Wednesday, December 23, 2009

Happy Xmas!

After a year of fighting crackpots, logical fallacies, pompous claims, a few loopy commentators, my ego and my stuttering, lets have a truce for a few days. I am looking forward to more fighting next year!

My reply to Leys' reply

Here is my reply on Leys' reply on my post of him being sloppy on science:

On the first point, I am thinking of Kate Watkins et al who, on the 10th of October, 2007, published the following in Brain: 'Our data support the conclusion that stuttering is a disorder related primarily to disruption in the cortical and subcortical neural systems supporting the selection, initiation and execution of motor sequences necessary for fluent speech production'. I accept, as do most other people, that many other factors contribute, particularly as time goes by, and these can turn stammering into a kind of syndrome. But none of that detracts from the view that the ROOT CAUSE of stammering is a neurological condition, a kind of faulty wiring in the brain.

As I wrote, I do not disagree about there being an underlying neurobiological issue, but you exclusively talked about the neurological aspect. However, stuttering symptoms are so diverse and fluctuate significantly that a pure neurological explanation is not enough. Moreover, cognitive beliefs and social anxiety make up a great part of the handicap. Watkins or any other neuroscientist have not explained the symptoms of stuttering. My

Prestigious clinical meeting in May

TheStutteringBrain keeps you up-to-date. A few readers made me aware of a symposium happening on May 22-24th in Crotia. According to the author of the email announcing the meeting: we are shaping up to have the most productive and prestigious clinical meeting in the field for some time Anyone wanne guess whose style of writing that is? ;-)

If you are a clinician and not invited, here is the list of connected clinicians and non-clinicians important enough to count as clinicians that were invited:;;;;;;;;;;;;;;;;;;;;;;;;;;; Cook, Frances; Norbert Lieckfeldt;; Ross Menzies; Sue Obrian; Millard, Sharon; Nicholas, Alison Cc: Jasmine Katakos; Suzana Jelčić Jaksic

Michael Mills

Mills' response to his Crackpot Award shows how ignorant he is about the science behind stuttering. He is treating people who stutter, and he should at the very least be up-to-date with the current understanding on stuttering.

stutterers do not block when speaking out loud alone in a room - that is an objective fact - it is true for all the thousands of people who stutter that I have come into contact with - and it is true for all the fluent speakers who, when asked to give a public speech, panic (i.e. alone in a room they can give a great speech - but when giving the same speech in front of people they panic and block) - why is it so? Alone in a room fluent - explain it in other terms apart from social panic - that is your challenge - if you have the courage for it - or are you going to revert to your evasions of attacking the person rather than debating the concept
You are mixing two things here: the observation that stutterers have few blocks when alone, and the interpretation of this observation. Your interpretation (1) is that social panic causes the block, because that is what we sometimes see in other people. And further you say that this developed in childhood due to bad

Monday, December 21, 2009

Per Alm: Battle of The Stuttering Brains

Here is an edited transcript of a Skype debate I had with Per Alm: click on Read More below to read all! That is a good scientific debate for me, much like the debates that I had and am having with friends who are top scientists at top universities, and very unlike what you hear at most stuttering conferences. There you hear buzz words, parroting, self-congratulations, no talk about weaknesses of own models or mistakes, consensus-seeking, and lots of pseudo-scientific bla bla bla.

Tom: There are two issues in stuttering in my view
Tom: 1) to obtain an overall framework within to fit the disorder
Tom: 2) to look at what goes wrong in a specific individual from gene to symptoms.
Tom: your focus is on 2)
Per: And 3 -- what to do about it.
Tom: ok... that's too real-life for me :-)
Per: my main focus is on 1 but in that work I also look at 2, because the empirical data is in 2 (but also on clinical implications)

Thursday, December 17, 2009

Dual-tasks misconception

Chris writes:
I've stuttered for 26 years and I don't believe that the ability to do dual tasks at once is my problem. I can do two tasks at once. Matter of fact, I can usually speak better when my mind is preoccupied prior to speaking.

You may be onto something. I'm not sure the cause of stuttering, but I know it is a combination of physical and mental dimensions.

You misinterpreted the evidence. It seems as if people who stutter as a group perform worse than fluent speakers. It is an inferior average performance. We can of course perform dual tasks, but on average we might be worse. And you could well be better than many fluent speakers. Also it is mainly on motor tasks. And an inferior performance might not be the cause for stuttering at all. Might well be that the brain wiring is suboptimal leading to suboptimal speech and dual-task performances.

I agree with the combination of physical and mental dimensions. But I would add that there are two types of "mental dimensions": cognitive like beliefs and individually learned like associations.

