Crackpot Award for Sigmund Freud

I am awarding a Crackpot Award to Sigmund Freud for his outrageous pseudo-science. His theories about stuttering are not only completely unsupported by any evidence, no he has also consistently misrepresented his case studies. And so have many followers of his. They are a good example of what happens when an ambitious, cocaine-taking, intelligent but pseudo-scientific mind starts day-dreaming without constraint from reality-checking experiments. His criminal negligence regarding the accuracy of his theories has done more than anyone else to confuse the weak minds of the 20th century. His influence still lingers heavily today in stuttering theories about the influence of the subconsciousness and traumatic experiences in childhood.

He has done more harm to people who stutter than any one else, certainly more than any previous crackpots. If anyone thinks of Freud as a great mind who has led to great breakthroughs, think again. Here is what wikipedia says:

Although Freud's theories were influential, they came under widespread criticism during his lifetime and afterward. A paper by Lydiard H. Horton, read in 1915 at a joint meeting of the American Psychological Association and the New York Academy of Sciences, called Freud's dream theory "dangerously inaccurate" and noted that "rank confabulations...appear to hold water, psychoanalytically" [21]. Peter D. Kramer, a psychiatrist and faculty member of Brown Medical School, said "I'm afraid [Freud] doesn't hold up very well at all. It almost feels like a personal betrayal to say that. But every particular is wrong: the universality of the Oedipus complex, penis envy, infantile sexuality." A 2006 article in Newsweek magazine called him "history's most debunked doctor."[22]

Freud's theories are often criticized for not being real science.[23] This objection was raised by Karl Popper, who claimed that all proper scientific theories must be potentially falsifiable. Popper argued that no experiment or observation could ever falsify Freud's theories of psychology (e.g. someone who denies having an Oedipal complex is interpreted as repressing it), and thus they could not be considered scientific.[24] Author Richard Webster characterized Freud's work as a "complex pseudo-science"[25].

H. J. Eysenck claims that Freud 'set psychiatry back one hundred years', consistently mis-diagnosed his patients, fraudulently misrepresented case histories and that "what is true in Freud is not new and what is new in Freud is not true".[26]

Mikkel Borch-Jacobsen claims that "The truth is that Freud knew from the very start that Fleischl, Anna O. and his 18 patients were not cured, and yet he did not hesitate to build grand theories on these non-existent foundations...he disguised fragments of his self-analysis as ‘objective’ cases, that he concealed his sources, that he conveniently antedated some of his analyses, that he sometimes attributed to his patients ‘free associations’ that he himself made up, that he inflated his therapeutic successes, that he slandered his opponents."[2]

Freud: unbelievable nonsense

I am shocked by what I read here:

At the beginning of the twentieth century, adult psychiatrists became interested in stutterers after Sigmund Freud wrote that the etiology of stuttering was "for the most part" psychological. Later, he stated that "stammering could be caused by displacement upward of conflicts over excremental functions"' Freud felt the adult stutterer's speech mechanism was enmeshed in a conflict between the wish to defecate symbolically on his parents and authority figures by using hostile words and a concurrent fear of retaliation that caused the stutterer to hold the fecal-oriented words inside.

The early psychiatric theories about stuttering (1900-1945) generally supported Freud's anal displacement theory, and led to the recommendation that stutterers undergo psychotherapy or psychoanalysis. However, child psychiatry and child psychoanalysis did not take shape as a medical specialty until the 1940s.

Modifications to Freud's theory were seen after 1945, as in the work of the psychiatrists Kolansky and Glauber and this author, who discussed the parents' role in the etiology of stuttering. In 1960, Kolansky wrote about his treatment and cure of a 3-year-old girl who began stuttering when her mother gave birth to twins and her grandmother concurrently vigorously bowel-trained her.' In 1965, he became one of the first child psychiatrists to emphasize that the treatment of a child's stuttering should include the parents' active participation .7 His treatment of the 3-year-old involved having the mother and child together in his office playroom. This author described the treatment of two stuttering early grade school girls and the concurrent' therapy with the girls' mothers.

I cannot believe why so many people glorified and still glorify Freud, when in fact the vast majority of his theories are just complete and utter non-sense. Especially his methods to "prove" his theories. Just imagine how much misery he and his blind followers have brought to the millions of sufferers from various disorders with their completely ridiculous theories and associated treatment approaches. And think about all those down-to-earth and honest doctors that told their patients that they just don't know what is going on, and were of course completely ignored. Who wants to go to a doctor or therapist who does not know what stuttering is about?

Inspirational Article

Here is an inspiration article on how to handle your stuttering, even if you are not fluent.

(Thanks to Rehan Nasir for the link)

Some changes to my blog

I made some changes to the blog layout. I added a Donate button to support my blog work to cover my costs. Of course, please do not feel obliged to contribute! It is just for the wealthy and charitable ones! :-) I also added Sponsored links where I have added conferences that have given me a reduced conference fee in return to linking to their website. I also accept purely commercial links, but I need to decide whether I feel comfortable with their product and the marketing of it. The same is true for books. So if there is anyone who wants to have their book advertised, please let me know. I also changed the order of the archive so that the oldest are first, but what I really want to have is a list of 20 randomly selected posts from the last 3 years. I also changed my name to T--tom. I guess that my outing is. :-) If it gets on my or your nerves, I'll change it back.

I would like your feedback on the changes. Do you think that the changes are appropriate or destroy the integrity sphere of the blog? Or should I make some small changes to the changes? Just let me know.

Money, money, money

I am NOT stuttering on the title. It is just a recurring thought! I am spending much time and money on stuttering, but have exactly zero revenue: money-wise that it. I also have hidden costs of loss of opportunity, because I am spending my intellectual energy at age 35 (where you are apparently most productive?) on an area where I do not have a career. I am neither a speech therapist/pathologist nor a scientist working on stuttering. Instead I could be spending my time on more "productive" work and earn more money as a consultant. Of course, I get a lot emotional revenue (also from your posted comments and emails), because I am driven to understand what stuttering is about, and what helps most. And 1000 weekly readers is a great but unhelpful stimulation of my ego... ;-)
My goal is to make my efforts a zero-cost affair, but I am not quite sure how I can extract money from you, my readers, to cover costs. :-) Surely, no-one will pay to read me. My only chance might be to ask the few wealthy or charitable for donations but I am not sure how I should do this. My best bet is probably advertising. But, I have chosen not to advertise on my blog via goggle AdSense because most adverts are really fake promises of cures and I kind of find it difficult to rail against them and at the same time to get revenue from them! I might change my mind, and do it but only for a few selected one. I can certainly make the case that I have over 1000 unique readers per week and I am high on google search. So there is good exposure for the advert. This strategy is already working well for getting free books and reduced conference fees.

