. Nan Bernstein Ratner. She set the tone for the need to look at all these areas as she explained, “We tend to ‘swing’ between trying to find a physical ‘locus’ for stuttering (in the larynx, tongue or brain), or origins in the ‘mind’ (whether by learning, repressed needs, or anticipatory struggle) … without making much effort to build theories that can accommodate aspects of both approaches AND fit within well-attested understanding of normal speech production.”

My theory of stuttering is, of course, an exception; as it does take into account all of these aspects. It also provides some preliminary understanding of how they interconnect as well as showing how to apply research to a practical therapy approach that actually gives people who stutter a way to speak with normal and comfortable fluency.  As research progresses and we learn more about the brain, neuroplasticity, the speech motor system, linguistic processing, monitoring processes and more, I’m certain my theory will be more refined and that the basic premise I am proposing today will become mainstream.

All in all, the symposium left me feeling optimistic that the field of speech pathology is reaching the consensus that stuttering is multifactorial in its nature and needs to be treated as such.

Filed Under: dynamic stuttering therapy

Understanding the Dahm Theory of Stuttering

July 6, 2011 By Leave a Comment

If my theory of stuttering is valid, it must be able to explain the variable nature of stuttering. There are some people who stutter in almost all conversations, but this rare, and even these people do not stutter on every word. Most people have times, or situations during which they report that they don’t stutter. Sometimes people can predict when they will stutter, but sometimes it just seems to happen without any warning.

According to my theory both stuttered and fluent speech is the outcome of the way the brain functions when speaking. Brains are dynamic. Therefore, while there is a preferred neural network for carrying out a specific task, different neural networks can kick in at different times according to the circumstance, health, thoughts and feelings of the person, or environmental cues. Let’s take the task of writing. The letters we see on the paper are the outcome of a neural network that we develop as we learn to form letters to express language, and do this repeatedly. After a while our handwriting becomes automatic and individualized. However, over time it changes. It also changes if we are relaxed/excited, happy/sad, distracted/concentrated, and, according to graphologists, as our personality develops. The same is true of speech. Fluent or stuttered speech is the outcome of a neural network that we develop as we learn to verbally express language, and do this repeatedly.

One of the factors that I believe affects the way the brain functions is the degree of conscious control that the speaker exerts over how to move the mouth to form words. More control equals more stuttering and less control results in better fluency. If you are speaking to myself, to an animal or small child, you are probably not at all concerned about speaking. In fact you might even be oblivious of the fact that you are speaking. What you are doing is simply giving expression to your inner thoughts. You are not thinking at all about talking, let alone trying to be fluent. Here is a situation that will not trigger the control mode of speaking, the mode that helps to create stuttering. Different situations can be linked to different modes of speech production. In later blog, I will explain the neurophysiological speech control network and why it creates stuttering.

Of course, there are people who also stutter in the situations that I’ve mentioned. Maybe they stutter less than when speaking before an audience or telling a joke, but they do report that their speech is not completely fluent. According to my theory, the network may have become so hardwired that even when not trying to control fluency, it is the default program. You might say it is basically the way the brain functions.

I invite all of you who stutter to see if there is a connection between your trying to speak fluently, articulately, or just trying to talk and the degree to which you stutter. When you totally forget that you are speaking, as in swearing or making asides, such as “I-I-I b-b-built a mmmm-mmmm-mmmm (aside: ‘This word is not coming out’) mmmmodel airplane,” do you have some spontaneous fluency? After you look into  this, I invite you to share your experiences. You might just find out why “chasing fluency” is so very unhelpful.

Filed Under: controversy, dynamic stuttering therapy, fluent speech, therapy approach Tagged With:

Confusion surrounding stuttering – and your questions

June 12, 2011 By Leave a Comment

Understanding stuttering would be much easier if we knew what we don’t know. We think in a certain way, so we are not aware of the possibility of thinking differently. This seems confusing, but what is very clear is that by thinking the same way we thought before, keeps us in a state of confusion.

Today people who stutter are confused. If you stutter, you have probably asked yourself, “What made me stutter this time?” or “Why can I speak in one situation, but not in another?” Wouldn’t it be great if there were a theory that would explain the why and how of stuttering, and how people who stutter can speak with ease and comfort?

So far there is no widely accepted comprehensive theory of stuttering. Furthermore, there never will be one, if we keep thinking about stuttering from the same perspective. By opening our minds and realizing that there is more to know and many different ways of looking at stuttering, we may be able to put crystal clarity on a condition that has until now been surrounded by a cloud of confusion.