Wednesday, December 16, 2009

Dead stuttering blogsphere

Not much is happening in the stuttering blogosphere. TheStutteringBrain has fewer posts lately, and not that interesting ones. ;-) StutterTalk seems to be talking more to themselves as an answering phone message that repeats over and over again. StutteringHub is gone more or less silent. Greg at Stuttering.Me hasn't posted for weeks.

Physiological vs psychological

A reader asks a sensible question:

Those guys said "... speech blocking is not a physiological problem, but a psychological ...", and you disagree.

The header says "Stuttering is psychological".

Fair enough, but perhaps you can answer a question for me. What is the difference between a physiological disorder and a psychological disorder? I'm not trying to be argumentative just for the sake of it; I'm just interested in your answer.

Physiological is about the functioning of the neurobiology of the brain. And psychological is about everything

Tuesday, December 15, 2009

Leys Geddes: Sloppy on science

Working on science of stuttering sometimes drives me insane. One hour ago, I had to give a crackpot award to a website that has not clue about stuttering and assumes stuttering is purely psychological. And, then when I was done with the psychos, the neuros needed to be corrected.

Leys Geddes, Chair of the British Stammering Association, writes in Speaking Out:
There are two main things that people need to know: firstly, that the root cause of stammering is a neurological condition, a kind of faulty wiring in the brain, which makes it very difficult for us to control our speech and speak fluently.
In itself, the sentence is probably correct to a first order approximation. However, misleading when considering stuttering as a whole. It's too neuro, and psychos understandably disagree. A lot of stuttering behaviour is learned, re-enforced, and kept alive by an underlying neurological issue. I would even argue that a stuttering event is often not due to the neurology at that precise moment but environmental or internal stimuli triggering stuttering behaviour. And controlling stuttering will mostly involved changing the cognitive behavioural aspects rather than the neuro.

And secondly, that Early Intervention is particularly effective for very young children - because that faulty wiring has not yet kind of hardened up. So, if they are seen by a speech therapist, who is qualified in paediatric stammering, there is about a nine out of ten chance that those at risk of a lifetime of stammering will recover.

There is no evidence for any of the statements:

1) particularly effective? There is no hard evidence for full recovery of any child who would have recovered anyway. No-one ever reads the follow-up study of the flawed Lidcombe study: Three of the children (16%) who had completed treatment successfully had relapsed after 2 or more years of speech that was below 1% syllables stuttered. That's about the recovery rate! Again there is no clear evidence for full recovery. But you could argue that those who would not have recovered anyway have lighter stuttering symptoms. Fine but no cures proven as far as I see. No magic happening.

2) It is not even clear that the natural recoverers ever were at risk of developing stuttering. They might well have recovered anyway and just suffered from temporary stuttering due to a temporary developmental mismatch.

3) And this "faulty wiring not having hardened up" is Alice in Wonderland stuff. The stuff that makes us dream. A messed up brain is a messed up brain, and at best can the brain compensate so that it bypasses the messed up area or optimizes in and outputs and behaves fine overtly.

Monday, December 14, 2009

Crackpot Award for the Gimstedts

I am happy to announce yet another Crackpot Award. Douze points pour la Suede. For Lars and Hildigerdur Gimstedt on Psykosyntes. A special mention goes to Lars Gimstedt. He cannot even claim naivety for the stupid claims they make because he has a degree in physics! Shame on you! You didn't do any background research.

Let me de-construct what they write:

Stuttering is a learnt behavior

The speech blocking is caused by a reaction into a conditioned state in certain conditions or situations. This conditioned state is a result of learning, although sub-consciously. The state is characterized by nervousness, "mind reading" (of the presumed attitude of others), muscular tensions and spasms.

Explain me why some start stuttering and others don't. Explain why stuttering has a strong genetic component. Explain why brain imaging consistently finds differences in brain structure and functioning.

Stuttering is a psychological problem

As there in almost all cases are other states, induced by certain types of situations, where the stutterer is able to talk fluently, speech blocking is not a physiological problem, but a psychological...

Wrong. It doesn't mean that if I am not stuttering sometimes that it is not caused by a physiological underlying issue. So are you saying that because a drug addict does not consume every day, that it is purely a psychological issue. Are you saying that semi-deaf people who hear better on some day, that it is purely psychological?

To summarize, they have no clue about stuttering but offer treatment for stuttering. Extracting money from people who might be desperate to cure their stuttering. I especially despise the way how their website puts the emotional screws on people who stutter.

Please email the good news to them:!