Going to Oxford Dysfluency Conference

After some long thoughts, I have decided to go to the Oxford Dysfluency Conference. There are several people coming that I want to talk to, for example: Per Alm (he works on neuroscience and theory), Jerry Maguire (I think, he led the Pagaclone Phase II trial), Kate Watkins ( I would guess as she is from Oxford, experimental brain imaging work) and other good people. By the way, Michael Palin is coming to the conference. So I feel like I cannot afford not to be there. I didn't enter any talk proposal, but I sure will ask questions to the poor presenters! And maybe I get invited to a panel discussion...
I am also stingy about the costs involved: 500 pounds. I am not saying it is not a good deal for the services offered, and I am sure Dave has done his best to keep the price down. But still combined with the travel, it is as expensive as a one-week holiday if not more. Though I have to mention that for the last ODC conferences, the British Stammering Association paid the full or half of the conference fees, for which I am very grateful. They usually have a few grants for the conference, and might have it this year, too. And I have also started trading with the organisers of recent conferences for a reduced fee in return for full coverage on "the by far most read stuttering blog on the Internet". As you can see I have started to use you as a bargaining tool! :-)

Chess: a sport for stutterers!

You probably don't know that I played a lot of chess when I was a teenager. I even managed to participate in the World Junior Chess Championships in Chile in 1990, in Romania in 1991, and in the Netherlands in 1992 for my country However, let me tell you straightaway that I am no Kasparov or Fisher and I always finished up in the bottom of the tournament. Being from Luxembourg, your chances of being one of the best is a bit larger than in the US or Germany, for we only have half a million inhabitants! :-) So I am a strong club player on the local level with an international rating of 2040, but the weakest on an international level. I only started to play in a club at the age of 16, far too late. All grandmasters and international masters start at 12 or earlier. The reason I didn't post for a few days is that I qualified for and played at the national championship, after a pause of more than 10 years of real competitive chess. I did OK against semi-professional chess players with relatively little preparation.
In a sense chess is an ideal sport for someone who stutters. You don't have talk, you just need to move your pieces around. It is a very good practise for mental control, strategic thinking, concentration, patience, willingness to accept risks, handling difficult situation and so on. Chess also allows you to build up self-confidence, and very importantly prevents you from blaming your defeats on your stuttering. My only issue is when I want to propose a draw ("a remis"). It even happened to me once, that I just couldn't say it and so I just told myself: f**k it, I am going to win this game and continued playing. :-)

H--appy Easter!

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.

Idiotic introduction to stuttering article

If you are ever looking for an idiotic introduction to an article about stuttering, how about the introduction to this otherwise good article Verbal Bottleneck in Scientific American Mind from October/November 2006:

Greg K. was only three when the problem began. During a family vacation he saw two crashed cars burning. Soon after that, his parents recall, the boy began stuttering. Even today, at the age of 40, Greg is more likely to order lasagna in a restaurant and forgo his favorite pizza, capricciosa, because he cannot manage words that begin with explosive sounds like the letter "k."

Again and again, stuttering is linked to an accident story. And again and again, I am saying that MILLIONS of kids had traumatic experiences like a accident and only 1% is stuttering today, the same percentage as the general population! And MILLIONS did not have traumatic experiences and still stutter!

To the author's defense, I vaguely remember her saying that the editors sexed up the story without telling her, and this migrated from the German version to the US version. This might include the accident part.

The collapse of Bear Stearns

You might have heard about the sudden and spectacular collapse of Bear Stearns, one of the largest investment banks in Wall Street. But, what you probably did not know is that I have worked for Bear in 2001! Namely in Risk Management, of all departments! :-) Risk management is a relatively small but important department of an investment bank that very carefully studies the risks taken by all trading desks and incorporates them into a firm-wide risk analysis. It is staffed only by quantitative PhDs and very experienced ex-traders, and uses a lot statistical and financial modeling tools.
After a post-doc in Manchester and a visiting researcher grant at Trinity College, I started working at Bear Stearns in London at the central tower of Canary Wharf with a fantastic view of London. I was responsible for monitoring the equity derivatives desk in Tokyo. I worked on/next to the busy trading floor, and every week we had a video-conference to discuss the risk exposure for Bear. I have to say that I didn't get off to a good start: I had serious back problems (a prolapsed disk) and couldn't sit for longer than 20 minutes, house mates from hell, my stuttering was quite bad due to my back and high pace, and didn't get on well with my supervisor.
Bear is quite different to the other investment banks. They are more of a creative chaos led by talented traders rather than a well-structured bank with a systematic risk management approach supported by strong IT. We completely lacked IT integration of firm-wide data into a risk management system. There was always a concern for the credit derivatives that are very difficult to price, and this concern grew over the years as what I heard from former colleagues. My guess is that the reason for the collapse lies within senior management and their failure to limit exposure to difficult-to-priced securities, and the (political) weakness of risk management to make this case.
It is quite dramatic for the people who work there, as many received bonuses via company shares that are locked for 3-5 years and it was considered bad taste to sell them even after the lock-up period finished. By consequence, the Bear employees own 33% of their company and lost most of it. The top people were millionaires or billionaired, and their fortune dropped by 90%! However, I have no pity for them. It is insane to hold stocks at the same company that you are working. It's the most obvious mistake of diversification. Still, there is a perfectly reasonable argument for why they did this. Bear Stearns is the most aggressive investment bank on Earth dominated by trader mentality. Their ethos was: Show us loyalty to the firm by keeping your stock, and we are proud of you. They want to bind you, and make you part of themselves. They might have lost, but I wouldn't be surprised if they say to you: "So what? We played though and lost. I am proud of what I have done. Life goes on. I took the risk. Others run." For that, they deserve respect: they have all taken common responsibility for their actions or lack thereof, unlike CEOs who get outrageous bonuses without taking any risks and even get golden parachutes for messing up companies.

My first speech at Toastmasters

Tonight, I have done my first speech at Toastmasters. Toastmasters is an association for people who want to become effective communicators and leaders. It is an excellent way to become a better speaker and overcome those butterflies. I heard about Toastmasters before, from people in the stuttering community and from Einar, a friend of mine who stutters, too. The group meets twice a month in an hour and a half long session. The first part consists of interpromptu speeches called the table topics, the second is a set of 4-5 speeches, and the third is an evaluation of the speeches.

Coming back to my speech, it was rather surreal. I had already attended two sessions and I introduced myself and mentioned my stuttering. The old story: I stutter, I have to work on it, Toastmasters might be a good way to practise, need to have patience with me and so. And then, I gave my speech and my evaluator said afterwards: Not sure Tom mentioned stuttering, because he didn't stutter! So I had to interrupt and say that I do stutter! My mentor who heard me stutter a lot from when I talked to her, was amazed that I was able to talk fluently. My trick was of course to: 1) write down the speech, 2) practise it 10 times 3) put on an acting mode. I was fluent... And they all seem to love it. The comments were: good sense of humour, good body language, CLEAR AND STRONG VOICE (give me a break ;-), interesting,...

Anyway, Toastmasters is a fantastic environment to work on your speech and to become more relaxed. I wholeheartedly recommend it to everyone!

Crackpot Award for EFT people

My next crackpot award goes to the EFT people. Check out this webpage. Unlike the standard crackpots, she is not claiming to understand what causes stuttering rather she seem to say that EFT (Emotional Freedom Technique) helps stutterers deal with the emotional side.

Nevertheless she deserves an Award, because her report of improvement is obviously completely naive (and shockingly unprofessional for someone who studied speech pathology) as stuttering can easily be reduced using ANY method (my favourite one is walking on all four) and she neglected the placebo. I am CONVINCED the improvement is placebo.

