Sunday, September 13, 2015

How does Lidcombe work? No as they thought it would!

Lidcombe is apparently the miracle treatment for young stuttering children. A recent study by Franken et al. showed that another treatment based on Demands & Capacity theory is equally effective than Lidcombe, a behavioural therapy.

Many times I have said that I am not convinced that Lidcombe treatment is more effective than natural recovery, but they do claim that for a short-term control group the treatment group does much better. And I currently argue: yes that is true but only for those that would have recovered any way AND the therapists and kids know that they are being treated AND the kids know what is expected of them.

Of course, if Lidcombe claims to be a miracle treatment, I expect that they tell me what causes the miracle. And here, I say: they will not find anything. Many outcome studies of psychotherapies have shown that anything can work and that the key success factor is the patient-therapist interaction.

I often criticize the Australian but they did the right trial to look into it. An article on An investigation of the role of parental request for self-correction of stuttering in the Lidcombe Program. by Donaghy, Harrison, O'Brian, Menzies, Onslow, Packman, and Jones gives the answer I expected: nothing.
METHOD: Thirty-four parent-child dyads were randomized to two treatment groups. The control group received standard Lidcombe Program and the experimental group received Lidcombe Program without instruction to parents to use the verbal contingency request for self-correction. Treatment responsiveness was measured as time to 50% stuttering severity reduction. 
RESULT: No differences were found between groups on primary outcome measures of the number of weeks and clinic visits to 50% reduction in stuttering severity. 
CONCLUSION: This clinical experiment challenges the assumption that the verbal contingency request for self-correction contributes to treatment efficacy. Results suggest the need for further research to explore this issue.
So what really drives the treatment outcome?

And the same question goes to the Demands & Capacity treatment.

Friday, September 11, 2015

Amino acid supplementation seems to have worked for one reader

I get many emails from readers telling me about significant changes in fluency. One of them is John and he agreed to share his story with us. Read below about his search for an explanation to his sudden fluency. He would be happy to discuss via email: 

Like a lot of people who stutter, as I am told, I frequently experience issues with low mood. On about my 15th effort to find a solution for this, I started supplementing with various amino acids to target various neurotransmitters, specifically the ones known to cause mood issues (e.g. serotonin, beta endorphins, dopamine, etc.). Quite unexpectedly, after using these supplements, I noticed a marked drop in stuttering, on the order of about 90% most days (some days 100%). I found myself being able to have conversations with people where I was talking a solid 20-30 minutes without a single stutter. Even the people around me remark that "it" is just "gone". I have stuttered for over 30 years, and this had never happened, especially for this long (I have sustained these effects for about 15 months now). I have tried on my own, as a hacky citizen-scientist, to try and piece together what I have observed. What I *think* is happening is some sort of synergistic process between boosting both dopamine and beta-endorphin. Ironically, this sort of flies in the face with what I understand about he current pharmaceutical approaches to stuttering treatment, that is, trying to cut down on available dopamine. What is amazing about amino acid supplementation is that, at least for me, there are zero side-effects. My mood is a ton better and my speech is a ton better. Of course, it could just be that, that my speech is better because I feel better, but I do see a definite increase in stuttering when I stop taking the aminos, even before I notice a drop in mood. What I would love to be able to do is be able to study this further. I would love to be able to work to understand what I have found, if I am just an anomaly, or if this sort of therapy holds promise for others as well.

Wednesday, September 09, 2015

What drives treatment success according to Heather Grossman

Ora send me his report of a presentation he attended by Heather Grossman, the director of AIS (American Institute for Stuttering) in New York.

I overall agree with this assessment.

Stuttering linked to rhythm perception deficiency

McAuley and Soo-Eun Chang has conducted a study that got reported as "Stuttering may be more than a speech problem. For the first time, researchers have found that children who stutter have difficulty perceiving a beat in music-like rhythms, which could account for their halting speech patterns."

I am a bit sceptical, but research by Webster has already shown that they are worse in certain dual tasking. We need more research and also on adults. And I would not be surprised of the stuttering and non-stuttering kids still show overlap in ability. But I am not convinced zebra finches will help "McAuley also works ... to investigate rhythm perceptions in zebra finches to probe the neurobiological source of stuttering." They are missing the cognitive level.

New DNA bank

Deryk Beal (University of Alberta’s Institute for Stuttering Treatment and Research) has started a DNA bank with people who stutter, see this article:

"The idea that stuttering runs in families has been around for more than 50 years, says lead researcher Dr. Deryk Beal, the institute’s executive director. Some research has suggested male children of women who stutter tend to be at highest risk for developing the disorder. And males are much more likely to stutter than females. Yet few large-scale studies have examined the underlying genetics of the disorder. Beal explains that the long-term goal of his project is to combine the participants’ genetic data from the DNA bank with neuroimaging to understand how their genes contribute to their brain development. Once they’re able to understand the root causes of stuttering, researchers can start looking for molecular pathways that are involved in brain development, which eventually may lead to better treatment. Currently, stuttering is treated with speech therapy, which involves training an individual to use skills that promote fluid speech, and by addressing the social and emotional effects of living with the disorder. There is no cure." If you are in the region, please considering donating your spit! :-)