Memento Stuttering

Self-reflection causes pain, especially when focusing on not-so-wanted aspects of one's behaviour. Let me look at what I am doing when I stutter. Dave Rowley's pictures during my guest lectures are a good example. I really hate to see those pictures, and would like to dig them away very deep. However, that would mean that the behaviours are controlling me, my digging that is. I am reminded of the Capucin Crypt monks' Memento Mori in Rome: see here, too. They dug out the bones of their dead fellow monks and decorated a whole crypt and cellars with them! Bones on the walls. Bones as an altar. Monks out of bones and skull. Crosses out of bones. Looks really morbid, but great experience. Or go to the Parisian catacombs! Same thing but a bit more somber. Millions of bones and skills. It's like my monster speech. You don't have to run from them, just face them, go through a scary moment expecting certain death and they run away and you look like a fool for having run away for years.

I always close my eyes, and look down. If you have the sound on, you would probably hear. lots of fillers like ehhhh.

Again, I am closing my eyes but not looking down. I have to say that my body language with hands is still pretty good! ;-)

I am most shocked about this picture. I don't really show symptoms as such, but I look very on the edge. Note the red patch on my neck. That's blood ready to burst out at any moment. My God, isn't that a recipe for a stroke at a more advanced age?  This reminds me of a shocking comment of someone close to me: Sometimes you are in near hysteria when stuttering.

To all of those who would not dare doing what I just did and claim to have recovered, are you really? Is stuttering not taking the front seat in your life?

Sunday, December 13, 2009

Crackpot Award for StutteringInnovations

The Stuttering Brain awards the team of StutteringInnovations , especially the founder Michael Mills, for the outrageous and completely unproven claim that:
Stuttering is now defined as a 'panic attack' over speech that starts in early childhood. Stuttering does not respond well to fluency training because the person already knows how to be fluent.
Here are a few questions for our brainy crackpots:
  • Who defined stuttering like this? And based on which arguments?
  • How does genetics fit in here?
  • What about brain imaging work showing differences in young kids and adults?
  • So singing and choral reading does not trigger a panic attack?

Saturday, December 12, 2009

Conspiracy theorist and stuttering

Here is an interesting quote on conspiracy theorists that Ora has sent me. Might this apply for some theories on stuttering, too?
Conspiracy theorists typically argue indirectly. They don't pit the merits of their theory against the merits of competing theories. Instead they try to erode confidence in some "official story" to the point where it seems arbitrarily incredible, whereupon their conspiracy theory is supposed to stand as the "default" conclusion when the official story fails. The conspiracists never put the conspiracy theory "default" to the test to see whether it too make sense.

In other words, they never test their tests. The myths that were tested on the program are the basis for the conspiracy theory "rules" that purport to distinguish genuine photographs from fake ones. But before relying upon them, the conspiracy theorists never put them to the test. Their suppositions about shadow direction are wrong. Their supposition about fill lighting is wrong. In the real world, where there is no "default" conclusion and where both hypotheses are tested equally rigorously, the conspiracists' conclusions simply don't hold. They appear to hold only because the conspiracist authors manipulate the discussion to avoid a meaningful test.

Friday, December 11, 2009

Looming Deadlines Antwerp and ECSF

I have submitted a seminar proposal for the EU SYMPOSIUM FLUENCY DISORDERS 2010 at Lessius College Antwerp on April 23rd and 24th. More information here. The conference has a decent level and mixing science with clinical stuff. The key speakers reflect this good mix. I like to hear what Dennis Drayna has to say. He has been saying the same things for years now. I hope to hear some new stuff. What genes? And what are those genes doing? Come on: society pays you a lot of money! Inviting one of the key speakers was definitely a bad move; presentation-wise (very boring) and politically unwise (disliked or feared by many, he seems to quarrel with everyone).

If you are from overseas, consider Luxembourg on your road trip. Not too far by car!

I want to talk about a framework NDC2 I have been developing to incorporate the multi-causal and multi-dimensional nature of stuttering. I am applying NDC2 to give a possible explanation for natural recovery in child.

If you are interested in a specialization course on fluency disorders. Here are more details. Again Kurt Eggers is coordinating.
Call for application ECSF-specialization course 2010-2011:
Registration for the 2010-2011 course is open and applications are taken chronologically.
More information here.

Wednesday, December 09, 2009

Guest Lectures at de Montfort University

I am back from London from attending the Downing Street reception on the invitation of Sarah Brown, wife of prime minister Gordon Brown, for the British Stammering Association. I also had business meetings, and met up with a friend who is a reader at London School of Economic.