(Thanks to a reader for pointing this out to me.)

The bloguette of Mr BSA

The stuttering blogoshere has just undergone a phase transition: Norbert Liekfeldt, CEO of the British Stammering Association, has a blog where he talks about his activities: see here. (I have also put a link in my blog links.) The blog will be a good way for BSA members to see what's going on within the BSA on a day-to-day basis. But of course there will also be the delicate business that will not find its way onto the blog. Or can you imagine Norbert writing: "Today, I again had an annoying call from one of our BSA members. We need to do something about him." or "Today, we finally got rid of XY whom we recruited last year. He was a complete disaster and only cost us money. I need to find a way to exclude trustees from selecting staff in the future. And I still have to write a note for the website, and I am thinking of writing something like >XY has left the BSA to pursue his career at another charity. We thank X for his valuable contribution to the BSA.<" (No allusion intended to any real BSA event from the past year!)

In an email to TheStutteringBrain, Norbert Liekfeldt writes: "Just a bloguette.... Say something nice!" So here it is. Norbert is really Mr BSA, the glue of the BSA. He has been leading the day-to-day business for many years. Trustees (like myself) have come and gone, members have come and gone, financial crises have come and gone, staff members have come and gone, but Norbert is still there, a bit like the Cheops pyramid. So he certainly deserves credit for inducing stability to the BSA. Without Norbert, the BSA might not exist anymore. If there is one failure that I see, then it is the precarious financial situation of the BSA which has persisted for many years. The BSA is never far from the brick despite relatively conservative spending. Norbert but also the trustees (former and current) and especially the last and current BSA chairs have completely failed to recruit and keep wealthy and influential donors. If you could be one, call the BSA!

It's before the task, stupid!

Weber-Fox's team has looked at school-age children's brains while performing a visual rhyming task. They used ERP (event-related potential or evoked potential) which is a range of methods that record electrical activities in form of potentials in the brain due to a stimulus: see picture above. They want to understand why kids who stutter have lower accuracy on rhyming judgment (not sure exactly what they did; I guess the kids were given two words on a screen and had to judge quickly whether the words rhyme or not). They did not find any differences in electrical activity for the task, but they found atypical activities before the task itself. This observation makes sense to me. Many of the non-speech related deficiencies like in dual tasks or rhyming judgment are probably due to a sub-optimal coordination between the different brain regions, which is probably due to the brain having to compensate for some failing region(s). Think of a transport system of a big city. Imagine a bridge must close and be re-built. The impact on the transport system can be dramatic and impact not only the local area. For example, the heavy lorries now have to use another bridge which is less equipped to handle heavy traffic and therefore fast deteriorates, too. Or there are suddenly traffic jams in unexpected parts of the city, and for example disrupt the functioning of a big factory or hospital.

Atypical neural functions underlying phonological processing and silent rehearsal in children who stutter.

Weber-Fox C, Spruill JE 3rd, Spencer R, Smith A.

Speech, Language, & Hearing Sciences, Purdue University, USA. weberfox@purdue.edu

Phonological processing was examined in school-age children who stutter (CWS) by assessing their performance and recording event-related brain potentials (ERPs) in a visual rhyming task. CWS had lower accuracy on rhyming judgments, but the cognitive processes that mediate the comparisons of the phonological representations of words, as indexed by the rhyming effect (RE) ERP, were similar for the stuttering and normally fluent groups. Thus the lower behavioral accuracy of rhyming judgments by the CWS could not be attributed to that particular stage of processing. Instead, the neural functions for processes preceding the RE, indexed by the N400 and CNV elicited by the primes and the N400 elicited by the targets, suggest atypical processing that may have resulted in less efficient, less accurate rhyming judgment for the CWS. Based on the present results, it seems likely that the neural processes related to phonological rehearsal and target word anticipation, as indexed by the CNV, are distinctive for CWS at this age. Further, it is likely that the relative contributions of the left and right hemispheres differ in CWS in the stage of processing when linguistic integration occurs, as indexed by the N400. Taken together, these results suggest that CWS may be less able to form and retain a stable neural representation of the prime onset and rime as they anticipate the target presentation, which may lead to lower rhyming judgment accuracy.

How to tackle complexity

Stuttering is a very complex disorder, and I want to talk about strategies to control this complexity in order to understand the underlying dynamics. They are mostly inspired from methods or tricks that I learned from fellow physicists.

- Always remember that every phenomenon no matter how complex is ultimately an interaction of atoms! There are no ghosts or paranormal forces or magic at work. There are better explanations for why something happens, but sometimes it is damn difficult to achieve understanding. In some cases, it might be (nearly) impossible, like in fluid dynamics, climate models, social interactions, but nowadays computer simulations are very helpful in reproducing complex phenomena whose internal dynamics we do not understand theoretically.

- Do not talk to people who advocate a "holistic approach" or "to view every person as an individual" consciously or unconsciously acknowledging defeat to complexity. They are like the ancient tribes assigning a God for every phenomena they do not understand, or the 18/19th century scientists inventing concepts like elan vital as the fluid that makes matter come to life, like the calorific fluid that transfers heat, or the ether to give classical physics alive. They are only stating the obvious that we already know, namely that stuttering is a very complex disorder. Very rarely, do they have to say anything deep. We must strive for better explanations and not give up.

- Construct theories up to a first order approximation first. For example, we conveniently talk about males and females, but there are some people who are different physically or genetically. Or, let's take planetary orbits. At a first order approximation, they are circles, at second order they are ellipses, at third order they are ellipses with some correction due to the other planets, and at fourth order, these corrected ellipses have corrections from general relativistic effects.

- Cut out sources of complexity that are not fundamental to the disorder. Here, I would put psychological and social consequences of stuttering in this group. I am purposefully ignoring them, not because I think that they are not important in other areas like therapy but because they add considerable complexity without adding much insight into the underlying causes. A clearer example is hair loss. There is a wide range of complex reactions in males and females and their environment, but they tell us nothing about hair loss itself.

- Throw out any atypical cases. In stuttering, we need to "get rid" off people who started stuttering after age 7, who have undetectable dysfluencies, who have other disorders, and even who are females in the case of brain scans. This relates to the first order approximation in that we need to first try to understand the typical cases. Clearly, this atypical group might well be a source of inspiration and explain the typical behaviour better.

- Look at every possible dimension you can think of independently. Here are a few: brain imaging, self-reports, genetics, therapy, phenomenology, linguistics, child development, and so on. But, it is clear that a full picture only arises once you look at all dimensions at the same time and look for the interactions between the dimensions. Nevertheless, you should first understand each dimension independently.

- Concentrate on more quantitative dimensions where you can get clearer and more OBJECTIVE results. Genetics is the king here, because the DNA is well-defined. For example, we know due to twin studies that genes have a big influence, but how it happens we have no clue. Still, we can identify genes and bypass the enormous complexity.

Stuttering hijacked for bird lobbying

Check out this webpage on bird conservation. The authors want to convince us that bird conservation is essential for stuttering research! I think this argument is a bit far-fetched, but I would certainly support the conservation of birds:

Bird studies are constantly helping us advance scientifically.

