Tuesday, June 23, 2009

American Institute of Sloppiness?

You can read on the American Institute for Stuttering website on early intervention
Some of the most important and innovative work now being done in stuttering is early intervention treatment. It is cost effective, in both financial and emotional terms. It is almost unconscionable for a child to be denied it. Recent research now supports our common sense that tells us to intervene early. We now know that:

The sooner a child receives treatment, the shorter the treatment time will be and the greater the likelihood for lasting gains in fluency.

Early intervention treatment with the critical involvement of parents and caretakers can prevent a lifetime of potential shame and debilitation. The goal is to reverse the course of stuttering and resolve it before it becomes chronic and “hard-wired.”
The statement is typical for the sloppy and confident manner in which early intervention is glorified. Looks very professional and solid at a first glance, doesn't it? But dig a bit deeper, and every single sentence falls apart. It is symptomatic of the field of "evidence"-based intervention. Here is my dissection:

Some of the most important and innovative work now being done in stuttering is early intervention treatment.
Who did what? Too vague. Important and innovative sounds really great doesn't it?

It is cost effective, in both financial and emotional terms.
In which way? Where is the calculation? Surely no treatment is cheaper? Especially because the 80% who recover are treated at financial and emotion costs? Statements are made without any supporting argument.

It is almost unconscionable for a child to be denied it.
Wow. Can you feel the guilt? Pure propaganda. Puts pressures on parents. Anyone not agreeing is guilty of a crime against their child.

Recent research now supports our common sense that tells us to intervene early.
Name the research! In fact, recent research has shown that Lidcombe is NOT as effective as thought, but no-one ever talks about the latest study. You cannot just make statements like this. How can anyone check your claims? Is the common sense not to wait because most would recover anyway?

We now know that: The sooner a child receives treatment, the shorter the treatment time will be and the greater the likelihood for lasting gains in fluency.
Now my brain goes hyper. This statement is a classical example of correlation-causality fallacy. The statement itself is probably correct but the implied message is not. Let me give you a few pointers. First of all, do you mean "sooner to onset" or "sooner as in age".

Re onset, the longer from onset of stuttering, the most likely you keep on stuttering. It is obvious, because the proportion of kids who recover goes down to zero as a function of time from onset. So the longer the onset, the less kids who recover are in the sample, so those in the sample are more and more likely NOT to recover! Can you see where I get at? It is a mirage! Yes, there is a relationship, but there is a trivial explanation!

Re age, girls start speaking earlier than boys by an average of 6 months (my guess). Girls are much more likely to recover without clinical intervention. If I remember correctly, girls and boys are roughly as likely to start stutter (or may half as likely), but many more boys do not recover. So the sex ratio of 1:4.5 only happens after natural recovery and not at onset. So the earlier you pick up the child the more likely it is a girl and the more likely it will recover. Again the effect can be explained without any reference to treatment whatsoever.

Early intervention treatment with the critical involvement of parents and caretakers can prevent a lifetime of potential shame and debilitation.
So here is the first sentence up to debilitation that I moderately agree on if the therapist is good. You can certainly work on attitude of all involved for those that keep on stuttering. But to be honest the "prevent a lifetime of" is too strong. Even though I know a lot about my stuttering: I still feel discomfort, embarrassment, shame and all other things occasionally but it is not running my life any more or holding me back big time.

The goal is to reverse the course of stuttering and resolve it before it becomes chronic and “hard-wired.
They clearly did not read the latest brain imaging by Chang et al as explained in a post. Even recovered kids have this hard-wired in their brain. Their brains are different, but they managed somehow to deal with stuttering.

Please read the passage again:
Some of the most important and innovative work now being done in stuttering is early intervention treatment. It is cost effective, in both financial and emotional terms. It is almost unconscionable for a child to be denied it. Recent research now supports our common sense that tells us to intervene early. We now know that:
The sooner a child receives treatment, the shorter the treatment time will be and the greater the likelihood for lasting gains in fluency.
Early intervention treatment with the critical involvement of parents and caretakers can prevent a lifetime of potential shame and debilitation. The goal is to reverse the course of stuttering and resolve it before it becomes chronic and “hard-wired.”


Can you feel the intellectual hollowness and sloppiness of the text? That's what we all need to fight to improve the level of debate!

14 comments:

Pam said...

Good stuff. The more and more I learn about my own stuttring, the more I want to find out what is legitimately going on in the field.

I always appreciate that you back up your statements, and offer up real evidence.

And you make it easy for the non-science minds to understand.

I too largely feel I amover my shame issues, but it still creeps in from time to time.

Anonymous said...

"Re age, girls start speaking earlier than boys by an average of 6 months (my guess)."

For someone who claims to champion the cause of evidence-based practice, this is not a very strong statement.

Tom Weidig said...

>>> "Re age, girls start speaking earlier than boys by an average of 6 months (my guess)."

>For someone who claims to champion the cause of evidence-based practice, this is not a very strong statement.

Even if I do not present any, weak, or wrong counter evidence, it does not actually validate their statements nor does it validate my statements.