For the past quarter of a century, I have been asking myself what is it about stuttering that I don’t know. Trying to find the answer to that question lead to observations that lead to another question. Through this process, I eventually found myself with the beginnings of a theory of stuttering. In this blog I want to check out this theory, but I will need your help. You see, if my theory can be proven to be true, it has to be able to explain all of what you know now about the characteristics, and nature of stuttering and fluency inducing factors. It also has to explain the speech behaviors, attitudes and feelings of people who stutter and how stuttering begins and develops. If my theory is valid it has to be testable and applicable to all people who stutter. It also has to be able answer all your questions or at least generate questions for research that can answer your questions. This is where you can help. In the weeks to come, I am going to explain my theory and see if it is plausible. So please post your questions below and let’s get a dialogue going. Let’s see if together we can get to know what we don’t know.

To get started, I will give you a basic overview of what I think stuttering is. As I comment on your questions and comments, I will explain it in more detail, but for now, it goes like this:

Stuttering is a condition in which the normally automatic way the brain transforms thoughts into language while producing a voice that is automatically shaped into speech sounds comes under too much control. Instead of all the elements of speaking working simultaneously, the speaker pays attention to words and then tries to get them out.

All the symptoms we see in people who stutter, such as blocks, repetitions facial and body tension, a lack of breath, fear of speaking, discomfort and so much more are the result of the malfunctioning neurological system that involves speech planning and production. Genetics, learned behavior, misconceptions about speaking, attitudes, reactions to outside stimuli and emotions can affect and may be affected by the way the system functions.

I look forward to explaining this theory further and to being stimulated by your questions.

 

Filed Under: fluent speech, general information, history, nature of stuttering, therapy approach

Throwing Away Speech Tools That Don’t Work Anyway

May 26, 2011 By Leave a Comment

stuttering therapy, online stutter therapy, web stutter therapy, fluent speech techniques

I have received several emails from people looking for quick tips on how to eliminate stuttering. I try to answer each and every email with as much helpful advice as I can give, but I know that I have disappointed the writer when I reply that changing speech from stuttered to fluent involves more than taking a deep breath, speaking slowly or trying to relax in one way or another. People have been trying to do these things for many hundreds of years. They don’t work. Occasionally, at best, techniques such as these can act as a catalyst that starts the person on a process of change. The problem is that in the vast majority of cases, these techniques become the focus of attention and as such, they are not helpful. In fact, they may even cause more frustration, added physical tension, and increase the person’s difficulty in speaking.

We know that speaking is meant to be an automatic and subconscious activity. Nevertheless, people tend to look for some way to control their speech. You can’t learn how to do an automatic activity by trying to find ways to control it. You can’t dance flowingly to the music while you are thinking about how to move your feet; you can’t speak with flowing thoughts while you are thinking how to say the words, take breath, or formulate your language.

The concept that speaking will improve by way of speech controls that are sometime called “speech tools” is deeply ingrained in the human psyche. Even as my clients are experiencing the natural and automatic way of speaking, I see that some of them still want to find a trick to control what they did so automatically.

In answer to all of you who are looking for that elusive fluency trick, I’m going to give you a tip. Take the first step toward speaking fluently. Do as the National Stuttering Association suggests in the title of their newsletter, “Letting Go”. Let go….of your speech controls. Stop looking for a magic trick. Accept that stuttering is not a speech problem. Stuttering is symptom of a malfunctioning system for speaking. Then take step 2: on your own or with the help of a knowledgeable clinician, explore what you can do to get it your system to work in the natural automatic way that it’s meant to work.

 

 

Filed Under: dynamic stuttering therapy, therapy approach

One small step for stuttering therapy

May 23, 2011 By Leave a Comment

Last week I experienced a first for me in the realm of technology. I had been invited to give my first 3-hour online seminar to the Speech Clinicians attending the Mississippi Speech-Language-Hearing Association Convention. The seminar “Treating Stuttering With Confidence” was held last week.

During the seminar, I was able to show slides along with movies and recordings. However, the audience and I could not see one another. While I was not able to converse with the audience during my presentation or afterward, I have received feedback from some of the participants telling me that they enjoyed the presentation. I did miss the interaction that I have when training clinicians via video conferencing and hope that the next time video technology will allow for face time contact. However, it was wonderful to be able to reach so many people from a great distance.

I am always happy to share my experience and the knowledge that I have gained over the years in the field of stuttering. I do not intend to stop treating the people who stutter in the near future. However, I would like more people than I can treat myself to have the opportunity to receive Dynamic Stuttering Therapy from clinicians who understand the importance of helping their clients develop the normal processes for speaking.