Researchers at the Methodist Neurological Institute (NI) in Houston and Weill Cornell Medical College in New York City used functional MRI to determine that songbirds have a pronounced right-brain response to the sound of songs, establishing a foundational study for future research on songbird models of speech disorders such as stuttering. - Science Daily

The argument might actually go against the aim of the authors, because such stuttering research would involved animal experiments. In research, scientists need to be very careful as not to endanger the human experimental subjects, but such a restriction is not needed for animals especially non-primates. So having an animal model is certainly useful, but I am not convinced that such an animal model exists for stuttering. Stuttering starts around the age of 3, when grammar develops and I just find it hard to see an animal having similar abilities.

Crackpot award for Jerry Halvorson

I received emails from Jerry from http://jerryhalvorson.com/, and as you can see below he is propagating statements about stuttering that is not supported by hard evidence and has no intention to change his mind. As I have done in the past, I am rigorously exposing such people. (I am not saying he is a bad person intentionally, but he clearly has a responsibility of checking facts before "educating" people who stutter.) I give him my crackpot award: see here.

Hi Tom,
Noticed your blog…thought you might benefit from reading my new book on stuttering, Regression Therapy For Stuttering. Check out my website for details jerryhalvorson.com
Jerry

Hi Jerry,
>>> The wrong word, spoken at the right time to a vulnerable child can be devastating. People who develop speech avoidance are victims of accumulated traumas that are shuttled into hiding.
1) How do you explain that genetics research has shown that genes contribute about 70% to the occurence of stuttering. For example, twins which share the same genes (monozygotic twins) are 3-4 times more likely to stutter both than dizygotic twins?
2) How do you explain that the vast majority of kids who experience trauma do not become stutterers?
Tom

Hi Tom,
Great questions…ones asked often…Short answer=all depends upon STUTTERING DEFINITION
Jerry Halvorson

Hi Jerry,
sorry but that answer is not good enough for me. So what is your definition of stuttering?
You also claim that the Monster Study has caused children to stutter. This is factually not correct as the claimants of the compensation trial were rewarded damages not for existing stuttering but for psychological trauma and others.
Best wishes,
Tom

Hi Tom,
My book, Regression Therapy For Stuttering, will answer your questions.
Jerry

Hi Jerry,
With all respect, but that is a very cheap answer and you are avoiding the answer which of course you cannot have because what you say is not supported by evidence. You should be more careful what you write, because there are many real people out there who suffer from their stuttering and it is my duty to present them with hard evidence. Stuttering is not caused by traumatic events in childhood. That is the opinion of all leading therapists and scientists.
Tom

-no more emails-

Knew what to say but...

I came across the disorder called Broca’s aphasia (or expressive aphasia), and I was struck by this statement on the wikipedia entry:

Patients who recover go on to say that they knew what they wanted to say but could not express themselves.

That's exactly what people who stutter experience. We know exactly what we want to say but cannot pronounce the words fluently; as opposed to express themselves:

Sufferers of this form of aphasia exhibit the common problem of agrammatism. For them, speech is difficult to initiate, non-fluent, labored, and halting. Intonation and stress patterns are deficient. Language is reduced to disjointed words and sentence construction is poor, omitting function words and inflections (bound morphemes). A person with expressive aphasia might say "Son ... University ... Smart ... Boy ... Good ... Good ... "

To summarise, the internal thought processes do not seem to be directly related to speech or grammar: We think somewhere else and our thoughts are coded into grammatically correct sentences, coded into speech motor sequences, and send to our speech muscles. But where do we think? That is a deep puzzle in neuroscience.

Stuttering starts 13.7 billion years ago

I have to share with you this beautiful picture of the temperature distribution of the universe called micro-wave background radiation: see here. It is a snapshot of the start of the visible universe when the universe cooled down sufficiently from the big bang to allow light to travel over long distances rather than being re-absorbed by the hot plasma. This event happened 300'000 years after the big bang which happened 13.7 billions years ago.You can see that the temperature (which is -270 degrees Celsius!) is not completely evenly distributed; there are minute difference of 0.0001 Celsius. These differences are the seeds that made galaxies form, and stars, and planets, and life, and humans, and people you stutter! Without these tiny temperature fluctuations 13.7 billion years ago you wouldn't be stuttering! Isn't that amazing.

Stuttering produces no genuises

This Telegraph article describes that Prof of Psychiatry Fitzgerald believes:

"Psychiatric disorders can also have positive dimensions. I'm arguing the genes for autism/Asperger's, and creativity are essentially the same.

I only agree to some degree. A mild form of autism might push people to do extraordinary work, but in the vast majority of cases they just suffer from their disorder without doing any high standard work. Some researchers even view autism as an extreme version of a male brain with more of its strengths and weaknesses!

A reader has sent me the article and asked whether this is also true for stuttering. First, stuttering is not a psychiatric disorder but a motor-control and integration problem that leads to psychological and social issues. We have an average brain with average capabilities. Second, I would argue that any disorder that doesn't kill you and that can be overcome to some degree may be a source of motivation. The saying goes: What doesn't kill you makes you tough. I have seen many people who stutter who were successful because instead of giving up because of stuttering draw an enormous amount of drive and motivation from it. And, it is an open secret that over-protected kids from caring and wealthy families rarely make it big; they just don't have the need to do so. With exception of Paris Hilton, maybe. Of course, we need to contrast this with the many (in fact the majority of people) who live a life below their potential due to their stuttering.

Finally, let me assure you that even if stuttering does not lead to geniuses, stuttering does not prevent you from being a genius either! So there is hope for us all. ;-)

The Hawthorne Effect in stuttering

Have you ever heard of the Hawthorne effect in psychology? A study looked at the impact of the lightening condition on factory workers. They increased the lightening, questioned the workers, and got a positive feedback: the workers enjoyed the improvement. Then, just be on the safe side, they re-did the same experiment but now they decreased the lightening. Results? The workers gave positive feedback again! So any change provoked a positive feedback. Some speculate that workers just reacted positively because someone was finally given them some attention and they wanted to support them.
I am convinced that the same could happen in therapy. Assume that a therapy is made of 5 components A,B,C,D, and E. If you increase any of the five components in importance, you will get a positive feedback from people because they see how much you invest in improving the therapy and they do not want to disappoint you.
Another experiment that I have in mind is the following. Drop one of the five components, lets say A, and do the test but without telling them about the test, I am convinced the therapy outcome will stay stable. OK, then you can argue that A is not needed. Repeat this test with the remaining four and always drop one component. I am convinced you will always get similar results. So at the end, you can conclude that no component is crucial by itself, so what did produce the improvement? You could always first drop A, then also drop B, then drop C too, and so on. Again I would say that the results will not dramatically change. OK, maybe at the last one because you give them no therapy.

Oxford Dysfluency Conference 2008

The registration for the Oxford Dysfluency Conference in Oxford, England, is open. You can register here. I have attended the last conference, but I am not sure whether I will attend this summer's conference as I have to pay all the costs myself. I also missed the deadline to submit an abstract, and I always find it difficult not to talk!