It sounds a bit like politics. I make a case and you look for a weakness in my case and then hammer away at this weakness implying that the whole case needs to be dismissed even though this weakness (wrong argument, evidence, wrong reference) is insignificant with respect to the big picture.

Could I have phrased this better. Yes I could have. Could I have looked this up. Yes I could have.
But I do not have the time to spend hours looking up the precise data, but to me it is a fact that girls start speaking earlier. My guess is only on the number of months difference. It is irrelevant whether it is 3, 6 or 12 months for the effect to exist.

Anonymous said...

"I make a case and you look for a weakness in my case and then hammer away at this weakness implying that the whole case needs to be dismissed even though this weakness (wrong argument, evidence, wrong reference) is insignificant with respect to the big picture."

You do this yourself though Tom. For example, your blog post on 12/10/2008 - "A sample size of 15 is much too small. Either you do at least 100 or you do not do it at all!"
You overly elaborated on the point of a small sample size, to the point where you felt the research shouldn't have been done at all. In your own words, that does not take into account the spirit of the big picture at all with regards to that research.

You talk big on your blog about all the 'poor quality' research being done, but you do not handle criticism about your own poorly-researched appraisals very well.

"But I do not have the time to spend hours looking up the precise data, but to me it is a fact that girls start speaking earlier."

If you do not have the time to back up your statements with evidence, you are at best uninformed, and at worst lying. What seems like a fact to you is actually an opinion, and you are misrepresenting these opinions to your public. You need to verify such statements as fact, because otherwise they are opinions.

Anonymous said...

I agree with the previous "Anonymous". If you don't provide precise data to back up your statements, you are every bit as sloppy as the people you criticise. I do agree with you that stuttering research is very poor, but if you really want to convince people of that, you really need to do a little more homework.

Given that 80% of infant stutterers are expected to spontaneously "recover", and given that treatments like Lidcombe only claim approximately 80% success rates, there is something seriously wrong - at least bordering on fraud. So what is the problem? Is it a problem with diagnosis - i.e. the clinician diagnoses a stutter which isn't there? How are infant stutters diagnosed? Obviously they can't ask the baby whether he/she blocked, and as far as I know there are no tell-tale brain-wave signatures to indicate real stuttering (for example, ADD is characterised by excessive theta-waves). So the clinician just has to listen and make a judgement - which is not easy with baby-talk. In the meantime, the clinicians are making money by playing on the fears of parents, while stuttering research is going nowhere.

Tom Weidig said...

>>I agree with the previous "Anonymous". If you don't provide precise data to back up your statements, you are every bit as sloppy as the people you criticise.

There is a big difference here. I am writing a blog post which is about brain storming. Researchers are PAID by society, and they publish a scientific article. To vastly different enterprises. Were I to write a scientific article on the issue, I must be much more dilligent and research the topic carefully, obviously.


>> You talk big on your blog about all the 'poor quality' research being done, but you do not handle criticism about your own poorly-researched appraisals very well.

I react poorly, because the criticism is not actually on the substance of the argument. If you want to criticise the argument, please find a counterargument or prove that my guess is wrong.

>> If you do not have the time to back up your statements with evidence, you are at best uninformed, and at worst lying. What seems like a fact to you is actually an opinion, and you are misrepresenting these opinions to your public. You need to verify such statements as fact, because otherwise they are opinions.

I wrote that it is my guess, so how can I lie? Again, my blog is not the truth. It is a collection of my thoughts, sometimes well thought out and sometimes instinctive.

Let's get back to the issue. Do girls start to speak earlier than boys. Yes or not? And by how much. MY GUESS is YES and by about 3-6 months. If you find evidence that proves me wrong, great.

Anonymous said...

You wrote:

"I am writing a blog post which is about brain storming"

This is the second time you've mentioned brain storming. And yet, in a previous recent blog, you wrote:
"The time is over where you could just waffle along with random logical thoughts"

I think you're really losing it.

Tom Weidig said...

Again, where is the debate of what I wrote? If you disagree than put forward a counterargument. Your goal seems to be to show that I as a person did something wrong where as you should show that one of my ideas is wrong.

I wrote this statement because nowadays we have a lot of empirical findings that constrain the possible theories about stuttering. So you cannot just come up with logical thoughts and say that's it.

In my brain storming, I consider the experimental findings, but sometimes I guess the findings. Of course, if I were to write it up as an article, I would check it. But not in a post, time wasted because I rarely get it wrong. And if I do, I learned something.

I and everyone else I know in science work in this way, but what you exactly see from them is only the final product, the journal article.

Anonymous said...

There is nothing wrong with brainstorming, but please do not deny others that same right simply because they may be presenting ideas that do not agree with your worldview. Show some respect. And you are not a scientist anymore. You are a glorified accountant.

Anonymous said...

"In my brain storming, I consider the experimental findings, but sometimes I guess the findings. Of course, if I were to write it up as an article, I would check it. But not in a post, time wasted because I rarely get it wrong. And if I do, I learned something."

How do you know you rarely get it wrong if you don't check your guesses? How do you learn if you don't check your guesses?

