Thursday, March 20, 2008

Primary and corrective-feedback phase of stuttering

From time to time, I have these flashes of enlightenments which either quickly vaporise or stay and I see clearer. Actually, it becomes so clear that I am wondering whether not everyone knows that anyway because it is so simple, and that I was just too stupid to have realised.
Stuttering goes through two completely different phases, the moment of onset being the phase transition. In the first phase (the primary phase), the subconscious brain, the person that lives with the brain, and its environment knows nothing about the abnormal nature of the brain. It is functioning happily. Still, the abnormality is there and detectable, and caused by either genes or a neurological incident. The phase transition happens at onset of stuttering. The moment of onset per se is nothing special at all, as its causes go back years, back to the genes or the neurological incident. It is like the emergence of a rock when the tide goes out again. The moment of the rock emerging looks special but it is not the rock that is not emerging, but the water that is receding and for the water it is nothing special at all! Still, something dramatically has changed that triggers a feedback loop leading to the corrective-feedback phase. Suddenly, the subconscious brain, the person of the brain, and the environment realise the abnormality, because it leads to atypical and functionally disruptive behaviour: dysfluent speech plus secondary effects. Immediately, corrective behaviour sets in by the brain, by the person who stutters, and by its environment. The future development of the disorder now depends on two things: the severity of the underlying abnormality, and the correcting ability of the brain (brain plasticity), the person who stutters, and its environment. And, the goal is clear, too: to change the atypical behaviour to within normal and functional behaviour. Note that the emphasis is on correcting behaviour, whether the brain is still abnormal is irrelevant as long as it produces normal behaviour. Of all the children who start stuttering, a majority of eighty percent manages this task well, the others like myself go on to become adult stutterers.


MommaWriter said...

Actually, that really was an interesting suggestion. I'd never considered it in quite that way before. You're saying that ultimately, whether someone stutters or not has to do with the plasticity of the brain. Two people with the same neurological or genetic anomaly causing stuttering might have completely speech patterns in the end because they compensate (or attempt to correct) differently. Right? So what if, theoretically speaking, you could do something to improve the plasticity of the brain? Would it help or would it be too late after the brain had already put its compensating mechanisms to work?

Anonymous said...

Ok. I thought about this stuff too and my view is the following. After stuttering appears (I mean speach itself, not brain abnmormality) there was only one overt feature of abnormal behaviour - SOUND of speach. So my brain tried just to make speach SOUND normal: it tried to tense muscules, to close eyes, to start avoidence behavior, to substitute words etc. Some of these tasks really made me SOUND better. But, shit, the other sides of my behavior worsen, in general my behavior became more abnormal then ever. Looks like my brain cared only about sound, not overall speach behavior. Why? Maybe if I have a mirror in front of me every time I speak, my brain would notice this visible abnormalities and tried to fix them too?
(use "my" and "I" here just to escape generalization)

Anonymous said...

I've wondered if a person that already has an above average potential to develop stuttering is more likely to become a stutterer if he is high strung or has a nervous disposition that will cause him to overcompensate when stuttering first appears.

Once it takes root in your head there is no way to dislodge stuttering but learn new speaking skills. I've noticed that as I get older my stuttering progressively gets worst. Lately I'm having troubling "stuttering dreams" that have been waking me up. Usually I'm talking to a coworker, have a severe block and then wake up. Its a great way to start the day.

Anonymous said...

I wonder if a speech therapist or speech therapy can make a PWS stutter more severely?
I know my stuttering has gotten more severe and increased since I started therapy...I guess if I'm honest with myself, I'm so FUBAR by stuttering that I'd really rather not talk...
Fluency Training and Stuttering Modification Therapy sucks...

MommaWriter said...

I think that's a really interesting question...whether therapy can make stuttering worse. I'm coming from a different position, as the mom of a little boy who stutters. He just turned 6. We've had him in therapy since he was about 4.5, I think. His stuttering *definitely* got worse with his first therapist. She initially told us that was to be expected since it put so much focus on his speech, but even she became alarmed after a few months, as it was still getting worse. In fact, she suggested we go see all kinds of specialists and finally decided maybe he needed to be medicated for Tourette's.

Instead of doing that, we switched to Lidcombe, but he was already 5.5 by then. Kinda late for Lidcombe. After 8 months of Lidcombe, his dad and I were really burned out on the program. It's a LOT of work and although his speech changed and improved from when we started, it was still up and down a lot. And his behavior was completely off the wall with us in the room at therapy. Hard to stomach paying the money for your kid to act totally bizarre, like he's got much worse problems than "just" stuttering.

