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

October 14, 2012 by Leave a Comment

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.

 

 

Filed Under: dynamic stuttering therapy, general information

Sharing Stories – Changing Perceptions – 14th Annual International Stuttering Awareness Day

October 2, 2011 by Leave a Comment

The Fourteenth International Stuttering Awareness Day (ISAD), Online Conference, hosted by Judith Kuster, professor emeritus, Minnesota State University, Mankato, Minnesota has begun. This year’s conference, Sharing Stories – Changing Perceptions is freely available live until October 22nd. The conference is linked to the Stuttering Home Page website. Papers will remain available online after the conference concludes.

The Online Conference includes papers by people who stutter, their families, educators, students, researchers, and clinicians. It is a great chance to ask questions and discuss your thoughts and ideas about stuttering. For SLP’s it is also an opportunity to achieve CEU’s. This conference is a wonderful learning opportunity for everyone who is interested in stuttering.

Filed Under: general information

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

“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: , , ,

New Year Wishes

December 24, 2010 by Leave a Comment

During this special time of year, I want to wish all of you who are celebrating Christmas a very Happy Holiday. I hope Christmas will be a meaningful day for you and that you will have the opportunity to celebrate with family and friends.

While you are celebrating, I want to wish you the opportunity to speak freely and to resist the all too natural tendency that people who stutter have to avoid speaking. We all know that effort to avoid stuttering increases the frequency and severity of stuttering. For this reason it is far better to speak without concern of whether or not you will be able to say this word or that one.

Giving up trying to avoid stuttering is not easy.  However, a good 1st step toward doing this is to start talking more openly about the subject of stuttering. This helps, because once the subject is out in the open, the fear of having your stuttered speech heard is somewhat reduced.

This Christmas holiday as you are sitting around the table or visiting with friends and relatives, it will be easier than ever to bring up the subject of stuttering. All you have to do is mention having seen, or not having seen yet the new movie, “The King’s Speech”.  For anyone who has not yet heard about or seen this movie, it focuses on the effect of stuttering on the life of King George VI of England and his speech therapy.  What a wonderful icebreaker for the subject of stuttering!

As the New Year approaches, this is also be a good time for new beginnings, for looking at stuttering in a new way, for making 2011 the year that you make the changes that make it easier for you to speak. During the coming year I am planning to continue sharing my thoughts about stuttering, my knowledge about how to treat stuttering effectively and some of the experiences of my clients as they actually make these changes.

I wish you all a very Happy New Year!

Filed Under: fluent speech, general information, therapy approach Tagged With: , , ,

“People Who Stutter: Inspire!” – a conference in honor of International Stuttering Awareness Day

October 4, 2010 by 2 Comments

I would like to bring to the attention of all the readers of my blog that October is a special month for all of us who are interested in stuttering. Several years ago, October 22nd was designated as International Stuttering Awareness Day. Since 1998 Judith Kuster, Emeritus Professor, at Minnesota State University, Mankato has been hosting an online conference to commemorate the date. This year the 13th conference, “People Who Stutter: INSPIRE!” began on Oct. 1 and will continue until Oct. 22. It can be found on the top of the Stuttering Home Page (http://www.stutteringhomepage.com).

This conference is a wonderful vehicle for discussing the issues that interest, inspire, confuse, frustrate and enlighten people who stutter, their families and friends and professionals. The online conference features several papers written by well-known professionals and people who stutter from around the world. Participants can interact with the authors and other participants on threaded discussions attached to each paper.

This year I have written a paper about online treatment for stuttering. It will be an opportunity for people who stutter and clinicians to learn more about this treatment option that is becoming more and more popular. In a survey of my clients’ opinions about the pros and cons of doing therapy online, “convenience” received the majority of votes for the pros and “technological glitches” for the cons. Surprisingly there was another pro mentioned by many clients. They told me that doing the therapy in their home, instead of a protective clinic that is isolated from their real life, made it easier for them to continue practicing on their own. The feedback, in general, was so positive that I think that as technology improves, online treatment will become the treatment of choice for adolescents and adults who stutter.

I invite you to participate in this conference, to read the many interesting papers and to express your thoughts and ask your questions. This conference is a wonderful way to communicate. See you there!

Filed Under: general information, therapy approach Tagged With:

A new concept of stuttering

June 9, 2010 by Leave a Comment

For the past 60-70 years treatments for stuttering have been based on the concept that stuttering is an uncontrollable thing that happens to people. This “thing” is often described as repetitions, prolongations and blocks that stop the forward flow of speech. Not knowing why and how this happens, the focus has been on the stuttered speech and the consensus for treatment is to accept, control, tame or get rid of it by trying to identify and change the external conditions that are assumed to disrupt speech.

Some conditions that tend to disrupt speech:

  • Rate or rhythm of speech
  • Fear of stuttering, speaking, or words
  • Shame
  • Pressure to speak
  • Anxiety
  • Physical and mental tension
  • Lack of control
  • Faulty breathing

Over the years this concept of stuttering has become deeply ingrained in the psyche of most people who do and do not stutter. Today it is the basis for most treatments, coping strategies, and advice for people who stutter. In fact it has become so ingrained that ideas that do not fit into this concept are often rejected or not considered serious enough to be investigated.