Also, since you don't seem to like verifying your statements, I took the liberty of doing this for you. Girls do tend to speak earlier than boys (though this is a tendency, not an absolute) and this tends to be by about 1 month earlier. As a man of statistics - would you say a month difference is statistically significant?

(Anonymous the first)

Anonymous said...

I think Anonymous has a point....why don't you reply and maybe admit it Tom....he found the fact for you. It is 1 month, not 6 month.

John Books said...

I really enjoyed your posting on the American Institute of Stuttering (AMIS).

I totally agree with the idea that the statements made by the AIFS are really for the most part not based on anything scientific.

I understand that the Director of AIFS once worked for Ronald Webster of Hollins College and first served as a clinician providing Dr. Websters Precision Fluency Shaping Program (PFSP) and then was the Director for Dr. Webster PFSP clinic in Manhattan before separating from Dr. Webster and starting her own clinic.

Does anyone know about the history of Ms. Montgomery's work experience with Dr. Webster and the PFSP ? What kind of experiences have people had with PFSP, Dr. Webster and the scientific claims made by Dr. Webster for PFSP and his most recent Hollins Fluency System Program?

Anonymous said...

This "Institute" does not offer a real stuttering program. AIS was founded by someone who originally worked for (Professor/Dr.) Ronald Webster of the Hollins Communications Institute in Virginia,a real Institute associated with a University, AIS occupies a few rooms on one floor in downtown Manhattan. The Founder of AIS delivered the Hollins Precision Fluency Shaping Program (PFSP) for Ronald Webster in NYC for approx. 8 years until Dr. Webster finally determined she wasn't delivering it correctly and he fired her. I went to the NYC PFSP in the 80's and knew her. And went back there several times for refreshers. What I found out the hard way is that she never understood Dr. Webster's stuttering program, she never delivered it correctly and she probably was never really interested to deliver it correctly. She was too influenced by her experiences at the Option Institute in Mass. that she heavily attended. The Option Insitute is has a cult like environment led by a charasmatic leader who provides advice on how to be happy and successful using such techniques as "don't judge yourself or others" which you are supposed to do constantly all day long (how practical is that?). With respect to her and Dr. Webster, she was fired as I said and she then started the Total Immersion Fluency Program (a rather bold title don't you think?) using the same information and technique provided by the PFSP without their important feedback computer to judge your voice and used the same material in new manuals with her name on it. SHE ADVERTISED HER NEW PROGRAM "AS THE RESULT OF TRAVELING ALL OVER THE WORLD"!! I took this program and she told me before I came that it was all new material!! She had dropped one PFSP speech target and I trusted her and then I walked around stuttering out of control until I put it back in and then my speech improved. She then continued to change the PFSP program until it was called the AIS. The AIS Founder seems to think that she has the "option" to change the speech program she delivers for approx. $4,000 whenever she wants to and experiment with people who are hoping to have control over their speech. The AIS program is yet one more program that the Founder came up with that does not work. But AIS has a board of famous people who stutter whose speech problem was mild in the first place (obviously) who you would think is active in the AIS stuttering program providing tips and such but they are not, they are just on the Board for show. The AIS program is a buffet of all and any techniques for stuttering determined over the past 100 years including a small part of the Hollins program (hey, what the heck!). AIS is actually guilty of false advertising indirectly since one of course assumes that either the people on the Board took one of her programs or that they use techniques that are in the AIS program or that YOU will be able to eventually talk like them. This is not true. One major part of the AIS program is heavy use of Option techniques to reduce the nervousness associated with stuttering. Their effectiveness is questionable. The AIS program is actually a glorification of the Founders personal experiences at the Option Institute where now SHE is the guru of HER Institute. People believe she is wonderful because they believe she has the right idea that stuttering cannot be cured or really controlled (it is neurological and genetically based) and that she is wonderful enough to know that and tell them that which is not true. People love her because she doesn't make them do the unfortunate tuff work which one has to do to control stuttering (which the people on the Board may have done) and gives them recognition for their stuttering problem and "emotional" support for the problem. AIS is a mini Option Institute who had an uncanny knack for charming people of all backgrounds and professions to do things for her like be on her board. The main stuttering technique is RANDOM FLUENCY MANAGEMENT. Go to Hollins and work hard

Anonymous said...

I once took a program with the Fouder of AIS when the program was called Total Immersion Fluency Training (TIFT). I had done the Precision Fluency Training Program with her and came back to see her to do the PFSP again, not knowing that she had changed it and called it TIFT. There were no feedback computers that was used in TIFT, everyone sat on the floor talking to each other and she advertised her TIFT program as the result of "traveling all over the word". If I had to do it all over again I would have not gone because 1. THe title of the program has the words Total Immersion which is ridiculous and 2. because she implied she came up with a program as the result of traveling all over the world!! THe Founder of AIS was just as sloppy when she ran TIFT as she did when she founded and ran AIS, no change at all And she had an "associate" who was a "body man" as she called him who cured himself of cancer in "every part of his body".It was a case of sloppiness and fantasy.