We've recently started trying some other things. He now goes to his Lidcombe specialist by himself and she's working more on the social/psychological stuff that actual speech therapy, I think (hey, I'm no longer in the room!). We've also started taking him to an OT for "sensory issues" (it's all kinda new-agey stuff, to me) and she has him on an listening program that's supposed to help his vestibular system and get his whole body more "organized". For the first couple of weeks, his speech was much, much better, but now he's having a lot of trouble again. Is there any reason? Is it all random? No clue! I'm still not sure if our instinct to get him into therapy ASAP was a good one or if we should have held off and let it go...

Anonymous said...

I can't help but think that the nervous disposition or high strung personality is a result of neurotransmitter dysfunction. Even if the outward behavior is modified, chemically, it is still present.

Is it possible that only one pathway is affected (nigrostriatal)and that a genetic abnormality coupled with viral exposure is the cause of intermittant neurotransmitter (dopamine) dysfunction? This would mean that receptor shape changes occur under specific conditions (pH, know the list) that affect uptake and/or reuptake, right?

How could plasticity be treated without causing problems in other areas of behavior? Maybe my thinking is too limited here, but I can't come up with a possible solution that would be stuttering specific in terms of functional activity in the brain. Can anyone explain a possible theory to me?

Tom, your posts are so thoughtful. You are an inspiration to our son and our whole family. Thank you.

Anonymous said...

I have a question for one of the adult stutterers who has chronic dysfuency and received therapy as a child.

Are you glad that your parents tried to help you or would it have better to have not had treatment?

Do you think it is appropriate for us to include our son in the decision about how to proceed?

Like mommawriter, I am second guessing our decision to continue with therapy. Currently, we are using Lidcombe at home. He practices easy breathing, eye contact, easy speaking and journal writing about feelings at school. Our son rarely has secondaries and is down to 5-6 stuttered syllables a minute, no blocks in the last year and a half or so.

He enjoys going to speech therapy during school and has made friends with another child who has other speech challenges and has attended with him for two years.

He is extremely talkative at home, participates during class a lot and does get teased by a few children. He responds with "I have bumpy speech, but everyone has something different."

Increases in dysfluency coincide with the high levels of eating prior to growth spurts, creative thought, excitement and occasional lack of eye contact.

Thanks so much.

Adrian said...

The idea that therapy can make stuttering worse in children is an important point which I believe has been ignored by SLPs. Has this ever been researched? I would assume not, because the SLPs have nothing to gain and much to lose with this type of a study. I wonder if some adult stutterers would have outgrown their stuttering if no adults had interfered when they were kids. I was in almost contant therapy as a child and I truly believe it made my speech much worse.

I am not opposed to speech therapy in children who stutter, but I do think SLPs tend to ignore any downside of therapy. They seem to have the attitude of "it can't hurt."

To the above poster, I would certainly discuss with your son whether or not he would like to continue therapy. In my non-professional opinion, a child who is communicating well, talking in class, and does not seem overly bothered by their speech does not need to be in therapy. But, if he is enjoying therapy, I think it would be fine to continue.

Anonymous said...

I am a 54 year old adult who stutters...Have my whole life. I had all kinds of therapy from "experts" as a kid growing up and as a young adult. (3 - 24 yrs of age)
The majority of my therapy as a kid was fluency training/fluency shaping and stuttering modification. I also was involved in drug therapy and DAF therapy as well. Both my mom and dad - prior to their deaths - told me they wish they'd have never gotten me into speech therapy as a kid as they definitely felt the therapy worsened my stuttering, inhibited my talking, and whacked my self esteem. I know I felt I got worse and became afraid to stutter and talk...I was kinda choosing silence rather than risk stuttering or talking.

I did have what I would call a "successful therapy" experience working with a speech therapist over a course of time from the age of 17 - 23. Basically, I learned how not to be afraid of stuttering, and not to have a fear of talking. I do know that as a result of the therapy, I talk -- I guess you'd call it "natural speech" -- a whole lot more than I stutter. I am so glad for this change!

Stay involved in your child's therapy outcome. You are their best hope!

Anonymous said...

brainstorming post

Anonymous said...

The failure of stutterers in therapy is never the fault of the therapy...never the fault of the therapist...but always the failure of the stutterer to practice the techniques as required to stop stuttering.