Joe Biden

Joe Biden, the vice presidential candidate on the democractic ticket with Obama, was once a stutterer!

WHEN Joe Biden was a youngster he had a stutter, cruelly earning him the name Bi-Bi-Biden. He conquered that affliction to become one of the Senate's great talkers and Barack Obama's pick as his vice-presidential running mate.

As a child, Biden stuttered and was teased by his classmates. He practiced reading aloud in front of a mirror and worked hard to overcome it. During law school he befriended a stutterer and worked with him regularly on his speech. Now Biden is known as a loquacious orator.

In the Biden family, children were taught to respect Catholicsm, but not necessarily the person in it. As a boy, Biden took endless ribbing from classmates for a stutter he later overcame. Much of the time, the nuns tried to help. But when a seventh-grade teacher mimicked Bu-bu-bu-bu-bu-Biden's stutter in front of the class, his mother, Jean, demanded a meeting with the principal and the offending nun. "If you ever speak to my son like that again, I'll come back and rip that bonnet off your head," she said. Later, when then-Senator Biden told her he was going to visit the pope, she said: "Don't you kiss his ring."

Check out this NSA story. I can already see the stuttering associations world-wide salivating on the prospect of a golden opportunity to spread the message!

(Thanks to Ora for the story)

No tics when alone

I just saw a documentary on tic disorders. Interestingly, a women affecting by tics said that she is symptom free when she is alone, but the tics start when her husband comes home and gets worse in public social situations. Sounds awfully familiar to stuttering. I wouldn't be surprised if a similar mechanism is behind this phenomena.

Maguire talks on medication on StutterTalk

Check out StutterTalk's interview with Jerry Maguire on medication. Jerry is the main investigator of the Pagoclone study. He introduces the field, and talks about side effects. He said that he is guinea pig amd tried several compounds. He thinks that a combination of medication and speech therapy is more effective. Greg talks about his experience on medication: he said that secondaries reduced but he had significant side effects. Then Maguire talked about Pagoclone. He says that the Phase III is going to go ahead. In Phase III, they will play around more with dosis. Pagoclone seems to be more effective with longer use. He said that Phase II showed 20 to 40% improvements, (I DO NOT AGREE BECAUSE PLACEBO DID SIMILAR. THE DIFFERENCE BETWEEN BOTH WAS ONLY ABOUT 10% REDUCTION! THE OPEN LABEL DID BETTER BUT IT IS NOT PLACEBO CONTROLLED AND NOT ALL PARTICIPATED) They then talked about fluency shaping and it's unnormal speech unlike medication. Maguire says that it is not going to be a cure with all, but he believes in a combination of different approaches is the future. Then, they talk about different cocktails that some advertise. Jerry spoke about the use of telemedicine. So whereever you are in the world, you can get a consultation with Jerry and Dave at the Stuttering Center at Irvine in California.

StutterTalk interviews TheStutteringBrain

Yesterday, I got interviewed by Greg and Peter from Stutter Talk, the second best blog on the Internet! ;-) We talked about crackpots, medication, early intervention, outlook on research and treatment, and my view on the dormant and reactive phase. I will link once it's on-line.

Side effects very often kill benefits

A reader e-mailed me on his experience of someone taking medication:

On a different subject, I discovered tonight that someone in my group has tried Zyprexa (olanzapine) on several occasions. Most recently he’s been taking it for several months. I’ve noticed that he’s been gaining weight, but I didn’t know why till tonight. He’s gained about 30 pounds (20 kg), and is hungry all the time. He also feels tired. He’s was first on 5, now 10 mg per day, but has just decided to stop it because he doesn’t like the side effects. He took it for two previous periods, and it did have a beneficial effect on the stuttering those times, but this time, he’s not seeing much benefit. He was also in the pagoclone study. He thinks he was originally in the placebo arm. He continued with pagoclone after the end of the double-blind phase, for several months only. I didn’t get a clear sense why he discontinued; I think it was simply because he wasn’t seeing much benefit. He’s also being treated for OCD and sometimes anxiety (most recently Zoloft, I think), and he says that its hard to get the balance right because Zoloft definitely exacerbates his stuttering. I think he discontinued the Zoloft when he started Zyprexa, so he could isolate the effect of the Zyprexa.

I am getting consistently such reports. Side effects are outweighting benefits, and initial gain in fluency is gradually lost. Result: all that I know have stopped taking medication with 1-2exceptions. Pagoclone is somewhat different as it is better tolerated, but I haven't received any very positive report. Except long-term fluency gains in the open label trial. So if you have taken Pagoclone or other medication and experience stable fluency gains, let me know. I want to hear of your experiences

Christian Kell at the Paris workshop

Here is the last talk of the Paris workshop: a few weeks late. Christian Kell was the last speaker. He is a post-doc at Ecole Normale, and did his PhD in Frankfurt where he collaborated with Katrin Neumann on brain imaging studies on stuttering. I have already dedicated one post to him, to recapitulate: he is famous for finding the sensory location of the male penis in the brain!

Thank God then for Christian Kell of the University of Frankfurt who stuffed eight blokes into an MRI scanner and then tickled bits of their bods with a feather while (no doubt) keeping his eyes firmly fixed on the brain activity monitor. The NS notes: "Each man's penis was represented in the same place - flanked by the areas for the toes and abdomen - Kell told the Organisation of Human Brain Mapping annual meeting in Toronto." Kell went on to lament: "The only depressing thing is that the representation is very small."

