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Stuttering Isn’t a Mystery – Laying One Myth to Rest

isa stuttering conference, 2013, netherlandsOnly 1 week to go before the 10th ISA World Congress for People who Stutter that is going to be held in the Netherlands. It’s going to be the largest International stuttering event of the year! At least that is what I was told. I’m really excited, because it is the first time that I will be at this conference. I’m really looking forward to being there and meeting people whom I don’t yet know and seeing again many of my friends in the stuttering community.

The theme of the conference is “Breaking Taboos Around Stuttering”. The talk I am planning to give is going to help in that regard. I promised to talk about 10 Important Things You Should Know about Stuttering. I wish I had made it at least 15, because there are so many misunderstood aspects of stuttering that I have come to see in a different light over the past quarter of a century working with people who stutter. It’s hard to choose which ones to leave out. I’m sure there will be so many interesting talks and presentations. I will try to share some of the highlights and my thoughts with all of you.

Before the conference even begins, I am going to break one taboo here and now. In the press release put out by conference organizers, they wrote:

“To a large extent stuttering is still a mystery and therefore definitive treatment beneficial for everybody is still not available.  We are looking for both the cause and the cure, but also for ways to deal with stuttering as long as there is no scientific explanation for the problem.”

It might not be very acceptable for me to say so, but I disagree with this statement. I do see that there is a definitive treatment that is beneficial for anyone who stutters. Of course, the absolute benefit does depend on variables within the framework of therapy, such as the experience and ability of the clinician and the active participation of the client. However, the principles when followed of Dynamic Stuttering Therapy are universally beneficial.

I do agree that we don’t yet know the cause of stuttering, but I do think that there is a scientifically valid theory. It states that stuttering is one symptom of a malfunctioning dynamic speech production system that includes elements of speech-language planning and production. System malfunction can cause physical and mental tension that makes speech production an effortful task. The system is driven by thoughts, attitudes and learned responses. I have been defining stuttering this way since 1993. Interestingly, a lot of the research that has followed supports this theory.

In addition we don’t cure stuttering, but we can do more than deal with stuttering. People who stutter can actually change the way their system functions so that the malfunction becomes normal function.

I hope to be able to discuss my dissenting beliefs with many of you at the conference or online.

We Create Our Monsters

opendoorWhen I am working with clients, I am often reminded of a day of play that taught me a lesson in life. It showed me how easy it is to create a state of fear, and how quickly imaginary monsters created in our mind can become our beliefs and attitudes that drive our behaviors and reactions.

When I was 12 years old, my mother went out for a few hours leaving me at home with a friend my age. Looking for excitement, we pretended to be two little girls, home alone when a thief was about to break in. Knowing the only room with a door that locked was the bathroom, we grabbed some chips and Coca Cola and made a run for it. During the hour or so that followed, we talked about how afraid we were and imagined the danger we were about to encounter (fearfully sneaking out to gather more snacks to take back to our bathroom hide out). Suddenly there was a loud noise outside the bathroom door. By this time, we had worked ourselves into such a state of fear that our hearts raced; we were close to real tears and were too afraid to come out to see my mother opening the front door.

For people who stutter the monster can be specific speech sounds or words. Often based on memories of a past experience that might have made them feel embarrassed or frustrated, they are convinced that the danger is real. Consequently, they react by putting themselves in a mode of flight or fight. They either fight to get these sounds out with as much effort as possible, or they take flight, avoiding the sounds by scanning ahead and substituting words that contain different sounds. The end result is that they are inadvertently interfering with the normal way of speaking. They are making it more difficult to speak, the sounds or words become even harder to say and the belief is reinforced.

When imagination takes over, logic is often ignored. The fact that the same people are able to say their “hard sounds” when they are singing, talking to babies, dogs, themselves or in many other situations may not really matter to them. Facts can become an annoyance to the emotional brain that works according to feelings, not logic. However, as clients make progress, they realize that their problem is not the actual speech sounds. Their problem is that they are scanning ahead or “trying to get these speech sounds out”. This realization brings change and allows them to use the automatic process that they have learned. Thoughts change, feelings change. The imaginary monster looses its power to make them react in a way that creates stuttered speech.