 

Filed Under: dynamic stuttering therapy, history, therapy approach

‘Your patience and knowledge was just a miracle for our son!’

May 16, 2011 By Leave a Comment

We’ve added some recent testimonials to the site – we hope you’ll enjoy reading the successes patients and participants in Dynamic Stuttering Therapy have achieved. We’re very proud of each of them and what they have accomplished.

Hi Barbara,

Since we the last session, I must say that there has been a definite change in the way Josh speaks.  I can’t tell you the change that has occurred.  It seems like he really has just GOT IT.  He has control of his speech and it has lasted well over a week.  This is the longest that a notable change has been observed. Last night, he had 30 minute telephone conversation with his friend – absoultely beautiful speech.

I suppose I was waiting for the fall before emailing you again for another session.  Maybe we won’t need any more – a very unusual concept in this household as Josh has needed speech therapy since he was 6 and he has just turned 14 years old.

We have really not needed to remind him to use any technique, he self corrects – this approach to his speech works.  At times, I can see Josh working at using the strategies he has learnt from you – it works  …. IT WORKS.  He practices the strategies all the time – using it at all times – he has control – he feels in control.

Last December, I searched for an approach to Josh’s speech that would work for him – he had all the ingredients for success – interest, focus and dedication – but he needed a brilliant therapist and approach.  You are unique – the long search for an approach to fluent speech that worked was worth it.

Barbara, apart from the approach to speech, it was the discussions you had with Josh about the way he feels, linking this with his speech and ability to take a different perspective on board that was also integral to the improvement.

And can I also say that Josh not only enjoyed the skype sessions, but felt respected and liked by you – so thank you for the whole package.

Forever grateful,

Ellen

 

Dear Barbara,

This letter is past due.  I’m sorry it took so long but my husband and I, wanted to personally thank-you for the unbelievable work you put into our son, Avromie.  Before we started treatments with you, we thought it would be just another try, and another large sum of money, going to waste.  At our first visit, we were able to see how your idea and way of treatment just made so much sense!!  Your patience and KNOWLEDGE was just a miracle for our son!!  When our son does practice your techniques, it’s like, (as my husband put it), as if he swallowed some sort of pill!!  Thanks again of everything.

 

Hi Barbara,

Here’s as promised, a review of the therapy:

I have been trough the online stutter therapy,

I had my first sessions for some months ago.

I chose the online therapy because, first of all it was avialable for me - it is available for everyone who has internet.

And the online stutter therapy is very diiferent from other therapies.

What I learned was that my “stutter” (we are thought in the therapy to not use the word stutter) was affected from the major areas: 1) positive thinking and feelings towards my language

2) Fosucing on my vocal chords

3) Speeking in syllables

And also, I learned that my stutter is an old habit, from producing controlled language, in the wrong way.

The goal with the online stutter therapy is a fluent, enjoyable way of speaking.

And after 5 months of therapy I feel that being very much more the case than before, and I recommend this therapy to everyone. Just make sure you have the time for it first. If it is your goal to become fluent, and you have time for it, then I suggest this approach.

Friendly regards,

Oliver

 

Dear Barbara,

I need to tell you how valuable the Dynamic Stuttering Therapy program is to my students. Your approach gives students a “new” way of speaking which they can embrace and share with their families. Being in the public schools it’s often difficult scheduling students but I find my students seek out additional time to work on their speech, because of the program’s “user friendly” units/ goals. Thank you for clearly stating the goals and objectives and providing so many appropriate techniques.  Your program has been extremely helpful to not only the stutterer but to families. Thank you.

Susan Abrahamson CCC/SLP

 

(translated from the original Hebrew testimonial)

Hi Barbara,

First of all, thank you for the online session we had. I really enjoyed talking to you and of course reviewing the natural and normal way of speaking that disappeared from me for some time. The session was very successful and I got a lot out of it. I learned a lot about myself and about the way to speak.

I understand the (treatment) approach at CTI. I know that this approach is the right one and most important the natural method of speaking.

I’m happy to share with you and help you understand the person who stutters. Even though I have always stuttered mildly, I suffered from a lack of confidence in some situations when I had to talk or express my opinions. That was certainly very frustrating and caused me discomfort and not a few times bitter disappointment.