Katrin scolded me for writing about this, saying that he was shocked to read about this on my blog. I asked him at the conference, and of course it was not true but her over-reaction as always. Chris said that he was surprised by the deluge of interest, that he got used to it, because after all it will stay with him for the rest of his life. To be honest, I think he enjoys his claim for fame. Chris seems multi-talented. He asked good questions. His French for being a German is quite good. He was a driving force behind the conference. And at the end of the workhop, he played the piano supporting a singer he recruited. So if he fails to get another job in neuroscience, I am sure he can make his money in a piano bar in Pigalle!
Chris spoke about research he has done in collaboration with Katrin in Frankfurt. I haven't found the article on PubMed, so it might not be out yet. They looked at people who recovered unassisted, who improved due to a fluency shaping therapy (before, just after, and one year after), and controls. What are the brain differences? It is an interesting question. Is there a difference between unassisted recovered stutterers and controls? Is there a difference between unassisted and assisted recovered?
(It is important to say a few words on unassisted recovered. I am not sure he said something about it his talk. But, I remember someone saying that many are not really like fluent speakers, but still have hesitations at times. When you ask them about this, they say that they are fluent for all practical purposes. They do stress that fluent speech is not always automatic and that they have to work to get it. This is even more true for people who undergo therapy and become fluent. The major difference is probably that unassisted recovered have managed to have lasting improvement, whereas people who become (more) fluent through therapy are likely to relapse fully or partially.)
As with all the other talks, I do not have access to the slides, so I can only rely on the abstract and my notes. They use functional and structural MRI. Not surprisingly, they find grey matter reduction and white matter anomaly on the left side in all stutterers. I think also in unassisted recovered stutterers. So constancy across groups. However, there were clear difference in activation. Stutterers activated several regions on the right side including the activation of the right analogue of the anomalous left brain region. After therapy, the right hand side activation was normal except again activation of the right analogue. And unassisted recovered stutterers show similar activation but additionally showed activation in the anomalous right region. He refers to the Brodman area 47/12. And they conclude that: "recruitment of the left posterior orbitofrontal cortical region (BA 41/12) appeared in this study as a unique and necessary feature of long-lasting repair of stuttering.
He further states that this region is probably involved in executive control of rhythmic tension. He actually talked a lot about rhythm, but I did not follow it all. I just have written down that the right side keeps rhythm and the rhythm competence (not sure exactly what it stands for, but this is probably understanding rhythm as opposed to executing rhythmic tasks) is on the left side.
I asked him a question on methodology. They used people from a fluency shaping therapy: the Kassel Stuttering Therapy. I have also attended the intensive course plus a one-year daily practise. One striking feature is the strong rhythm and gently onset of the newly learned speech pattern. It is quite funny. If you go to Kassel, everyone speaks the same way. Though I have to say that this is on purpose and the idea is to reduce the strong rhythm gradually: over-learning. I was concerned that the stutterers were just using this way of speaking and so you should see activation in rhythm areas, after all you speak in a rhythm! He replied that they told them to try to speak as natural as possible. However, I do not completely buy this argument, because when I was in this mode of speaking and tried to speak normally, I found it hard to do. In fact, some region in my brain kept me in the other mode, and I would only gradually shift and loose the restraining power of the new speech mode. Anyway, it is an interesting study! ;-)

Facebook Group

I have created a facebook group for readers of my blog:

Readers of TheStutteringBrain Blog

I also have a facebook account: here. Become my friend! I have so few... :-)

Urban myth: more left-handed stutterers?

Check out this article on the Day of Left-handers: here. This is another urban myth.

Stuttering and dyslexia occur more often in left-handers (particularly if one is forced to change their writing hand as a child).

 Or are there more left-handers who stutter??? But I seriously doubt stuttering can be induced by changing writing hand?

Jaik Campbell

 

Well it is a bit late. The show was last week, but have a look at Jaik's comedy acts. He also stutters and is quite funny. Actually, he is already funny without teling a joke! We had some great time in Dubrovnik at the last IFA conference. He was chasing Russian girls. ;-) Check out some of his videos: here.

News from one of my crackpots

You should have a look at Steve Hill's attempt at intellectual musings on the causes of stuttering: here. He has already received a Crackpot Award, but deserves more attention.

I have a number of e-mails from people who are worried that their children might in some way "catch or copy" their stutter and therefore develop a stutter in this way. We all know how damaging our own speech impediment has been and therefore would not wish a stutter on any person let alone our children.

Other people have told me that they developed a stutter after being involved in some form of scary incident, such as a car crash. The stutter seemingly developed due to some form of shock reaction.

He clearly has no understanding of the difference between correlation and causality, is relating on anecdotes, completely disregards genetic and brain imaging work.

Stuttering is colour blind

I am wondering whether this research was necessary. They looked at whether African American kids are stuttering more or less than "European American" (poor US whites they are now labelled after us Europeans!). I guess to see whether black kids are discriminated. I would not be surprised  (but I do not know for sure) if this was a clever move by the researchers to get funding for their stuttering research by tapping into the racial equality money, and use some of the overhead for other projects. I am wondering whether we could somehow link stuttering to global warming, and we could get more money for stuttering! Or, even better for terrorism, no lets make it bioterrorism (that's closer to stuttering which is also bio) because then we can kill any criticism to our stuttering-makes-terror theory by calling  our critics unpatriotic or liberals! Seriously, the matter of the fact is that lots of money is dedicated for research that 99% of the politicians know are ineffective but politicians need to show that they care for the topic. But what really happens is that neighbouring fields jump on the bandwagon by re-writing their grant proposals to fit the political dictat. So if we want to get more money for stuttering, we need to either make us important enough to get big pots of research money or to tap others.

Actually on a second glance, this piece of research is very interesting! So I am glad it was done. Why? Well, it confirms that stuttering is roughly similar across at least two races, which fits with what we have been known anecdotally for a long time: people stutter in any culture or race. But, I am actually struck by the fact that the numbers are so similar. Yes, I would have expected that kids stutter in all races, but that the numbers are so close is interesting. It is well-known (that is a phrase I use when I have heard it somewhere but I am too lazy to look for a reference!) that different races have illnesses at different prevalence. The fact that stuttering seems to be remarkably constant might well point to the interpretation that there are many ways to start stuttering (many gene combination and no single gene) unlike for some illnesses which depend on one gene which could easily be selected out in one race. You can also argue that the same culture made them stutter in same numbers, but I do not pay this because the frequencies of illnesses is different for different races even though they live in the same culture (well do they really? There are very distinct sub-cultures in the US.)

But wait, why don't we do the same for gender and see whether one of them is discriminated! Wow, four times more boys stutter than girls! So there is a clear discrimination by society here, isn't there? But of course because the discrimination goes against the common urban myth "that women are discriminated", no-one bothers about it. Just imagine more girls had stuttered, everyone would be talking about it....

Here is the abstract:

J Speech Lang Hear Res. 2008 Jul 29. [Epub ahead of print]Links

Prevalence of Stuttering in African American Preschoolers.

Proctor A, Yairi E, Duff MC, Zhang J.

Department of Speech and Hearing Science, University of Illinois, Urbana-Champaign.

PURPOSE: This study sought to determine the prevalence of stuttering in African American (AA) two to five year olds as compared to same age European Americans (EA).

METHOD: A total of 3,164 children participated, 2,223 AAs and 941 EAs. Data were collected using a three-pronged approach that included investigators' individual interaction with each child, teacher identification, and parent identification of stuttering.

RESULTS: No statistically significant difference for stuttering was found between AA and EA children. Using the investigator and teacher method of identification, the prevalence of stuttering was 2.52% for the entire sample. For both racial groups, boys exhibited a higher prevalence of stuttering than girls. Of the three predictors (age, race, sex) of stuttering, only sex was a significant predictor.

CONCLUSIONS: AA two to five year olds are not overrepresented in the stuttering population for this age group. When data are combined for both racial groups, the prevalence of stuttering is 2.52%. More boys than girls stuttered in this sample of preschoolers.

PMID: 18664698 [PubMed - as supplied by publisher]

One of my heroes

Have a look at this interview with Richard Feynman, Noble Prize Winner and guru of theoretical physics. He is definitely one of my heroes. Here he talks about Social Sciences. He might as well have talked about the general status in stuttering research!



Also, check out his superb explanation of what science is about using chess!

Reduction of stuttering severity

I am on the mailing list of STUTT-L, and I like this post by Gunnars Neiders. Especially, the Gaining insight alone does not help strikes me fatally!