The theme is interesting and noble: Integrating the Evidence: Scientist, Clinician and Client. But, have a look at the composition of the organising and review committee and you immediately notice that it's the old socks of the last years! A committee chaired by the main sponsor of the conference the Michael Palin Institute, dominated by the standard UK clique of therapists, by women (a blatant discrimination against men. no wonder men are hesitating to become therapists in the UK!!), and all therapists except Dave Rowley. And if they want to include science, how come that the only person who has a decent scientific background though not involved in ground-breaking science is Dave Rowley, the conference organiser. And if they want to include the clients, how come no-one from the self-help movement or the British Stammering Association, is part of it??? I am not saying that the reviewers are not good therapists. In fact I know most of them personally (though not sure how much longer maybe :-), but they should have added a few international and leading scientists and therapists. I have spoken to a few international leading researchers and they were all not very keen on the conference and dismissed it as too UK-focused, only therapy-focused, and more-like-a-big-feel-good-happening-of-old-friends than a serious conference.

Another example on how not to do an RCT

Here is a second random control trial on the Lidcombe treatment (speech therapy for kids at onset of stuttering) by a German team of researchers. I think it is derived from Tina Lattermann's PhD thesis:

In order to investigate whether the Lidcombe Program effects a short-term reduction of stuttered speech beyond natural recovery, 46 German preschool children were randomly assigned to a wait-contrast group or to an experimental group which received the Lidcombe Program for 16 weeks. The children were between 3;0 and 5;11 years old, their and both of their parents' native language was German, stuttering onset had been at least 6 months before, and their stuttering frequency was higher than 3% stuttered syllables. Spontaneous speech samples were recorded at home and in the clinic prior to treatment and after 4 months. Compared to the wait-contrast group, the treatment group showed a significantly higher decrease in stuttered syllables in home-measurements (6.9%SS vs. 1.6%SS) and clinic-measurements (6.8%SS vs. 3.6%SS), and the same increase in articulation rate. The program is considered an enrichment of currently applied early stuttering interventions in Germany. Educational objectives: Readers will discuss and evaluate: (1) the short-term effects of the Lidcombe Program in comparison to natural recovery on stuttering; (2) the impact of the Lidcombe Program on early stuttering in German-speaking preschool children.

It is frustrating to see that their study has the same flaws than the random control trial published in the BMJ: see my rapid response here.
First of all, they have not taken enough children and have failed to understand that the natural recovery rate is undermining the standard random control trial. They need to take double the amount as I explained in my rapid response. Second, they have only looked at a period of 4 months post treatment which leaves so much room for alternative interpretation. For example, many children might well relapse as is well known in adult therapy, so an observation period of 1-2 years is the minimum. Another interesting alternative interpretation is that those who would recover naturally anyway actually recovered faster due to the treatment and it looks as though there was therapy success! Why on earth would a journal still publish trials with only 4 month post-treatment observation period??
Then, you should look at the results. Just look how variable they were. The kids were measured with 1.3% stuttered syllables at home and 3.6% in the clinic. Assuming the clinic measurement is more reliable, the stuttering rate did drop from 6.8% in the non-treated kids to 3.6% in the treated ones. But 3.6% stuttered syllables means that on average the kids are still stuttering because 3% is considered the borderline! Not very convincing at all, especially because the drop might well be due to the kids being more trained to perform when in the clinic. Even if it is real, the study then confirms that the Lidcombe treatment is NOT effective at treating all kids. And I would even speculate that if the child has remaining dysfluencies above 3%, they will be the seed for full-blown stuttering at some point in the next years. So maybe despite the flaws, the study did show that Lidcombe is not perfect.
But rest assured, we will hear that "Lidcombe has now been confirmed by a second random control trial to be an effective treatment for children". Why can't the researchers get their act together and conduct a proper trial so that we can solid results with no loophole?? My hope is that Marie-Christen Franken's trial which tests Lidcombe against Demand and Capacities therapy will do exactly that: see here!

Vivian Sheehan

I got this email from a reader Jack Brooks on Vivian Sheehan, a well-known speech therapist, working together with her husband Joseph Sheehan: see this page for some audios. (Also check out a documentary on the Sheehans.

I came across your blog and wanted to share my experience as a stutterer in therapy with Vivian (and Joseph) Sheehan:
Unfortunately, I learned of Vivian Sheehan's passing only recently and had been out of touch with her for several years due to relocating. My own experience with Vivian and Joseph Sheehan was as a severe stutterer who participated in the UCLA Group Speech Therapy Program in the mid 70's after fatefully seeing the Sheehans with Mel Tellis on a daytime talk show and thence contacting Vivian. She interviewed me thereafter at their house in Santa Monica and I saw immediately her deep understanding and empathy of the challenges faced by a stutterer.
After "passing muster" as a willing stutterer with Vivian, I participated in 3 rounds of the eight-week group sessions at the UCLA Clinic Speech Therapy Clinic with her, Joseph, and other therapist/trainees. This, unlike my prior years of well-meant but ineffective private therapy by highly respected speech therapists, was to be the life-changing help that enabled me to "earn the fluency" that came as a by-product of the real treasure that the Sheehan therapeutic process gave us participants, which was learning to become a stutterer "easily and openly."
Joseph and Vivian's radical but utterly logical therapy led this fearful, shamed recluse into becoming an excited, gregarious stutterer, who'd talk your ear off about "my stuttering," while looking deeply into your eyes, on fire about the new passion of communicating with the rest of humanity after so many years of self-confinement in a prison of fear to speak.
After Joseph passed, I went on to attend Vivan's Clinic at St. Joseph Hospital in Santa Monica periodically for "tune-ups" and to maintain contact with her. Visiting her at home once, when I expressed my interest in how "it all started," she freely shared copies of some of Joseph's groundbreaking early papers and writings that were the foundation of their therapeutic model. In early 2000, I had the privilege of attending a pre-retirement gathering at her house with of some of the stutterers who'd continued working with her and was able to share my deep gratitude and continuing inspiration for speech that she and Joseph so lovingly fostered.
My mother, also a stutterer, had said, "it takes a stutterer to know one!" Joseph Sheehan, a stutterer himself, knew this full well. I firmly believe Vivian did as well. She will live in my heart always.

What's in the crystal ball?

I got an email from Ora from New York who, instead of just speculating like I always do (remember I am a theoretical physicist! :-), has actually called up Indevus, the owner of Pagoclone, again and asked whether the trials will move to Phase III stage: see his first call. Not sure I learned anything new, but here is his summary:

She reported, there really isn’t much of an update since we last spoke [in December]: We’re still in partnership discussions and we’re still optimistic. The last time we spoke, I expected that we’d have something finished by end-of-year, but of course the problem with offering a timeline is that things always take longer than you hope, never shorter.
She said: We’ve been talking with more than one company. I said, this apparently means that the discussions are not as far along as I had previously optimistically assumed. She said: Well, it’s actually possible to have discussions with multiple companies simultaneously which are in a late stage; it’s not uncommon to do so, because there can be snags with one company and you don’t want to start over. All along we’ve been in discussions with multiple companies. We still consider this an important asset for our company and we want to get it into good hands to maximize its value to our shareholders. As previously reported, we don’t want to develop it ourselves because it’s outside of the core competency for our company.
I asked, what’s the status of the Phase II trials? She said, Phase II has ended, except for the open label phase; participants were given the option to continue; we’re still continuing to monitor. Anecdotal reports continue to be favorable.
I said, I keep looking for a scientific article. She said, actually we’ve submitted to a couple of different journals. But publication is not up to us, it’s up to the journal and their sense of the importance of the results. We’d like to have it published because it’s good publicity for us...The journals tend to be more interested in Phase III results because it’s closer to becoming a reality.