10 Important Things You Should Know About Stuttering–Treatment & Therapy

People who stutter and clinicians who treat stuttering are going to be gathering in the Netherlands for a very interesting and worthwhile conference. I’m looking forward to attending. I’m also presenting an eye opening workshop that will talk about aspects of stuttering that aren’t usually known. I hope to see lot’s of my Facebook friends there. Please share this so that all those who don’t know about the conference can register.

Purpose/target audience
To provide information that will give everyone interested in stuttering a logical perspective of the stuttering experience and a direction for more effective treatment

Patients or Materials
Experiences and reports of thousands of clients, including audio and video clips

Results/analysis
People who stutter can become aware of the different ways that their speech production system can function

Conclusions
When the speech production system functions normally the result is effortless speaking and enhanced self-confidence

Between blogs, books, forums, Oscar winning movies, conferences, etc., there is a lot of information out there about stuttering. However, there are important aspects of stuttering that are not widely known. Knowing them can be life changing for people who stutter.

From time immemorial, stuttering has stymied everyone. One theory after another has come into vogue, but attempts to apply these theories to treatment have lead to frustration. Even today, with all that we know about stuttering, there is no comprehensive theory that can explain the observations, personal experiences, and current research findings. In this talk I will discuss 10 aspects of stuttering that help to develop a unified theory of stuttering, and support an effective treatment approach.

I have come to understand these aspects of stuttering during a quarter of a century of trying to figure out the most effective way to treat stuttering. Everything I will discuss comes from empirical studies of thousands of people who stutter, and what I have learned about normal speech production, the way thoughts, feelings, beliefs, perceptions, and neurological networks interact, as well as brain plasticity and the benefit of mindfulness training. The outcome is that clients, even those who have been through years of previous treatment approaches, report that the talking points to be discussed have given them a different way to think about speaking and stuttering. They came to realize that their problem isn’t the stuttered speech. People who stutter covertly or overtly saw how they were incorrectly using their speech production system and how they can change the way it functions. They experienced speaking in an effortless way without monitoring their speech, talking slowly, or using artificial techniques designed to hide stuttering. They found that it is possible to speak naturally with ease and confidence and that speaking can be an enjoyable and satisfying experience.

What’s Wrong With Spontaneous Fluency?

Several years ago I was invited to a fluency shaping practice group. The group leader suggested that I have my clients join the group, so I went to see what it was all about. As we sat in a circle, each person spoke about what he (they were all males, except me) had done about speaking during the week. As one young man spoke, I wondered what he was doing in the group. He spoke with natural fluency and apparent ease. When he finished talking, the group leader and other participants came down on him quite hard. He was doing it all wrong. His fluency was spontaneous. He wasn’t monitoring. One would think he hadn’t learned a thing. Later another person who I would roughly rate as being in the 88th percentile of stuttering with a lot of secondary symptoms was praised for his exceptional monitoring.  This might make sense to some, but I felt that I had entered the world of the mad hatter.

This experience is not out of the ordinary. Many people believe that spontaneous fluency is a negative, while controlled fluency is the gold standard. I think I understand why they feel this way. Controlled fluency gives you something to do. Our ethic is that if you try hard, you will succeed. After all, we’ve all heard it time and again, “Get control of yourself; keep it under control” People really believe that their hope for speaking fluently lies in doing some technique i.e. stretching syllables, taking a full breath, making light articulatory contacts, and pulling out of blocks, etc. They believe that there is power in control. The hope is that by controlling your speech every time you talk, you will be fluent. The problem is that monitoring and using speech controls takes lots of effort, sometimes even more effort than it takes to stutter. It is too bad that most people don’t realize that spontaneous fluency also means doing something. It means letting go, giving up the monitoring. Conceptually, this may seem strange, but when my clients do give up trying to control their speech, they do have the spontaneous fluency that comes from doing what everyone else does to produce speech.