I believe that reduction of all the significant dimensions of stuttering is a valid goal of stuttering therapy. The main dimensions of stuttering are:

1) Disruption of the communication process,

2) Secondaries (eye blinks, pursing of lips, head jerks, snapping fingers, etc.,

3) Distressing emotions of anxiety, shame, etc.,

4) Avoidances of sounds, words, situations,

5) Unhelpful ... attitudes, beliefs or self-talk ("I can't stand stuttering" instead of "I don't like it, that's OK, I can stand it anyway"; "Stuttering makes a person less worthwhile as a human being" instead of "There are inconveniences associated with stuttering and sometimes I may lose out on some of the goodies of life due to stuttering, but I can unconditionally accept myself, I am just as worthy to myself, whether I stutter or not", etc.),

6) Self-limitation in social and vocational settings. (not pursuing career of choice, limiting socializing, etc.)

There are techniques to reduce all of them. Gaining insight alone does not help. There are homework assignments that help; but learning exercises does not help if one is not inclined or does not find it cost effective to do massive practice. Some techniques are more efficient than others. Six things that hold back a persons are:

a) perfectionism/all or nothing thinking (I either succeed to completely change, or it is not worth my while),

b) not knowing what type of homework exercises to do,

c) learned helplessness ("Since I have failed in the past, I will always fail),

d) not experimentally trying all types of techniques to find out what works,

e) not having persistence and

f) the self- formal therapy not being cost efficient.

If the cost in time, energy, money, etc. is too big for the effective results, it just is not worth it. It would be silly to pursue a goal in life which is too expensive, too dear.

Long live free information flow!

I am writing this post in support of PloS, the Public Library of Science. It publishes online journals with the aim to propagate free flow of information! If you are a researcher, consider publishing there whenever possible.

I am sick with the current state of publication of scientific research in bio/medico-oriented journals. Big publishers like Elsevier making money by charging high prices for journals that are composed of works by scientists who they do not pay for their work BUT THE TAXPAYERS DO, and reviewed by scientists who they do not pay either for their peer reviews. And on top, the authors loose all rights to their work, have to wait months for publication, are not allowed to submit to another journal at the same time, and have to keep their work secret until publication which means that useful research is delayed by up to two years and by consequence other scientists might go down blind alleys or commit the same mistakes. It is absolutely outrageous. And, you have to pay to get access to the research which is in 99% of cases PAID FOR BY THE TAXPAYER!

Compare this to physics, computing, and mathematics. Every researcher publishes his or her preprints (the non-peer reviewed article that is sent to a journal) on the same server arXiv.org and then sent it to a journal. The journals were forced to accept that the work will be online, and they add the peer-review stage to it. Now, you can read all research that any physicist, computer scientist or mathematician has done over the last decade for free on one single server.

Are kids who stutter more sensitive?

At Oxford, Per Alm showed that most research on emotional reactive / sensitivity is far from conclusive. He specifically referred to an article in the Washington Post. In response to a question Per said that the research group around Conture did not really respond to his criticism. You can see a brief episode of this debate here.

I am going to look at this in detail, too, and I'll write a few posts.  I am getting a bit bored with the statistics on the Lidcombe trials, and may be I should move to other fields. ;-) Unfortunately, two rather influential professors are deeply involved in this research... never mind.

Biased sample fallacy in stuttering research

As I said before, I think of stuttering as a disorder coming in two phases: the dormant phase until onset of stuttering, and the reactive from onset onwards. A question of the causes of stuttering must then we split into two questions: What causes onset of stuttering? What causes recovery or non-recovery of stuttering children? In stuttering (and I would not be surprised in other disorders, too), the majority of children grow out of stuttering. Therefore, if we study the sample of persistent children, it will be a sub-sample and very likely biased, because the whole sample is the children who start stuttering.

Here is an example. Imagine, you interview 10 lottery winners, and they all tell you that they had a dream, wrote down the numbers and won! You are inclined to attribute some cause to the dreams. However, this is a fallacy, because you need to look at the whole sample, the set of all lottery participants who had a dreams and wrote down the numbers. Of course, if you look at this sample, there is no effect at all!

How could this happen in stuttering? Well, I just wrote a post on Kate Watkins' talk in Paris where she tentatively explained a reduced activity in auditory regions with a reduced input from motor regions (likely due to some bad connectivity). So one could conclude that bad connectivity causes stuttering. However, the reduced activity might just be an effect of a biased sample, because the persistent kids could not recover from stuttering due to a lower-than-average connectivity to the auditory regions. To put bluntly, if you better integrate motor and hearing data, you are more likely to develop a good compensatory system to speak (more) fluently! I am not saying that this is the case, but I am saying that it might be the case and that we must be very careful with interpretation. The 2-phase disorder framework is useful here.

Google decides

OK. I let Google decide on neurological and neurophysiological.

    6 050 hits for "neurophysiological stuttering"
125 000 hits for "neurological stuttering"

So neurological is used 20 times more often! So I will keep on using neurological for anything related to either the brain's constituents (anatomical / structural) or its primary functioning and interacting (functional).

In any way, neurophysiological is too long a word to type, and too pompous.

Neurological or neurophysiological?

Back to the debate as to the difference between neurological and neurophysiological. A friend of mine with a PhD in pychology in pain research writes:

neurological = anatomical/structural
neurophysiological = functional

I looked at the web again, and finally found someone actually describing neurological rather than refering to neurology:

neurological: Having to do with the nerves or the nervous system

But I could not find one for neurophysiological, but neurophysiology studies the functioning of the nervous system. But it seems to me that neurology should in principle include the functioning of the nervous system, because it has to do with the nervous system. And I think neurophysiologists argue that neurology is traditionally concerned with "truely anatomical and structural" deficits with clear symptomatology and not with more subtle dysfunctioning of parts of the nervous system like dyslexia for example. But I think neurologists would say that they would deal with all brain-based disorders.
Interestingly when the Society of Neuroscience talks about stuttering (here), they do not use the words "neurological" or "neurophysiological" but the word "biological" and "anatomical". However, the article is for laypeople.

Merci à Oliver

Oliver translates many posts from my blog into French. Let me thank him here for his efforts! You can read his blog: here.

Merci à toi, Oliver, pour tes traductions! Et bon courage pour ta grande nation au Tour de France et pour que vos cyclistes soient si vite que les coureurs du petit Luxembourg: les frères Schleck et Kim Kirchen! :-)

Better dead than half-alive!