Research from Iran

I am happy to see that there are also Iranian researchers working on stuttering. As with the Chinese, I have always been impressed by the Iranians I have met. They were highly educated and very civilized. The Iranian news agency talks about research on a computer model to simulate human speech processes and thereby showing that basal ganglia malfunction could be at the core of stuttering: see here. I am impressed by how scientific and clear thinking the article is, unlike 90% of articles from Western authors. If anyone knows who the researcher is, please let me know! Here is a shortcut of the press release.

Iranian researcher in medical engineering has worked out a project examining impacts of medical treatment on patients suffering from expression difficulty, stuttering. He managed to design a computer model upon the brain function to monitor the impacts of the medical treatment.
The mechanisms behind the stuttering are still not clear and scientists have introduced variety of reasons for it but a major line of research over at least three decades has investigated the possibility of a speech motor control disorder as at least one component that this is influenced by emotional stats and environmental factors.
There are strong indications that the basal ganglia-thalamo cortical motor circuit, through the putamen to the supplementary motor area, plays an important role in the pathophysiology of stuttering. Also the influence of emotional states on stuttering is well compatible with the suggestion of stuttering as a basal ganglia disorder.
Hence, the core dysfunction in stuttering is the impaired ability of the basal ganglia to produce timing signals because of the unregulated value of dopamine receptor density in it.
Although scientists showed the relation between the basal gang and stuttering, but yet there is not appropriate computational model to show this relation quantitatively. In this study, we propose a computational model that explains the role of basal ganglia in stuttering.
Different parts of the brain involved in stuttering are all considered in our model. Our computational model has considered the involved parts of the brain in a fairly accurate way, explaining the behavior and mechanism of the disorder according to physiological information.
Using this model, we can predict the effect of changes in dopamine and other basal ganglia neurotransmitters in different situation such as emotional states.
Also, we can predict the effects of different drugs on the stutterers.

What many therapists really think!

Have you ever wanted to know what your therapist really thinks? Here it is. I got an email from a therapist who shared his private views. I find that his views are quite similar to what other therapists tell me privately:

I am from Australia and currently work as a speech pathologist (as we are known here). I do not specialise in stuttering, but have seen around 15 cases of stuttering in children aged 4-14 since graduating 7 years ago. I read some of your blog early last year, and was reminded of it when I found an old email that I'd sent to a friend, who used to be a speech pathologist, regarding your "Do therapists believe in their therapy?" post. I thought what you wrote in this post was very accurate, and can be applied to other areas of speech pathology besides just stuttering. Currently, high-level scientific evidence (from meta-analysis of several independent randomised controlled trials) is lacking in virtually all areas of the profession. Your blog has many valid points regarding therapists and therapy for stuttering. I commend you for taking a sceptical approach to stuttering therapies, and am writing to tell you of some of my experiences. When I was a student, I took a semester subject on stuttering in the 3rd year of the degree course (of 4 years). The subject differed to other speech therapy-specific subjects in the course, in that it only had one lecture given by somebody other than the subject examiner. Nearly all of what was taught in the subject was 'smooth speech' (a variant of prolonged speech) for adults, and the Lidcombe Programme for children. I felt very much that the therapy techniques our lecturer used/preferred were emphasised, rather than giving equal time to other techniques. Much lecture time was also spent on practising 'rating' videos of stutterers - where we would count the number of syllables spoken, syllables stuttered, etc. We had a few 'recovered' adult stutterers who had gone through the university's intensive fluency clinic (learning smooth speech) speak to us of their experiences. We got to observe our lecturer taking a case history with an adult, and deliver a therapy session to a pre-school child.

In the final year of my degree, there was the option of undertaking an intensive fluency ('smooth speech') clinic with adults, but not everybody undertook this placement as it was part of an elective clinical subject, and not a core one. I did not do this placement, and the only stuttering clients I saw as a student were 2 adults, for 2 sessions each, in another placement at a rehabilitation hospital. I never directly worked with a child who stuttered until my first employment upon graduation. This level of exposure to stuttering would not have been uncommon amongst the students in my course. From my experience of working with children who stutter, the 'success' stories have all been with students aged under 7 (mostly under 6), and using similar techniques to the Lidcombe Programme and environmental modification (i.e. counselling parents and teachers on how to maximise their child's fluency/modify their own speech/what to do when the child stutters). I don't feel as though I have directly 'cured' the stutter in these cases, even though the students have gone on to have fluent speech. Rather, I may have helped assist/speed up the natural recovery process, and minimised the risk of the stutter becoming worse. It's possible that these children may have recovered on their own without my input. I must say that I do feel less competent when working with older students who stutter, because I feel that the expectation is that speech therapy should be able to 'cure' the stutter, but so far I've not been able to do this with the handful of older students I have seen. The stutter is usually also more advanced, and the student has passed the period of likely spontaneous recovery.

I agree with you on thinking that therapists' focus on the other, non-speech stuff may be because deep down they know (or soon realise) that fluent speech maintained over time isn't likely to occur due to their therapy; and that it's too easy to blame it on the patient when the therapy doesn't work. One of the greatest barriers to developing 'expertise' in stuttering for the typical speech therapist is that it isn't something that most of us commonly see. I might see 2 students who stutter a year, but 100 or so students for other speech/language disorders. Frequency and duration of therapy is also another issue, as currently I am typically able to see a student once a fortnight maximum during the school year. Also, there are also always new referrals/assessments, etc. to be done. One of the most frustrating things I think I would find with speech therapy, if I stuttered, is the therapist believing that *they* are the 'expert' in stuttering, when they haven't stuttered a day in their life. By the way, the lack of male speech therapists isn't just specific to Europe - in Australia it's around 3% male, and I believe something like 6% of ASHA members are male in the USA.

The Stutter Blog

Here is a new blog called TheStutterBlog. Most posts talk about stuttering research. Here is one I found interesting:

A study released by the University of Canterbury, Department of Communications and Development, suggests that stuttering in young children may not be linked to any kind of personal anxiety.

By measuring the cortisol (a hormone linked to anxiety & stress) levels in the saliva of children ages 3 and 4 years old, researchers found no higher levels in the children who stuttered versus those who do not.

According to Bianca Phaal, the masters student who recently completed the study, “Results of this study suggested that generalised anxiety and communication apprehension are not associated with early childhood stuttering, therefore it is unlikely anxiety is the root cause of stuttering”.

A Challenge to Lidcombe

I have been criticizing the Lidcombe random control trials in many posts (see for example here or search for Lidcombe in search bar) as not very convincing evidence due to methodological weaknesses and their uses as evidence to spread the message. It has been three years since the trials and the kids should now be at least 6 years old. I challenge them to publish data from those 50 or so kids that underwent treatment. How many are still stuttering? At ISA in Croatia, I or someone else asked Mark Onslow this question, and his answer was not very clear, but I recall something like "There are about 70%-80% fluent. So maybe Tom is somewhat right..." I didn't follow up as I should have.