On Wednesday I got the train to Leicester to give two guest lectures related to stuttering: one on evidence based practise, and the other one of the framework I am developing for stuttering. Dave Rowley is a lecturer there and was head of department. Many staff members were there, and only a handful of students, even though he organized the talks for theem! I was stuttering rather severely. More than at the BSA conference when giving the talks in front of more people, and in general. Maybe I am more scared of academics than stutterers? God knows, and if he doesn't even exist as Richard Dawkins suggests, I am in trouble. The return train ride was 60 pounds. Trains are ridiculously expensive in England, a good example that blind privatization can lead to disasters, but I am getting my expenses paid, in some years probably.

Dave gave me a brief sightseeing tour. The most striking of the ancient English city of Leicester is the many non-English faces. There are many Pakistanis living there, and shockingly many with strict head covers.

I showed Dave how my framework gives a possible explanation for natural recovery in children who stutter. I am currently preparing a submission proposal for the Antwerp conference next year (see link in the right border) to present the framework.

Wednesday, December 02, 2009

An interesting evening in London

I just came back from a reception from a place I am not allowed to talk about. Or so I was told as it is a private occassion. Kind of unfair because the host herself has a twitter site! Had a few good chats with old and new friends about stuttering. Being re-assured by an important therapist that quantitative research is important to her, too. Had a good look at the interior of the building. Nice painting of Queeen Liz 16th century. Probably never be there again in my whole life. Went to a room I was not supposed to be in after some mind twisting. But that I can definitely not talk about! Frightening how the imagined center of power is nowhere really. Chatted to Magareth Thatcher's former cook / chef / caterer reliving her past. Luckily she stutters, too. Apparently good old Maggie was funny and flirtatious (but not to her of course). Admired the new portrait but not courageous enough to use a big black pen for a nice mustache. She looks at you from all sides. Kind of saying: "Have you paid your poll tax?" Tried to google her nice ex-chef, who is well-known as I was told but I never heard of her, and I can only find sites to "Gordon Ramsey's business is stuttering!" Witnessed members of the charity fighting like animals just to have their picture taken with a door. Now how sad it that? I'll probably post one of me, too. Just to make sure you know I was there. The smiley girl got the police officer with her on the picture. Heard a good honest speech with quite a few blocks. Yes now you know who it feels to stutter. Will you twitter about it? And a very impressive performance from someone who stuttered as a child or so he said. No wonder he became a minister. Hopefully not to close to power not to survive? Using UK diplomatic slang, stuttering is getting some well-needed traction finally. Sorry stammering that is, and no-one knows why it's called stammering. That's British culture. Distinctively stylish and full of contradictions.

Trial as of Nov2009

Jerry Maguire, chief investigator of the Pagoclone trial, was on As I speculated, most patients from the Phase IIb trial have completed the trial period. In two months' time, all will have completed. So that would take us to the end of the year. I forgot the fact of the data being locked and the blinds only being removed once all results are in. That definitely makes sense. In a double blind trial, neither the patient nor the reseacher know which pills are placebo, i.e. a sugar pill, and which contain the to-be-tested compound. So they do not know more internally than we do. However, from the outcome measurements, they can already take averages across all participants (from high dosis to no dosis placebo). You should be able to look at the time evolution. I would predict that the outcome went positive after the first testing and then slowly declined.

Jerry expects the results in late winter. That sounds reasonable. However, do not expect a serious debate at that moment, because they will mostly likely only release a statement but not a scientific paper or the raw data (unless there is a FDA requirement to do so). Jerry also announced that the Phase IIa has now been accepted for scientific publication. The publication has taken far too long for a serious debate. Who cares about these results now? :-( The Phase IIa are presumably better controlled for loopholes and a bigger sample. The publication process in medicine is really a scandal. They should start doing pre-prints like in physics.

TEVA, an Israeli company, owns the destiny to Pagoclone, and it will be up to them to decide whether to go for an expensive Phase III trial. So what happens if Phase IIb is successful? Jerry talks about there being a Phase III before the FDA accepts Pagoclone as a stuttering medication. However, I guess you can probably get it off-label. Especially because the side effect seems to be very moderate. Peter and Eric asked about clinical significance. At what point is Pagoclone successful? 30% decrease? Or more? That's a good question. 30% is a lot for severe stutterers, but for someone who just stutters occassionally and fears such situations things won't change much!

I was struck by Jerry's subtle change of takt. He was more sober than usual about the prospects of Pagoclone. My feeling is that Pagoclone is not going to be the cure that some are looking for. Might even be a mirrage. Sorry. Jerry keeps on saying that it should be combined with psychotherapy. I agree, but only if Pagoclone is shown to have some efficacy.

What I am most interested in is the placebo effect over the long-term. It is levelling off to zero. That would be good news for the reliability of such trials. If not, does placebo really reduces our stuttering long-term or is it the design and act of measuring that makes it look as if there is an improvement?

Plenty more news and a critical review coming on this blog!