Not to Be Missed – Top Papers from the ISAD Conference 2012

October 22nd, International Stuttering Awareness Day, is fast approaching and the countdown is being celebrated in the form of the ISAD Conference, A VOICE AND SOMETHING TO SAY, that began on October 1st.  I have found the papers extremely interesting, so if you haven’t already joined in, I highly recommend that you do. Judy Kuster, the conference chair, once again deserves deep gratitude for putting together a conference that is very interesting and informative to professionals, people who stutter and anyone who wants to know more about stuttering. Kudos to Judy!

I have to admit that I still haven’t read all the papers yet, but before I do, I want to bring to your attention two that I found to be especially meaningful, because they put us in the direction of greater light and clarity in understanding how to treat stuttering. First, A preliminary survey of vocal tract characteristics during stuttering: implications for therapy by Anelise Junqueira Bohnen
from Brazil points out some of the laryngeal characteristics that can be seen better internally with a flexible fiber optic laryngoscope than externally by the observer. She even links to YouTube videos of the vocal folds. If you have never watched vocal folds in action, you will find these videos very fascinating. I think it would have been nice to watch a side-by-side video of a fluent speaker saying the same sentence, because it would have made the differences in functioning clearer. Nonetheless, her study shows that there are indeed differences in laryngeal function.

Of course, we have to be careful not to infer that laryngeal differences are the only important feature of stuttering. I am hopeful that more research will be done that will investigate the interaction of the laryngeal function with the functioning of the articulators, and the interaction of the articulators and larynx with language planning and the thoughts and feelings of the speaker.

This brings me to the second paper that I want to bring to your attention, What is stuttering: Revisited by Eric Jackson, Robert Quesal, and J. Scott Yaruss
from New York, Illinois, and Pennsylvania. This paper gives me hope that the perspective that I have been purporting since 1993 when I gave my first talk at the Oxford Dysfluency Conference will finally enter the mainstream. In 1993 I said that the definition of stuttering should not be based on a description of the speech produced …i.e. repetitions or prolongations of speech sounds, physical blocks or hesitations in the flow of speech. At the time, I suggested that stuttering is a condition in which the speaker distorts one or more of the processes involved in the planning and production of speech. At the time, one of the leaders in the field Hugo Gregory congratulated me on my presentation, but warned me that my ideas would not be accepted in our lifetime. Hugo who passed away in 2004 was partially right, but I am pleased to be here in 2012  and read that leaders in the field are suggesting the following definition:

“Stuttering is a neurobiological lack of integration of the underlying processes of planning and producing language and speech that, upon verbal execution, can lead to interruptions in the acoustic speech signal (e.g., blocks, part-word repetitions, disfluencies) and physical struggle (e.g., tension). These surface behaviors may not be present, however, when the speaker exhibits communicative avoidance (e.g., circumlocutions, fillers). The underlying features may lead to surface behaviors, as well as emotional and cognitive reactions. Depending on the individual, these may result in significant difficulties in communication and an adverse impact on the speaker’s quality of life. The physical symptoms, emotional and cognitive reactions, and impact on the speaker’s life all comprise the disorder of stuttering.”

This definition may still need to be tweaked and refined, but it is a definite shift from the usual definition that focuses on the speech that has been produced. Some people may still disagree with this shift in perspective, but I believe that now that professors are suggesting it, acceptance will come at a much quicker pace.  This will influence the direction of research in the future. It will also impact the way people will approach the treatment of stuttering. It is very possible that more people will want to explore a therapy model that has already been successful in treating the integration of the underlying processes of planning and production of language and speech. This model is called Dynamic Stuttering Therapy.