Some argue that recovered kids actually have a bigger deficit than persistent kids, because a bigger deficit means that the right side analogue needs to completely take over! And there is also some brain imaging results that point in this direction.
I have an analogy. Think about a kingdom where the king has been wounded in battle but he hasn't died. So he is still alive but unable to perform to his best. It would have been much better if he had died and his sucessor taken over. The same often happens in politics when two key figures wrestle for power. If neither of the two is fatally wounded politically speaking, one will hold the top post but the other will keep on interfering. Such a constellation creates a constant battle for power behind the scenes and is very counter-productive. Maybe that's what is happening in us stutterers, our left side deficit is not bad enough, and interfers with attempts of the right to compensate. So maybe we need to DESTROY the left side region to become fluent. This would fit into some evidence of a few cases that became fluent after a stroke!
This stuttering brain is getting more and more complicated. I should have sticked to quantum physics, the big bang, 10 dimensional space time, and general relativity! ;-)

Kate Watkins at Paris Workshop

With some delay, I am finishing off my comments to the Paris Workshop. If you are interested in the abstracts, you can find them on this very stylish French blog but translated into French: here. I didn't publish the abstracts by request from the organisers.

Kate Watkins is a lecturer at the University of Oxford, and a very dilligent experimentalist in brain imaging of the stuttering brain. Her recent work involved scanning young people who stutter and scanning stutterers while exposed to Altered Auditory Feedback (AAF).

She started out with a review of a few theories (basal ganglia, efference copy, incomplete cerebral dominance), and referred to the meta-analysis by Brown et al. (2005). She focused on the reduced white matter integrity found by Sommer et al, Chang et al, and Watkins et al, which indicates that the region is not well connected to other regions, especially between motor and auditory cortices. Interestingly, she superimposed the locations found by the three groups, and showed that they are quite close to each other; the Chang et al's location being being the other two. She also said that we need to look for bilateral abnormalities to find causal effects. Some were skeptical. She did not elaborate in depth so it is hard for me to judge. Maybe if one side is abnormal, the other side takes over and this shows in an abnormality, too. I think she mentioned animal experiments where one side was injured and the other side compensated.

Then she talked about her current work on scanning stutterers and controls while using AAF. They found the auditory cortex less active than in controls. She offered the interpretation of reduced input from the motor regions as the cause. And again they found white matter abnormality. I didn't follow it all in detail. But I think the essence was that under AAF there was less decoupling of the motor and auditory regions in stutterers, namely activity in motor region was more correlated to activation in auditory region. Moreover, I think she speculated that a big deficit might give a better compensation than a small difference. I am looking forward to reading the published research.

Quality of life for stutterers

I have an idea on how to measure the impact that stuttering has on a stutterer's life. We could look at what age they die, and then compare the distribution with that of the same population. Age is probably the best indicator of quality of life overall. My guess is that there is little difference between people who stutter and fluent speakers, but it would be worth the effort to find out.

Of course, we male stutterers already know that we will unfortunately die 5 years earlier than our fellow female stutterers who according to urban myth are suffering significantly more discrimination than men and therefore by twisted feminist thinking are not actually enjoying better quality of life overall but are forced by (male) society to live much longer so that they can be discriminated much longer! ;-) However, age as the best indicator of life quality to show discrimination by race (e.g. African Americans die earlier) is of course again valid, just don't do it for sex!

Neurological or neurophysiological?

At the Oxford conference, I asked a question to Mark Onslow during the panel session. I asked how a behavioural treatment like Lidcombe could possibly be highly effective if as he agrees stuttering is driven by an underlying neurological problem.

Instead of answering the question well, he replied by saying that I did not understand terminology and that I probably mean "neurophysiological", and that there is a big difference.

Well, is there really a difference? I asked three people after the session, and no-one understood quite why one would be better than the other.

I looked up the words "neurological" and "neurophysiological".  In typical dictionary manner, I got the following very enlightening definitions: "of or relating to or used in or practicing neurology", and "of or concerned with neurophysiology"!! :-) OK, so I had to look up "neurology" and "neurophysiology".

Let's start with neurology: The medical science that deals with the nervous system and disorders affecting it.

And for neurophysiology, I got The branch of physiology that deals with the functions of the nervous system.


I cannot see any big difference. Both terms seems fine.

Relapsed kids are as severe as before

Here is an interesting observation from the follow-on paper of the Lidcombe trial. They note that those three children that had dysfluent speech recordings stuttered with a similar severity than before the treatment. First, is this observation just a statistical fluctuation or a real event? Second, can we observe the same effect in adult who relapsed after treatment? And thirdly, does it tell us something about the nature of stuttering?
I think it is a true effect for both children and adults: the relapsed have a tendency to go back to the same level of severity than before treatment. But I do not know of research that looked at this aspect. I did not consider this aspect when analyzing the outcome data of the Kassel Stuttering Therapy (KST). But I plan to re-visit the data.
Assuming it's true, can we learn a bit more about stuttering? My theory-biased interpretation is as follows: Stuttering at its core is a neurological dysfunction modulated by the response of the brain to this dysfunction. A stuttering treatment is most of all a behavioural therapy: you change some behaviours and you become fast more fluent. So going back to your old behaviours, you go back to your own severity. I cannot imagine that, especially in adults, treatment improves the underlying dysfunction and then they relapse due to a worsening of the dysfunction to before treatment. With children, new behaviours might be more easily ingrained in the brain or underlying weaknesses rectified or well compensated. But there is not a clear case for either interpretations.

Results are even worse than in abstract

I have now the full article on the follow-up of the Lidcombe trial. The abstract claims that 16% relapsed, but that's on recorded speech sample. But if you look at the parents' feedback:

... parent questionnaires indicated that eight (40%) children had stuttered at some time during the previous month and twelve (60%) children had not.

So actually 40% of the so-called recovered kids showed some stuttered speech recently according to their parents! How can this be reconciled with the magic treatment claim that Lidcombe makes all kids fluent voiced by some? It is not hard to imagine that some of these kids who had a fluent recording are actually dysfluent at others times and will unfortunately start stuttering again more severely or become covert stutterers.

And this does not even include the discussion of the natural recovery rate. Due to the small sample of 20 kids, the statistical fluctuation is huge and all results have a huge statistical error on them.

And calling the trial a random control trial is a bit dubious considering that

The majority of controls could not be contacted, possibly because many had not had regular contact with the clinic and so could not be traced.

And I haven't even read the article closely...

Follow-up study to Lidcombe outcome study

The follow-up study of the Lidcombe random control trial is out. I do not have the full article and can only read the abstract. But the results are less than sensational: three out of 19 kids have relapsed leading to a recovery rate of 84% which is statistically close to natural recovery. What happened to the claim that Lidcombe makes all kids fluent?? And their design has failed as well as they write:

Meaningful comparison with the control group was not possible because an insufficient number of control children.

So where is the control group check then?? They are not even able to compare to a control group to see whether natural recovery is as effective. How can they claim to have done a random control trial???

I need to read the full article for more precise comments.

Extended follow-up of a randomized controlled trial of the Lidcombe Program of Early Stuttering Intervention.

Jones M, Onslow M, Packman A, O'Brian S, Hearne A, Williams S, Ormond T, Schwarz I.

Queensland Clinical Trials Centre, University of Queensland, Brisbane, QLD, Australia.