So again: What has happened to those 50 kids? What the Lidcombe people should do is the following: Ask an INDEPENDENT researcher to look at those 50 kids and evaluate their speech, and then make the results public. If all or nearly all kids are fluent, I will been more convinced about the efficacy. So if any of you hears someone cite the random control trial, ask the speaker whether three years later an independent person has confirmed that nearly all are now fluent!

Richard Curlee died

Prof Ingham has informed me that

we lost one of the major players in stuttering research. Richard Curlee passed away in Tucson AZ. He had been hospitalized for some time with reoccurrence of conditions likely related to his polio when he was a child.

I have never met him, but I found two books on stuttering. Here is a biography:

Richard F. Curlee was a professor and head of the Department of Speech and Hearing Sciences. He is a graduate of Wake Forest College, and earned master's and Ph.D. degrees in communicative disorders from the University of Southern California. He has been on the faculty at the University of Arizona since 1975 and teaches graduate courses on stuttering, counseling and research design, as well as an introductory undergraduate course. He is a speech-language pathologist with clinical and research interests in the study and management of people with communication disabilities, especially those who stutter. He has authored or co-authored several dozen articles and book chapters on stuttering and co-edited two texts on its nature and treatment. He has been an Associate Editor in the area of stuttering for both the Journal of Speech and Hearing Disorders and the Journal of Speech and Hearing Research. At present, he is an Associate Editor of the Journal of Fluency Disorders and the Editor of Seminars in Speech and Language. He is a member of Phi Beta Kappa, Phi Kappa Phi and Sigma Xi, and a member and Fellow of the American Speech-Language-Hearing Association.

New book by Prof Ingham

Roger Ingham has edited an interesting new book on neuro-imaging in communication sciences and disorders, which is very much in the same spirit as this blog, namely that neuroscience (and genetics) have given scientists new tools to explore and better understand stuttering. Here is the book cover text:

There can be little doubt that the huge developments in brain imaging technology over the past 15 years have opened up a whole new vista of possibilities for the assessment and treatment of human communication disorders. At issue of course is whether those possibilities are being realized and what form of influence this will have on the field speech-language pathology and hearing disorders in the immediate future. The rate of development in neuroimaging is so rapid that it is almost impossible to predict very far into the future in trying to understand this influence. Nonetheless, it is now becoming clear that the availability of technologies that make it possible to investigate, even in real time, the neural regions and systems that are functionally related disorders is having a transforming impact on the discipline. In this series we have brought together some of the principal researchers in our discipline and who are working at the "cutting edge" in applying neuroimaging to communication disorders.

China pushes into stuttering

I am pleased to see that Chinese scientists are also pushing into stuttering research. I have always been impressed by their drive, patience and cleverness. It is an open secret that the outstanding success of US science has often been driven by foreign (including Asian) scientists at US universities, and not by the more commercial and evolution-denying US Americans, but who have provided the financial and political safe haven needed for science to prosper. China is changing and more Chinese scientists see a good future at home. Check out their abstract here. They found structural differences in stuttering brains using MRI. I need to look at their article to know more.

Song LP, Peng DL, Jin Z, Yao L, Ning N, Guo XJ, Zhang T.

Rehabilitation College, Capital Medical University, Beijing 100068, China.

OBJECTIVE: To investigate the differences of regional grey matter volume between adults with persistent developmental stuttering and fluent speaking adults, and to determine whether stutterers have anomalous anatomy of speech-relevant brain areas that possibly affect speech fluency. METHODS: High-resolution magnetic resonance imaging (MRI) scanning was performed on 10 adults with developmental stuttering, aged 26 (21 - 35) with the onset age of 4 (3 - 7) and 12 age, sex, hand preference, and education-matched controls. The customized brain templates were created in order to improve spatial normalization and segmentation. Then automated preprocessing of MRI data was conducted using an optimized version of VBM, a fully automated unbiased and objective whole-brain MRI analysis technique. RESULTS: VBM analysis revealed that compared with the controls, the stuttering adults had significant clusters of locally gray matter volume increased in the superior temporal, middle temporal, precentral and postcentral gyrus, and inferior parietal lobule of the bilateral hemisphere (P <>

Starting to stutter at 18

I want to share with you the story of someone who started stuttering at age 18! It is a very unusual case which might tell us about stuttering itself.

I am 26 years old and study civil engineering. My therapist and people who stutter (PWS) say that my story is a bit unusual, since I’ve started to stutter at age 18. No stressful situation occurred at the onset of my stuttering. If this was the case, I’m sure I would remember, because it was only a few years ago. I’m sure that I have never stuttered as child. I have an older sister who stutters, and my whole family and our close friends know the differences between fluent and stuttered speech.

My story as a PWS starts when I was 18, attending 10th grade. I started to notice some difficulties when I had to say words starting with /r/. I would have to stop for a moment, before I would be able to say the word. At the beginning no one else noticed my difficulties, but I was very much confused. As time passed by, I talked worse and worse. Words starting with /r/ were not as much of a problem any more, but words starting with other syllables started to be a problem. My speech was still fluent most of the time, but after some 6 months people started to notice my problem. At this time, they thought that I’m kidding, but I couldn’t explain to them that I wasn’t jocking. Others asked me if I started to stutter, but I didn’t feel I was stuttering, since it wasn’t the same as other people who stutter whom I know. I felt angry at myself for having a problem that I have never had before, and I was already grown-up. That’s when I started to talk very bad and feel very bad about it.

Heavy stuttering started some 2 years after the onset, at the time when I started university. In addition to my disfluencies, I had repetitions, blocks, voice prolongations and facial muscles spasms (grimaces), as well as spasms of muscles all over body - I would move my arms as a orchestra conductor, kick my feet on the floor, and so on. That is when I started to intentionally use synonyms in order to avoid difficult words and I started to avoid almost all speech situations that I possibly could. It frustrated me a lot. Interestingly for me, at the beginning of a hard stuttering period, I didn’t stutter when speaking under influence of alcohol, nor when I spoke in English, a language that I have never knew perfectly.

For three years I couldn’t find a clinic or therapist, because people told me that no one works with PWS older than 18. In July 2003, I found out an Institute in Belgrade that works with adult PWS too. I immediately started a treatment with an experienced therapist. The first few treatments felt a bit silly, but soon I realised that if I want to improve my speech I will have to adapt to the treatment requirements. After only 6 months I have achieved big improvement, and I was extremely happy. Therapy consisted of individual and group treatment and included direct fluency shaping techniques with a lot of psychological counseling and some elements of cognitive-behavioural therapy. Therapy required a lot of work by myself, and for the first three months I was doing fluency techniques excercises 2h/day, 6days/week. I was attending ambulance treatment twice per week. Soon, I started to feel more self confidence and I could control my speech even in some everyday situations. I stopped to avoid speech situations. Stuttering was still there, but in smaller extent than before. I practiced direct techniques less than before, but used it in everyday speech situations more and more. In July 2004 I underwent intensive 14-days group stationary treatment led by my therapist. Not much I achieved in fluency, because I already spoke fluently most of the time; I felt a lot more self confident and free from fear of speaking in all situations. Afterwards, bad periods with more disfluent speech occurred only during very stressful situations, such as exams on faculty. Those ‘bad’ periods were characterised by low level of stuttering. Today, I still have some disfluences (light blocks), but I don’t pay attention to them and don’t find them disturbing to me. Since my intensive course, I stopped going to treatments. I continue working on improving myself as a person and a speaker. I occasionally attend self-help group and have participated in a live TV show talking about me and stuttering in general. After that show, I received many calls and messages from my friends and colleagues teasing me that I am a fake member of self-help group since I spoke fantastically.