 

 

Automating Articulation: From vocal vibration to superb speech

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I have written a lot about how people who stutter think too much about words and how to say them. Most people who stutter or stuttered any time during their life knowthat when they stop trying to anticipate what they are going to say, they have a sense of relief, an increased ease of speaking and increased fluency. However, giving upthinking about words and speech sounds is only part of what makes speech morefluent. Today I want to discuss a different aspect of stuttering. It relates to control, but can be more subconscious than thinking about words. I am talking about articulation,the movement of the tongue, lips, jaw, and other speech organs that transforms the basic voice (vocal fold vibrations) into speech sounds.

In the clinic it is obvious to me that there are 2 basic ways of articulating.One is by using a completely automatic mode and the other is by using a more effortful and controlled motor process. This means that the brain has 2 different ways of functioning to produce speech sounds. The difference can be seen (if youre looking for it) and felt by the speaker (if you do it both ways and compare).

To understand what I mean by 2 different modes, let’s compare the articulators to your eyelids. All day long you blink and don’t even feel it. Your eyelids move down and up on an automatic mode. However, if you blink on purpose, the movement is slower and you feel the blink at least a little more than when it happened automatically. The same thing is true concerning your articulators. When your mouth moves automatically, you are not even aware of it. It moves just as automatically as it does when you smile or frown. It’s a pretty amazing system. As our brain develops language, those articulators go full speed without any conscious or subconscious control. Anyway, that’s the way they’re meant to function when we speak.

So when I talk about giving up control, I mean giving up control in all ways. I know it’s hard for some people to believe that you don’t have to try to make those “hard sounds”. One new client recently commented that he couldn’t understand how his mouth could move on its own, but he was thrilled to realize that he could give up worrying about it and when he did it was so much easier to speak.

I guess this is why there are 2 approaches to therapy. One is to speak slowly to accommodate that slow controlled articulation. The other is the Dynamic Stuttering Therapy approach: speak naturally at any rate by letting the very efficient and automatic articulation mode happen.

fluent speech, stuttering treatment, stuttering therapyHave you ever wondered why you speak much more fluently when you are talking to yourself or to babies and animals? Aside from making you curious, the inconsistency in your ability to speak in different situations has probably caused a lot of frustration. There you are talking to yourself and having no problem. Then someone walks into the room and oops, the words don’t flow anymore. Talking alone or to pets is just one of the many fluency enhancing conditions that needs to be explained in any adequate theory of stuttering.

To try to understand what the difference is between speaking in the fluency enhancing situation and when talking to others, let’s look at the situations more closely.

Scene #1

Rover has just started to chew on your favorite pair of old slippers. “Rover, stop that. I love those slippers. Naughty dog. What am I going to do with you?” flows through your mind and without realizing it, your thoughts become audible speech.

Scene #2

Mother walks in the room, expressing her frustration that Rover is causing more damage. You want to defend him. You try hard to find the right words to tell her what a good dog Rover is. You have to say that “m” sound that is so hard for you to say. “M-M-Mother, HHHes only being (pause) playful.”

What is the difference? Between scene #1 and #2? In the first scene you forgot that you were talking. Actually, you were thinking aloud. The aloud part was secondary. You were not really conscious that you were talking. You were involved in the situation, not the speech. In scene #2, you were “trying” to talk, “trying” to find the right words to convince Mother, “trying” to get that awful “m” sound out. You were conscious of the act of talking.

In my theory that stuttering is a condition in which there is too much control and consciousness about speaking, these scenes make perfect sense. People who stutter are capable of developing flowing language as they think. It is only when they are thinking about the words they are saying and “trying” to consciously to make speech that they have a problem. “Trying” to talk and allowing your thoughts to flow aloud are two different neurological processes. The first is stuttering, regardless of whether it is perceived by the listener, or covert in nature. The other process is the way most people produce speech, most of the time.

Knowing this, it is possible for each person who stutters to explore what is easier, the conscious act of “trying” to talk, or talking with as little consciousness as possible about how to talk. This exploration will lead to a greater understanding of how fluent speech is naturally created.

http://stutteringonlinetherapy.com/2011/11/612/

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

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.

Mapping a Plan for the Future

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.

Understanding the Dahm Theory of Stuttering

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.