Background:

In the Lidcombe Program of Early Stuttering Intervention, parents present verbal contingencies for stutter-free and stuttered speech in everyday situations. A previous randomized controlled trial of the programme with preschool-age children from 2005, conducted in two public speech clinics in New Zealand, showed that the odds of attaining clinically minimal levels of stuttering 9 months after randomization were more than seven times greater for the treatment group than for the control group.

Aims:

To follow up the children in the trial to determine extended long-term outcomes of the programme. Methods & Procedures: An experienced speech-language therapist who was not involved in the original trial talked with the children on the telephone, audio recording the conversations using a telephone recording jack. Parental reports were gathered in addition to the children's speech samples in order to obtain a balance of objective data and reports from a wide range of situations.

Outcomes & Results:

At the time of this follow-up, the children were aged 7-12 years, with a mean of 5 years post-randomization in the 2005 trial. Twenty of the 29 children in the treatment arm and eight of the 25 children in the control (no treatment) arm were able to be contacted. Of the children in the treatment group, one (5%) failed to complete treatment and 19 had completed treatment successfully and had zero or near-zero frequency of stuttering. 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. Meaningful comparison with the control group was not possible because an insufficient number of control children were located and some of them received treatment after completing the trial.

Conclusions & Implications:

The majority of preschool children are able to complete the Lidcombe Program successfully and remain below 1% syllables stuttered for a number of years. However, a minority of children do relapse and will require their parents to reinstate the treatment procedures.

PMID: 18608610 [PubMed - as supplied by publisher]

If two experiments disagree...

Whenever there are two experiments and one of them gets an agreement and the other one gets disagreement [with theory], I think that it is much more likely that the experiment showing a disagreement is incorrect because it is much easier to introduce an error (any error) that destroys the agreement than to keep all things pure and accurate so that the agreement is preserved. In other words, it is unlikely to get an accurate agreement by chance.

A new blog on stuttering

Check out the interesting blog with a not-very-original title Stuttering: here. The author, Silvano Colombano, describes the theme of his blog as followed:

I am attempting to recapture a long dialogue about stuttering that I pursued on the STUTT-L list from 1994 to 1998. This dialogue was based on personal experience of my own stuttering problem and on a great deal of thinking motivated by my scientific training as a biophysicist.

I will do the editing of the list dialogue over a period of time, at the end of which I may decide to re-join the list and see what kind of progress has been made in our understanding of this affliction. I do know that no "magic bullet" has been found.

I have read a few posts, and Silvano has a good understanding of science and puts his arguments well though maybe too diplomatically thereby leaving those with muddled thinking the space to keep their opinions!

Surrounded by Germans at Oxford

Here is a picture of TheStutteringBrain and the Germans at Oxford. (Thx to Nicole)

From right to left: Martin Sommer (neurologist / university lecturer & researcher at Goettingen), myself, Nicole Spindler (Martin's PhD student), Beate Schwittay (German Association), Norbert Liekfeldt (British Stammering Association), and Veronika Gutmann (Martin's PhD student).

I also want to clarify that I am not German, but from Luxembourg which is a beautiful and independent country neighbouring Germany (a fact unknownst to many US Americans). :-)

Highlights from Oxford

I am currently in London on my way back to Luxembourg. Let me post the highlights from the conferences as I see them. I will talk details in future posts. If you have pictures of the conference, please send them to me!

1) Per Alm gave a scathing review talk on the emerging field of study that claim that certain temperamental traits are important causal components of stuttering. Specifically, he raises serious concerns about a study by the Conture group, and, on top, he said that the results of their likely-to-be flawed study have been misinterpreted and exaggerated by the Washington Post which have also found its way to the BSA (British Stammering Association) website. To summarise, the supposed evidence is evidence of bad methodology.

2) Dave Franklin from the Pagoclone group (and colleague of Stuttering Drug Tsar Jerry Maguire at Irvine) presented a poster with the results of the open label period of the Phase II Pagoclone. They claim that Pagoclone shows positive results in a subgroup and has less side effects. He handed out copies of the posters to everyone, and I am trying to get the permission to post the scanned handout here.

3) There is a widespread agreement that stuttering is a neurologically based disorder. Ann Smith pointedly asked in the final panel session whether it is not time to change from "the causes of stuttering are unknown" to "stuttering is a neurologically based disorder whose details are unknown". We all agreed.

4) Many speakers talked about very high rates of success of stutteringin early intervention, but barely mentioned the natural recovery rate. Many strongly believe that early intervention is effective above natural recovery. I can see improvements being possible but I am just not convinced that the vast majority recover fully.

5) Mark Onslow talked about a large scale longitudinal study of 1000 children starting before onset of stuttering. This should be a very interesting study, unless they mess it up statistically as they did with the BMJ study.

6) No new imaging, genetics, or theoretical developments.

7) Two talks were enlightening as they explained well concepts that I find lacking in stuttering research and therapy but are important to see the big pictures. Paul Dolan gave a good conceptually introduction to health economics, but I did not talk about specifics. Kuhn and Packman talked about complexity theory, and the complex brain with its self-regulating loops. But are these concepts applicable to help real understanding? I doubt it, and if not not by the speakers.

Some pics from Antwerp

Talking to Nan Rantner (co-author of the Handbook of Stuttering)



Talking to Dave Rowley (organiser of the Oxford Dysfluency Conference)



Talking to Ed Conture (well-known professor and researcher)

Talks from the Antwerp conference are on-line

The key talks of the Antwerp conference are now on-line here

I am off to Oxford on Thursday

I am going to the Oxford conference which is held from Thursday to Sunday. I will present a poster on logical fallacies when trying to assign a cause to the onset of stuttering in children, and I will give a talk on viewing stuttering as a disorder coming in two phases and acting on two levels.



Other interesting (:-)) speakers will include: Per Alm who talks about Fluency disorders: a discussion of possible causes and mechanisms, from a neuroscience perspective (I hope he will tell us something new as I heard talks with similar titles before) and on Temperament and Stuttering (where he will hopefully debug the current obsession with temperament as a/the major factor) Jerry Maguire has a poster on the results from the Pagaclone study. He told me that he cannot attend due to his father's 80th birthday (Happy Birthday! I met his father in October in LA) but his colleague Dave Franklin will be there. Jerry gave a workshop at the NSA conference this week where he talked about the results. I will report on the poster after the Oxford conference.



The conference program feels an adulation for the Lidcombe program. There are at least 10 talks, and of course they all talk about the "evidence" which I still cannot see clearly. That's probably because my statistical and critical thinking pain threshold is much lower! So I am still uncomfortable with the adulations.Even with positive evidence (which would be good news for kids) they of course forget that possibly any other treatment might very well give similar results, because only Lidcombe was tested. But the key sucess factor of Lidcombe is in my view that there are well-defined rituals for therapy; have you ever seen a religion without rituals? Humans need guidance and are habit aninals, and so do therapists. They love rituals even if the reasons behind the rituals are not so clear or well proven.