Over the past 20 years, while treating people who stutter, a different concept became apparent to me. I realized that there was more to stuttering than meets the eye or ear. The “how” stuttering is created started to emerge. I’d like to share this concept with you.

Within each speaker there is a speech production system and, as in all systems, the way it functions determines the outcome. I came to see stuttering as a breakdown in the way the speech system functions. The result of this breakdown is the variety of symptoms that people who stutter may exhibit.

Symptoms of a breakdown in the speech production system:

  • Repetitions, prolongations and blocks in speech
  • Facial tension
  • Eye blinks
  • Loss of eye contact
  • Body tension
  • Emotional tension
  • Low self-esteem
  • Uncontrollable movements of body and speech muscles
  • Poor vocal quality
  • Unclear speech
  • Unusual pausing
  • And many others

Fortunately, many people have helped me understand stuttering. First and foremost, I have learned so much from listening to and closely observing my clients, and other people who stutter, stuttered and never stuttered. I have also learned a lot from studies on the brain functions of people who stutter, neuroplasticity, and from researchers such as Levelt (1989) who describes how normally fluent speech is developed, as well as Smith & Kelly (1996); Watson, et. al. (1997) who through their research have also come to look at stuttering from the perspective of system function.

It is difficult to change ingrained concepts, because it is human nature to stick with the way we see things. I believe this is the reason that therapy for stuttering has not changed much in 60 years. The focus of therapy then and now is on stuttering as speech, rather than on the process of producing speech. Over and over again we hear that there are two basic treatment approaches – stuttering modification and fluency shaping. You either learn to live with stuttering or learn how to control or modify stuttering/fluency/speech.

There is an alternative stuttering therapy that doesn’t try to solve the problem by treating the symptoms. It focuses on how all of the processes of speech production interact, as well as on all the factors that influence the way the brain functions. I call this a speech processing approach. In this approach the focus is on changing brain functions so that speaking is virtually effortless and automatic. The treatment guides people who stutter to use their system according to Levelt’s model of a normal speech production. Stuttering disappears when the processes function naturally.

The process of normal speaking:

  • Attending to the nonverbal idea that the person is expressing
  • The brain automatically transforming ideas into language
  • The brain simultaneously sending a signal to the speech motor system so that a natural voice that contains intonation is produced
  • The mouth simultaneously moving subconsciously and automatically

In normal speech production there is no conscious word awareness, no control over motor activity, and no such thing as trying to “get words out”.  People who stutter may produce speech in this way some of the time, but it is not their exclusive way of speaking. If it were their speech would not be stuttered.

Changing how the brain creates speech is the goal of the treatment program Dynamic Stuttering Therapy. The treatment process involves exploration and self-discovery, identifying what changes need to be made and learning how to make them.  It involves making a commitment to effect neurological, cognitive, and behavioral change, and reinforcing these changes until they become habitual.

The specific goals of therapy that relate to neurological functions are not techniques for controlling speech. They are simply processes normally used by speakers to produce speech.

Specific goals of Dynamic Stuttering Therapy:

  1. Learning to develop internal (sub vocal speech) naturally without any attempt to get it out
  2. Allowing the speech muscles to work on an automatic mode
  3. Generating your voice naturally in a way that allows for the expression of mood and meaning

Many people who have learned to use techniques for controlling their stuttering balk at the idea of not using these controls. They say, “Sure I would like to produce speech more automatically, but I need a way to get out of blocks and to control my stutter”. It is hard to grasp that the point of learning to produce speech naturally is that when you do it, stuttering doesn’t happen. Most people are so locked into their way of thinking that they cannot fathom speaking without effort and thought. They do not realize that there can be a scenario where there is no need for speech controls. Training yourself to function in a new way requires awareness and repetitive use of the brain function. It is moving away from thought about how to say words and control speech, toward the automatic expression of thought.

Speaking naturally is different; it is possible; it is not physically hard to do and requires no special skills, but changing long held concepts and being open to a new approach is a great human challenge.

Sources:

  • Levelt, W.J.M. (1989). Speaking: From intention to articulation. Cambridge, MA: The MIT Press.
  • Smith, A. and Kelly, E. 1996). Stuttering: A dynamic multifactorial model. In Curlee, R. and Siegel, G. (Ed.)Nature and treatment of stuttering: new directions, (2nd ed.) (p.204-217) Needham Heigts, MA: Allyn & Bacon.
  • Watson, B.C. & Freeman, F.J., (1997) Neurophysiologic behavioral evidence for a fluency-generating system.  In W. Hulstijn, Pascal H.H.M. van Lieshout, & H.F.M. Peters, (Eds.), Speech production: motor control, brain research and fluency disorders. (pp. 341-349) Amsterdam, Netherlands: Elsevier.
Filed Under: controversy, dynamic stuttering therapy, fluent speech, general information, nature of stuttering, therapy approach Tagged With: , , , , , , , ,

Upcoming events for the summer

May 24, 2010 by Leave a Comment

For those of you in the greater New York/New Jersey area, Barbara Dahm will be available for therapy sessions and initial consultations this summer at The Ridgewood Speech and Language Center in Midland Park, and Tender Touch Therapy in Lakewood, New Jersey. Clients beginning face-to-face therapy will also have the option of continuing treatment via the web.