I consider myself lucky not to have started stuttering early in childhood. I speculate that this absence of bad and cruel experiences connected with stuttering during childhood and growing-up actually contributed in great extent that I solve my problem with stuttering in such short time. On the other hand, I think I would never achieve this good results if I haven’t continuously practiced and followed therapy tasks and demands.

When I started with the treatment, my therapist asked me what I would consider as my goal in this therapy. My answer was “I would consider myself ‘cured’ if I were able to say anything that I want to, at any time in every situation”. Today, I can say that I reached this goal.

Therapy that doesn't work often works

That's the conclusion I have drawn some time ago. It is the paradox of many treatments be it behavioural therapy or medication. Science tells us that the vast majority of alternative medicine does not work, except acupuncture. Nevertheless, many patients claim that such treatments worked for them. How is this apparent paradox possible? One word: placebo! If you give someone pill that contains no active compound like sugar, called a placebo (pill), and say that it works, it will actually work. OK. Maybe not cure the person but definitely show an improvement though often not very long lived. The key to understand this paradox is in the way that science defines how a treatment "does not work". Scientists ask the question: Is the treatment advocated better than no treatment or a placebo pill? If not, it does not work. It is a relative statement: it doesn't work better than a placebo pill. However, a person taking the treatment will experience an absolute improvement. He or she doesn't split into two: his clone A taking the treatment and clone B taking the placebo. So he will witness an improvement not knowing that he would have witnessed the same with a placebo. Of course, if you tell him that the pill doesn't work, it will not work!! So telling him it will work even though it does not work better works. I look at alternative medicine as a way to induce the placebo effect in humans.

This lesson is also very important for stuttering. Any therapy will work for us to some degree, but because it is often placebo it will be short-lived.

You can read about the placebo effect and alternative medicine in an article that Ora has forwarded to me: here.

Dying a silent death?

Indevus, the owner of Pagoclone, has just disclosed their financial results without any mention of Pagoclone. It is now getting more likely that Pagoclone is dying a silent death rather than being sold to someone else to cover the expenses of a Phase III trial.

Here is the CNN article. You notice that Indevus talks a lot about other drugs but no mention of Pagoclone.

News on Pagaclone soon?

Indevus, the owner of Pagaclone, is announcing its financial results on Thursday. Hopefully an analyst will nail them down on what they will do with Pagaclone: (see my last posts here and here)

Indevus To Announce First Quarter Fiscal 2008 Financial Results On Thursday, February 7, 2008

LEXINGTON, Mass., Jan. 31 /PRNewswire-FirstCall/ -- Indevus Pharmaceuticals, Inc. (Nasdaq: IDEV) will announce its first quarter fiscal 2008 financial results in a press release to be issued before market open on Thursday, February 7, 2008. The Company will host a conference call and webcast to discuss these results at 9:00 AM eastern time on Thursday, February 7, 2008.

Where is the measurement error?

In physics, we insist to include the measurement error into all our calculations. For example, lets drop a ball from five meters above the ground and measure the time it takes to hit the ground. Our time measurement will include an error, because we stop the clock ourselves. So the error might be of the order of 1/10 of a second. Let me repeat the measurement a few times in my head: 0.99s, 1.00s, 1.02s, 0.99s and so on. We can also measure the time with a laser, and the error might just be of the order of 1/100 of a second. But still you always have a measurement error. If we calculate the average speed of the ball, i.e. 5 meters divided by time needed, it will include an error because we need to include the time (and its error) in the computation. This procedure is very very important.

Is it done in stuttering research? NO. Let me repeat it again: NO RESEARCH HAS EVER INCLUDED MEASUREMENT ERROR!. What they should do is the following: For each measurement, they need to estimate the measurement error, and include in all the calculations like statistical tests the error range from the measured values. For example, if I measure the stuttering syllables a few times, I will get different values, e.g. 15%, 10%, 20%, and then I must conclude that the value is around 15% with an error range of 5%. And I need to carry this error range with me if I calculate statistical significance for example.

I discussed this issue once with Per, I think, and he said it is not done and anyway it is not physics and too much work. But, actually, because it is not physics, where measurements are much cleaner, quantifiable, and the error low, the argument to use measurement error analysis is even much greater! I think very few people are even aware of measurement error analysis.

If they had included it, I am convinced (and I bet my life) that ALL MARGINALLY SIGNIFICANT RESULTS WOULD GO AWAY, swamped away by the measurement error. If I am going to be cynical, I say that only those researchers who do not do measurement error analysis will be able to publish, and those who did perished because they have nothing to report on most of the time!

Let's try deep brain stimulation

A reader c sent me this article on deep brain stimulation. It's an interesting tool which leads to clear improvements in many LaTourette and Parkinson sufferers. Its main effect is inhibition of electric activity of neurons locally. Maybe we should try it with stuttering, though I am not sure which region to stab!

Clear conflict of interest in therapy evaluation!

After academic research in theoretical physics, I worked in risk management for an American investment bank. Core principles of any good risk management is independence of the evaluator and avoidance of conflict of interests. Virtually all outcome studies violate these principles. The studies are done by the therapists themselves, which is a very clear conflict of interest. The therapists have a great interest in getting good results, and are not focused on finding loopholes as independent evaluators would do. I have never heard of any therapists that published a study that showed that his or her therapy approach is not or less beneficial.

The most well-known example is of course the Lidcombe approach to treat children. The group around Prof Onslow are heavily promoting Lidcombe and at the same time have evaluated it! But, there is a bit of hope: an independent Dutch study is underway and looks at the Lidcombe approach versus a demand & capacities approach.

TheStutteringBrain is skiing this week!

A warning on drug trials!

Ora sent me this article (you need to be registered to access but it's free!) from the New York Times on how drug trials are misleading:

Researchers Find a Bias Toward Upbeat Findings on Antidepressants
By BENEDICT CAREY
The makers of antidepressants like Prozac and Paxil never published the results of about a third of the drug trials that they conducted to win government approval, misleading doctors and consumers about the drugs true effectiveness, a new analysis has found. In published trials, about 60 percent of people taking the drugs report significant relief from depression, compared with roughly 40 percent of those on placebo pills. But when the less positive, unpublished trials are included, the advantage shrinks: the drugs outperform placebos, but by a modest margin, concludes the new report, which appears Thursday in The New England Journal of Medicine.

My conclusion is two-fold. First, I am convinced that virtually all studies suffer from this publication bias effect (i.e. null or negative trials are conveniently not published or non-publishable) including stuttering research (not just on medication though). Second, I am always amazed at how strong the placebo effect is, and one can certainly argue that even the placebo is a significant improvement which the patient wouldn't have gotten if s/he hadn't taken the worthless or minimal-effect medication!!! Strange world...