Here are a list of talks I will probably go to either because I like the topic, like the speaker, or have a low opinion of the topic or the speaker and see whether I can resist asking a critical question. Remember this is therapist land, the land of consensus, so everyone is nice to everyone else even if they have another opinion or the research "findings" are obviously flawed! Actually, to be fair, most don't realize that the methodology is flawed. So here they are (see program here):



Angela Morgan & Sheena Reilly, Murdoch Childrens Research Institute Functional brain activation differences for motor versus language regions in adults with and without stuttering: An fMRI study



Lesley Kuhn, University of Western Sydney & Ann Packman, The University of Sydney Looking at Stuttering Through the Lens of Complexity Theory Nicole Spindler, University of Goettingen Altered lateralization of cortical control of movement timing in persons who stutter



Sharon Millard,The Michael Palin Centre for Stammering Children & The University of Reading, Susan Edwards, The University of Reading & Frances Cook, The Michael Palin Centre for Stammering Children PCIT: Adding to the evidence Rosalee Shenker, Montreal Fluency Centre The Lidcombe Program 10 years later; what have we learned - One clinic's experience



Ann Smith, Purdue University New Windows on the Onset of Stuttering in Young Children Hans Månsson, University College Copenhagen Early Childhood Stuttering: A Systematic Framework of Predictive Factors for Persistence and Recovery



Naomi Sakai, Mejiro University, Japan Brain activation in adults who stutter under delayed auditory feedback: a fMRI study



Gerald A. Maguire, University of California, Irvine Medical Center Pagoclone, A Novel Nonbenzodiazepine, GABA-A Partial Agonist, Reduces Objective and subjective symptoms of stuttering



Tricia Zebrowski, University of Iowa Why Stuttering Therapy Works: The “Common Factors” Susan Block, La Trobe University, Melbourne Significant issues in stuttering: Managing stuttering in the next decade



Mark Onslow, Australian Stuttering Research Centre, The University of Sydney Treatment of Early Stuttering in the Real World: Lidcombe population research unveiled



Per Alm, Danish Information Centre for Stuttering & Uppsala University, Sweden Stuttering and Temperament, a review

New features

I have added two new features to my blog. First, you can now easily subscribe to a RSS feed. If you will want a button in your browser tool bar which gives you a drop-down list for all my recent posts. Click on posts or comments, and click on Atom, and then subscribe and select in Create in Bookmark Tool bar. Second, I have included a blog list, so you can read the latest posts from other stuttering blogs. I have so far only included three which seem to be most active or relevant. But please do tell me if you are of a different opinion.

Talk on Stuttering

3) BRAIN-COMPUTER INTERFACE MAY HELP PEOPLE TO SPEAK UP
Functional Magnetic Resonance Imaging (fMRI) is allowing scientists to identify the brain regions responsible for correcting auditory errors -- the differences between how we hear our own speech and what we expect it to sound like. Researchers are now feeding this information into refining what they call the "DIVA Model", a way of modeling neural networks that could enable the design of neural implants and brain-computer interfaces for people with damage to their speech motor output.

Collaborating with Philip Kennedy at Neural Signals Inc. in Georgia, Boston University's Frank Guenther is developing a brain-computer interface that records brain signals from a person's speech motor cortex and transmits them across the scalp to a computer. This computer then decodes these signals into commands for a speech synthesizer, allowing that person to hear what he/she was trying to say in real-time. With practice, using the synthesizer should help someone to improve their sound output.

The long-term goal of the brain-computer interface is to enable almost conversational speech for individuals with locked-in syndromes or diseases that affect speech motor output, such as Amyotrophic Lateral Sclerosis (ALS, or Lou Gehrig's Disease). Other applications of the model include stuttering, apraxia of speech, and other related disorders.

Dr. Frank H. Guenther will speak on Thursday, July 3 at 8:40 a.m. "Involvement of Auditory Cortex in Speech Production" (Talk 4aSCb1) in Room 250B

Neurology is not all

My posts often focus on neurology and genetics of stuttering. I just want to clarify my stance: Neurology is a necessary but not sufficient part of the story. Beyond any doubt, we cannot explain the whole spectrum of stuttering with neurological and genetic concepts alone. The vast majority of stuttering symptoms from stuttered speech, secondary symptoms, psychological and social effects are not directly due to a neurological problem, but in my view the reaction of a normally functioning human brain to an underlying neurological problem in speech production. Moreover, I am loosing hope that a breakthrough in treating stuttering will come from focusing on the underlying neurological problems. Maybe in the distant future, but not in my lifetime. Medication might alleviate but not fix. At the end of the day, rather ironically I predict that after understanding the neurology better, we will realize that the best treatment approach are the old and current ways of treating stuttering namely changing our ill-adapted behaviour and training our normally functioning brain to better cope with the underlying neurological problems in speech production.

You need to pray

“I can’t remember any prayer that I have prayed that has not been answered,” said Helen Catchings, 62, of Vienna, Va. God cured her of stuttering and gave her the resources for her home-care business, she said. And she said she has seen members of her church cured of cancer, brain tumors and other illnesses through prayer, baffling doctors. “I give Him all the credit,” Catchings said.

MTV True Life

Have a look at the True Life Series from MTV on the life of young people who stutter. I like the documentaries; they are well done.

• MTV
• Music Videos
• MTV Shows
• Entertainment News

Another example of confused thinking?

Everyone (including myself) repeat the mantra that it is much more difficult for adult stutterers to recover from stuttering, because they have been stuttering for so long and the stuttering has imprinted itself on the brain. I just realised that this statement is a good example of misleading and confused thinking: not completely wrong but also not 100% correct.

Imagine you are a driving instructor who has 100 novice drivers in your class to start with. Over time you sent them to the driving examination according to the level of skills learned. After a few months, you still have a few "resilient" ones that you either haven't sent to the exams yet or that have failed them. Now, surely you wouldn't say that it is difficult to make good drivers out of them because they have been driving badly for so long? You rather say that they have no talent for driving and are the worst talents left from a pool of 100 average novices.

Let's get back to stuttering. How about this simple explanation: Adult stutterers have trouble recovering because they are simply the worst talents left from the pool of kids who stuttered in childhood! They are the ones with the worst underlying issues and/or a brain with low brain plasticity! So they have trouble recovering not because of the long time stuttering but because they are a biased sample, namely the once who were unable to recover in more than 15 years?? Doesn't this make perfect sense?

OK. I am not saying that the "long term" in stuttering does not make it more difficult, but now I strongly believe that the main reason is that we are the worst of the pool!

Uncertainty kills us

Everyone knows the phrase:

People who stutter know exactly what they want to say but are just unable to say it.

In fact, it is much worse, because we also do not know when this temporary inability ends and the motor command is sent to our muscles. It could be a half second or 2 seconds later. I do not remember anyone mentioning this specifically. It's like your head being forcefully held under water and not knowing when your torturer is letting you breathe again.

Imagine a world where people who stutter know that they can pronounce the syllable one second after they experience the inability to pronounce. Well, we would just wait the one second and then say it. No need for additional panic or counter-measures, as we know that we can say it one second later. We have perfect certainty about our temporary inability.