It is absurd to say that the normal way of speaking is the natural and easy way that little children speak, without any control or “filter”. It is just speaking without thinking about how to speak; speaking the way nature meant for us to speak. As a person who stutters mildly, I absolutely know that most people who stutter monitor their speech and plan what they are going to say. This is what disrupts the speech and makes it sound unnatural, causes prolongations, ends in blocks and causes certain words and sounds to get stuck. And it’s terribly, terribly frustrating for some one who has stuttered that unfortunately people who stutter still carry have a negative stigma. The secret is to speak without any monitoring, without filters, without preparing. Simply… talk automatically so that there is a natural coordination between the brain and the whole speech system!

I still think that it is not so easy to get rid of the habit of focusing on words and doing all sorts of preparations to speak, such as changing words, prolonging words. It is really difficult for someone who has used the wrong process for speaking for many years to give up old habits and get used to speaking naturally. Making this change is not easy or simple for everyone, but it is possible and it is the only way to speak naturally without stuttering!! Practicing internal speech (speaking silently in the head) is really worthwhile. (That was what was missing for me all these years!!)

So thank you very much for helping me get back my confidence in speaking. Already, during the past few days since our session, I have felt an improvement. This is the right approach!! A great approach!!! It is the approach that gets to the source of the problem instead of the syndrome and shaping the speech.

If you would like, I would be happy to send you heartfelt recommendations so that everyone will see and will learn the importance of realizing that this is the approach that can save everyone from the problem of stuttering.

 

Hi Mrs. Dahm,

That hope that you have been well. I’m afraid that I have the bad habit that when I don’t respond to an e-mail right away I get busy with other things and manage to forget about it completely… Anyways, here’s my update. I have overall been relatively pleased with the progress that I have made toward consistently speaking correctly. I would say that one particularly positive point has been my attitude toward speaking situations in general.

I have gotten to the point where I really don’t worry about any speaking situations any more. I gave an approximately 10 minute speech at my brother’s wedding, in front of a few hundred people, and I was not nervous about stuttering beforehand. No doubt related to that fact, I spoke correctly pretty much the whole time and therefore was able to speak fluently. There was a long time when I would have probably declined that opportunity to speak for fear of stuttering, and if I had done it I would have worried so much and tried so hard to speak fluently that I would have spoken incorrectly and therefore stuttered a lot.

In general, I have been making progress toward speaking correctly more of the time. I still sometimes slip back into my old way of speaking, trying to use my mouth too much to shape and force out my words. I think that I’m usually pretty good about noticing when I’m doing that and then going back to speaking correctly. I’m still working on making the correct way of speaking more habitual. I hope that you have been well. I’ll keep you posted about how things go in the future.

All the best,

Daniel

Filed Under: clients, therapy approach Tagged With: , , , , ,

Join Barbara Dahm for an interview on Rusty Mike Radio

May 4, 2011 By Leave a Comment

Barbara Dahm will be joining the Afternoon Schmooze, hosted by Nettie Feldman, this Thursday from 2-4 p.m. Israel time (7-9 a.m. Eastern time) to discuss stuttering and therapy methods.

To listen live, visit the Rusty Mike Radio website at rustymikeradio.com and click Listen Live.

A podcast of the broadcast will also be available afterward – we will share the link as soon as it becomes available.

Filed Under: dynamic stuttering therapy, therapy approach

The Key To A Successful Treatment Experience

April 7, 2011 By Leave a Comment

Do you want to speak with ease and confidence? If you do, read on. You are about to find out how every one of my successful clients has accomplished this. If you learn from this, you will better understand what you need to do to create the automatic and natural way of speaking that you desire.

Successful clients understand that once they learn the new process, they have to repeatedly use it with awareness. They know they are not going to become normally fluent speakers overnight. Speaking in a different way is not something that will instantaneously happen, they make it happen.

In addition, they know that thoughts and actions together determine the habits that they develop. Clients succeed because of the thoughts and the actions that they take. During Stuttering Online Therapy clients are encouraged to think beyond their habitual thoughts. Successful clients are able to give up their fears as they realize that the feeling of fear is related to thoughts connected to the past. They replace old thoughts with new thoughts of joy, ease and comfort that are part of their new way of speaking.

These are three of the basic ingredients to a rewarding therapy experience.

1. The first is to have a clear intent. Focus on your intent i.e. have a clear goal of what you want. You will learn that the energy for speaking comes from the signal that your brain sends to the vocal folds as you focus on the general message that you want your listeners to hear. You will learn that your voice, not words, is the essence of talking. Make your intent the discovery of how to make your own natural voice be heard in a way that is new to you. Dynamic Stuttering Therapy is a goal-oriented therapy that shows you how to produce speech naturally. If your intent is to achieve the goals, you will find that they will become a part of you. If you intend to change, you will make the change.