In addition, Barbara will be available to work with clinicians looking to expand their expertise in stuttering treatment.

For an appointment, please contact us at barbdahm@gmail.com or by phone, please call us at 201-378-0089.

Barbara will also be giving a workshop at the National Stuttering Association Convention in Cleveland between July 7-11, 2010.  She will be talking about the disparity between research and treatment for stuttering and explaining how this can be overcome. It looks like it will be a great convention. It’s an opportunity for people who stutter and their families to meet and discuss all aspects of stuttering and to have lots of fun with a great group of people.

Filed Under: clients, dynamic stuttering therapy, events, general information Tagged With: , , , , , ,

Leading to Recovery From Stuttering

March 31, 2010 by 1 Comment

My experience in treating a few thousand people who stutter has shown me that while it may not always be easy, it is possible for most people who stutter to develop the ability to produce normally fluent speech. We do not yet understand why some people do use different neurophysiologic processes for producing speech, but we see so many examples of people who have apparently changed these processes. These are the people who once stuttered and no longer feel the same difficulty when speaking.

There are a few examples of famous people who for the most part have become fluent speakers. Carly Simon, who once struggled with stuttering, set her speech to a rhythm. In an interview she gave with Tavis Smiley, she showed an example of how she made herself speak with what she describes as syncopation. To me it looked like her speech progressed in syllables, as she was no longer trying to get words out. In the same interview, Smiley, who also once stuttered, says he began speaking fluently by imitating the cadence of Dr. Martin Luther King’s speech. This is an example of achieving a normal pattern of intonation.

Vice President Joe Biden tells of his efforts to overcome stuttering by practicing reading aloud in front of a mirror and trying to eliminate the contortions of his face.

My clients changed their neurophysiologic processes by learning to develop speech internally without any effort to get it out and by letting their voice reflect normal patterns of intonation while giving up all control over forming words or speech sounds.

Whether the change was made by self-help or within a treatment program, we can learn a few things from people who as older children and adults do change how they speak I am listing a few of them here:

  1. They investigate how people who do not stutter speak.
  2. They learn from watching and listening to themselves when they speak.
  3. They become aware of the act of speaking, instead of trying not to stutter.
  4. They are persistent in looking for solutions, instead of focusing on problems.
  5. Whether or not it is their conscious goal, they change the intonation pattern of their speech.
  6. They take responsibility for the recovery process.
  7. They are willing to do repetitive practice on a daily basis.
  8. They believe they are capable of making changes.
  9. They focus more on what they do rather than blaming external situations for their stuttering.
  10. They realize making change requires patience and time.

If you want to help yourself to speak with greater fluency, the first step is to develop as many of these qualities and behaviors as you can. It will make the process of change easier and so much more rewarding.

Filed Under: clients, dynamic stuttering therapy, fluent speech, general information, therapy approach, treatment results Tagged With: , , , , , ,

The Fluctuations In Stuttering

January 13, 2010 by Leave a Comment

An almost universal aspect of stuttering is that people who stutter don’t always stutter. There is a small number of people who do stutter more or less the same way and to the same degree whenever they talk. However, they are by far in the minority. Most of the people who I have met who stutter (in the thousands!) tell me that they stutter more when… The ending might refer to people, places, words or letters, eating and sleeping, or even the weather, but most often to “tension, pressure and anxiety.”

In an effort to speak fluently, people who stutter, their family and friends are busy trying to find out what outside factors make them stutter. Their hope is to eliminate, change, or learn how to deal with these factors. The emphasis is on external factors. This search is ineffectual because the external factor is not the problem.

The role of external factors is that they may lead the speaker to use a more, or less, controlled process for speaking. It is the individual’s reaction to outside factors and the way their brain functions when these factors are present that actually causes the fluctuations of stuttered speech. Therefore, it is the individual’s reactions, not the catalyst leading to the reactions, that need to change.

Brain functions are not carved in stone. They fluctuate for the better and worse as a result of experience, learning, practice, self-talk and imagination. When an activity has been done in a certain way over and over again, it becomes automatic and consequently more efficient and less subject to influence by outside circumstances.

Taking control over normally automatic processes will always have a negative effect. We see this when we give too much thought to our body movements when we walk or dance. Controlled action makes us clumsier and less flowing in our movement. The same thing happens with our speech.

Stuttering comes and goes according to the degree that controlled processes function to produce speech. By learning how to produce speech automatically, and by accepting the need to speak without control, people who stutter can develop a stable system that generates fluent speech.

Filed Under: clients, dynamic stuttering therapy, general information, nature of stuttering, speech control, therapy approach Tagged With: , , , , , , , , ,
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