Unfortunately, we are unable to predict the length of our temporary inability. We could be a split second away from the word, or stand there for seconds looking like a complete fool. And at the start every inability could be one of those disastrously long blocks. My suspicion is that a lot of stuttering symptoms are triggered, because we succumb to the time pressure and want to do something. Most stuttering therapies say that "it is about controlling your speech" when in fact you could as well re-interpret by saying that "it is about resisting triggering your symptoms in the face of time pressures from the uncertain length of the temporary inability to pronounce."

More fluency versus side effects

Here are some quotes from someone who tried Zyprexa:

"I am glad that I am off the zyprexa......my weight has reduced and I feel more awake again......its funny how you can get used to feeling less awake/alert and for it to seem 'normal'....its only when you come off the drug that you realise how it affected you."

".....in hindsight when I was on the zyprexa I actually felt quite lousy....tired and probably lacking emotion to be honest, its only when I am off the drug that I can see how it really affected me."

"My speech did improve while I was on the drug, I cant get away from that fact, and thats not just a subjective view, my wife and others did notice the improvement, however the possible negative health benefits were too much......"

Stutterers "can" sing fluently

As a regular reader, you know how much I sacrifice myself for the cause of stuttering. And here is another example. Myself and Einar have undertaken a dangerous self-experiment last summer.

Here is the abstract that I want to send to the journal:

In this article, we show that people who stutter are able to sing fluently. To test our claim, we set up a Karaoke system in Tom Weidig's garage. Two male right-handed stutterers ("E" and "T") were used. They each were asked to sing Robin Williams' Love Supreme. Our findings show that both subjects were able to sing fluently, and did not deviate from the controls. One of them, "E", sang noticeably better, however the other subject ("T")'s dancing and entertaining abilities were clearly superior. We speculate that the difference in singing performance was due to either the higher level of alcoholic consumption in subject "E" or an inherent genetic predisposition. We have included two video recordings below.

Subject "T" video (the faces are darkened on purpose in order to adhere to restrictions imposed to us by the ethics committee.)



Subject "E" video (the faces are darkened on purpose in order to adhere to restrictions imposed to us by the ethics committee)

Riitta Salmelin at Paris

Let me continue my summaries of the Paris conference workshop talks. The next speaker is Riitta Salmelin from Helsinki University. She is a professor and leader of the Language Perception and Production group. Check out her web page. She is actually a physicist by training like myself. I only briefly spoke to her at Paris. She is mainly interested in language perception and production per se, and studies stuttering as an interesting example to understand the general language processes better. That's fair enough, as long as we get interesting results from her lab!

She is best known for her MEG work on the stuttering brain. In fact, I believe that she is the only scientist who used Magnetoencephalography to study stuttering. MEG is a very interesting imaging method because it opens up a different world to the experimentalists: the world of millisecond changes of electrical activity of neurons as opposed to the fMRI world of "slow and stretched over time" pysiological changes in blood flow enduced by neuronal activity. I asked her why no-one else has done MEG, and she said: It is difficult to do! In the last years, progress on MEG has been considerable mainly due to new hardware and algorithms. MEG is especially useful to create movies of neuronal activity unlike fMRI. So you can see how activity goes from one region into another. Such timing studies are very important to establish causal relationships between different brain regions. For example with fMRI, you can only say that there is a correlation between two regions, but due to the low time resolution you cannot easily say which one was first.

Her talk was divided in two parts: first she gave a summary of her work over the last years, and secondly, she presented a newly developed MEG method that allows to extract relative timing directly. In a 2000 MEG study (see their Brain article abstract), they found abnormal functional activation in people who stutter even during fluent speech: earlier activation in left motor and pre-motor cortex but delayed activation in left inferior frontal cortex when preparing an utterance, and stronger activation in right motor and pre-motor cortex during speech production. From studies that contrasted silent to overt reading (which allows them to see which additional regions are involved in overt speech production), they interpret their findings as pointing to abnormalities in processes specifically involved in overt speech production rather than core linguistic analysis by stutterers. Moreover, she spoke about abnormal auditory processing in people who stutter. I cannot remember what her interpretations of these findings are. Then, she also spoke about the interesting observation that hand regions are strongly involved in overt reading, and speculates that stutterers do not have the same motor cortical specialisation.

Finally, she explicitly spoke about a new method of analysis called Dynamic Imaging of Coherent Sources (DICS) that they have spent years to develop, and which is now ready to go. Check out the abstracts here and here. The papers are quite mathematical, and I doubt any biologist or neuroligist will completely understand them. During her talk, she showed some graphs of real-time neural connectivity during reading, I think. They will apply (are applying?) their new method to stuttering, and I am very keen to see the results. We would hopefully be able to see what is really going on during stuttering and fluent speech in people who stutter.

In fact, I am getting more and more enthousiastic about MEG as opposed to fMRI and MRI which feels more and more like getting at the crime scene just after the murder or watching the crime far away rather than during the murder and close up, which is of couse much more fun! So be prepared to hear more about MEG in the future on this blog, and I will bet my money on this new approach to move the field forward.

50% late recovery rate!!!!

You should check out the article Late childhood stuttering by Howell et al from University College London. They write that nearly 50% of all stuttering children at age 8 recover! This result is a real surprise to me. I thought that the recovery is very low after age 7. (Actually, they all had treatement, so it is not really natural recovery...) You can read the full article here. Here is the abstract, but I suggest you read the real manuscript as the abstract is a bit vague.

PURPOSE:
A study was conducted that examined factors that lead children who stutter at around age 8 years to persist in the disorder when they reach age 12 years.

METHOD:
Seventy-six children were verified to be stuttering at initial assessment. When they reached 12 years of age, they were classified as persistent or recovered. A range of measures was taken at the 2 age points, and measures were examined by recovery group.

RESULTS:
Although the tendency for more males than females to stutter was confirmed, the reasons for this tendency are not apparent for these speakers. Different patterns in speech were observed: Severity ratings of the recovered speakers dropped by age 12+. The severity ratings for the persistent speakers remained high at 12+, and dysfluency types tended to change from whole words to part words. Persistent and recovered speakers differed on temperamental performance at around age 8 years and performed differently on sensory and motor tasks at age 12+ years.

CONCLUSIONS:
Stuttering in late childhood affects mainly males. The later a child attends clinic, the longer he or she will stutter. Speech patterns of children who persist diverge from those who recover or who are fluent. As speakers persist, there are temperamental, sensory, and motor changes.

Off to study

I am off this week to study for an exam. I have read 2500 pages in the last weeks, and therefore suffering from an information overload...

Intro to imaging

If you want to learn more about brain imaging, here is an introductory article. (Thanks to Dave for the link)

Christy Ludlow's talk at Paris

Christy Ludlow is heading a research team at NIH: see here. She is quite a dynamic multi-area scientist not only working on stuttering but also for example on swallow disorders. She has published an interesting article A Dynamic Motor Control Disorder where she and Loucks puts forward the idea that stuttering is a system disorder and that no single area is defect as such:

...the central control abnormalities in stuttering are not due to disturbance in one particular brain region but rather a system dysfunction that interferes with rapid and dynamic speech processing for production.