2. The second ingredient to success is to be proactive. Thinking about what you should do, or knowing what thoughts would be nice to think will not help at all. You have to be the one to take action and make things happen. If you are not doing anything, you will produce nothing. The brain makes new connections through repeated experience doing the same thing. That is why repetitive practice is more important once the goals of therapy have been achieved than it is during the learning stage. Repetition of the process and making sure you do something each day to strengthen the process and create new thoughts is absolutely necessary for long-term success. Action produces results.

3. The final ingredient is to never give up. This is common sense, but unfortunately, too often people give up at the first barrier they encounter when working to achieve their goals. There are even people who go to therapy expecting failure. From the very beginning every mistake, every problem is reinforcement to their existing belief. Successful clients do not focus on and reinforce problems. Instead, they take note of every small change, and attend to how different and pleasant it feels every time they experience giving up the control of how to get words out words. They decide that they can change what they think and what they do and they do not quit until they reach their goals. They know that quitting is a waste of all the effort that was previously exerted. Successful clients see errors and setbacks as opportunities to learn that lead to improved knowledge and ability.

Some people look at how fluently successful clients are speaking and ask me what technique was used. The answer I give is that they became aware of what they needed to change, had the clear intent to change their mind and process and took the initiative to do so.

 

 

 

Filed Under: dynamic stuttering therapy, therapy approach, treatment results Tagged With:

“The King’s Speech” – Beyond the Red Carpet

February 28, 2011 By Leave a Comment

colin firth, stuttering, kings speech, oscar award“The King’s Speech” is officially the Oscar winner for this year’s best film, but what I love most about the movie is its effect on people who stutter.

“The King’s Speech” is a catalyst for bringing stuttering out in the open. A few weeks ago, I was sitting in a crowd of people who, with the exception of a few, were strangers to me and to each other. After I mentioned that I specialize in treating people who stutter, the topic of  “The King’s Speech” came up. A man in his seventy’s mentioned that he had just seen the movie. From the one sentence he said, I realized that he stutters, so I asked him for his reaction to the film. In his reply he answered, “Actually I once stuttered….”. Later, a woman who knows him well told me that she had never before heard him discuss stuttering. In fact, she said that this man hardly ever speaks in a social group setting.  Due to the film, on that evening, this person who still has the remnants of stuttered speech did both. I think that story sums up why I vote for “The King’s Speech” as the best media happening of the decade for people who stutter.

There are some negative aspects of “The King’s Speech”. The movie does mention many of the false beliefs people have that relate to stuttering. It does seem to reinforce the fallacy that stuttering is a symptom of emotional issues. Would that the world knew that fear of speaking is a natural reaction to the difficulty in speaking, and not the other way around! Bertie’s feelings were so normal and appropriate. At the same time, Bertie is a great example of a person attempting to deal with these feelings and overcome his fears in order to function well in his life and role as a King and as a person.

Hopefully most viewers will understand that the therapy techniques shown in the movie are not necessarily accepted today. However, while watching the film, I cried inside, because as a science, stuttering has not progressed nearly enough since those pre-WWII days. People who stutter are still being asked to do things that are sometimes ineffective, sometimes a ridiculous waste of time, and sometimes even detrimental. The shaking, dancing, rhyming, putting marbles in the mouth, and smoking for relaxation that we saw Bertie being asked to do are not techniques used today. However, other techniques that are equally far removed from learning to produce natural automatic speech are still being used. To me, this is a sad and painful state of affairs. The time has come for us to use more than intuition when treating people who stutter. Researchers are doing great work in learning more and more about stuttering. Therapy must incorporate these findings.

The New York Times recently published an article about research in stuttering. In the article they quoted Dr. Ann Smith explaining, “Speaking involves brain areas responsible not only for language, but for hearing, planning, emotion, breathing and movement of the jaw, lips, tongue and neck. While some researchers are considering all these aspects of speaking, most therapies do not consider stuttering as symptom of dysfunctional system. So often, instead of working to change how the brain functions, therapy comes down to learning motor controls or trying not to stutter by doing what Bertie did: bouncing or gliding through words, using light contacts, slightly prolonging sounds, emphasizing speech sounds and pausing after saying a word or two.

There is a science of speaking. It is time that this science guides therapy approaches. Bertie’s speech therapist gave him wonderful emotional support. That, of course, is important to the therapeutic process. However, I believe clients want more than emotional support. They also want to change themselves into people who can speak with ease. This is the best catalyst for becoming a self-confident speaker.

 

Filed Under: controversy, Emmotions, general information, history, nature of stuttering Tagged With: , , ,
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