Admittedly, the article is very vague on details of an underlying mechanism, and does not provide proofs as such. They rather draw their conclusions on what makes most sense given all the observations on stuttering and related disorder. And, I completely share the system disorder idea and have written about similar ideas like the traffic-jam prone transport system of a city: see here. Actually, I have a hard time to see how stuttering could not be a system disorder given our current knowledge and the considerable variability of effects, and unfortunately also how you would actually prove this with the current data!

During her talk, she made a few interesting observations. First, 37% of people with acquired stuttering after brain injury reported that they stuttered as kids! Second, none seem to have lesions in speech and language areas but connecting areas. She also said that about 50% of the kids who stuttered after age 6 recover. (I have never come across this observation, but I do remember that my professor at Imperial College in London said that he stuttered as a teenager and then it went away...) And 50% of stuttering kids have concomitant (or in plain English "also other"!) disorders. She also spent time talking about possible models of a neural basis of stuttering and mentioned possible starting points like delayed or abnormal development of fiber tracts, genetic predisposition, and cell migration and neural pruning. A brain with such a starting deficit would then be modulated both neurologically and behaviourally by reaction to stuttering. But she did not commit to any specific direction. To be honest, I did not remember most, but I see her efforts as a clear attempt to put some meat on the bones of her system dysfunction idea from the above article.

India stutters, too

Please check out the Indian Stuttering Association: here.

TheStutteringBrain found a rare species

In my last post about Anne Foundas' talk, I mentioned that she hasn't come across a female left-handed stutterer. And I wondered whether this is a true effect or just statistical fluctuation. Well they do seem to exist, here is a reply to my last post:

..Long story longer, I read your post and saw that there is a dearth of left-handed female stutterers. Well, I just so happen to be one of those. Maybe I'll contact her!

New brain imaging on kids

I found this call for participants to a new brain imaging study. I haven't heard of the group before. Their study would be good to replicate the finding of Soo-Eun et al. and Watkins et al.

Columbia University Neuroimaging Study
Seeking Participants Who Stutter

Conducted by Dr. Bradley Peterson, this on-going research study is focused on learning more about the causes of several disorders that develop in childhood and adolescence. One of the conditions of interest is stuttering.

The study requires participants to agree to one or two visits, and includes an MRI scan which lasts about one and a half hours. This study requires a total of 6-7 hours to complete.

Participants must be between the ages of 6-14, can be taking medications, and also may have other diagnosed conditions in addition to stuttering.

No expense will be incurred by eligible subjects, and a modest payment for participation is being offered. Participants will receive $120, in the form of a gift certificate or a check depending upon age, as a "thank you" for being in the study.

Study location: Columbia University, NY State Psychiatric Institute, New York, NY

Contact person: Kristin Klahr - 1-212-543-6072 <mristudy@childpsych.columbia.edu>

Note: Those contacting the study coordinator to learn more about the project are under no obligation to agree to participate.

A new blog called StutteringMike

Here is a new blog called StutteringMike.

Anne Foundas' talk at Paris

Anne Foundas, a professor of psychiatry and neurology at Tulane University, gave the first talk after the morning tea break (with free French patisserie) at Paris. I had never met her before, but she is well-known for her pioneering research on the anatomy of the stuttering brain. She was one of the first to report anatomical anomalies using MRI, though apparently the early MRI studies on brain anatomy were quite delicate to do. She is also quite interested in handedness. Check out her web page: here, and a recent article.

Her talk was different to the other talks in that she had a more systematic, top-down, and conceptual approach. She talked about the different types of possible models: anatomical, functional, and timing. She also mentioned a two-factor model of stuttering mentioned in (Buechel and Sommer 2004). This framework is a bit similar to what I had in mind when I wrote about stuttering being a two phase disorder: see here. She also made a distinction between local and global anomalies, and wondered which combination is leading to stuttering. Many people have abnormal brains but not automatically abnormal functionality, and many disorders show similar abnormalities. Interestingly, they are still looking for a left-handed female stutterer, and they just cannot find one. Is it a real effect (i.e. left-handed women are much less like to stutter?) or is it just statistics? Here is my calculation: of all stutterers, 20% are female (1 in 5), and 10% of the population is left-handed, so 2% of the stuttering population should be female and left-handed assuming no gender effect. Lets imagine they asked N stutterers, they should find 0.02*N. I guess they asked a few 100, so there should have been a couple of them. So if you are female and left-handed, post a comment! She also talked about their belief of possible sub-types with the main deficit in either 1) auditory processing-linguistic and sensory processing, 2) motor functions - speech motor planning & production, or 3) attention-arousal-emotion. She also talked about her latest brain imaging results, but again I got lost with too many brain regions. But she did say that the cerebellum in recovered stutterers is greater, (which would make sense if it helps with compensation), and she said that the typical female brains seem to be more variable.

At the end, Christian Kell made a very intriguing comment: Given some similarities in abnormalities across disorders, he was wondering whether stutterers should really be compared to controls as opposed to those with similar atypical brain anatomy? Do they have something in common? To me, this opens a fascinating possibility namely that all disorders have similar abnormalities because they share a common factor, namely abnormalities stand for the failure of brain plasticity: abnormal brains mean lower brain plasticity. Kids have deficiencies, and only the brains with low abnormalities can compensate well, and therefore the persistent ones (in all kinds of developmental disorders) are a biased sample.

Soo-Eun Chang's talk at Paris

Sou-Eun Chang spoke second at the Paris conference. Soo-Eun is a post-doc and a trained speech and language pathologist. She was there together with her boss Christy Ludlow. They are based at Bethesda, close to Washington, at the National Institute of Health (NIH), a US government institution. I visited them at NIH in October at the same time as I visited a friend of mine who heads a brain imaging lab studying the visual cortex and with whom I often have discussions on neuroscience, genetics, consciousness, meaning of life (not very uplifting really :-), and politics. NIH is a bit of scary place: lots of security checks, the usual government big-brother-is-watching regulations with email and chat monitoring and the feel of a science factory with scientists as hens studying hens in their labs! But they have superb facilities, good scientists and the researchers are generally not dependent on outside money and hassled with writing millions of research proposals. It was Soo-Eun's first time in Paris, and she was probably a bit on a culture shock! Unfortunately, as NIH policy generally forbids their scientists to stay on after a conference, they had to go back the next day! What a shame! Check out their group's webpage for more references on their work: here.

Soo-Eun talked about her brain imaging work on older children, which we have already discussed on this blog. So let me first refer you to these posts: here, and here. She spent a rather long time on established stuff like the Ambrose and Yairi study on childhood stuttering and recovery (the group helped them with their study), on past brain imaging studies, and on how the latest brain imaging works (with very cool pictures and process diagrams), which was well presented but gave her less time to talk about her work and ideas. I always prefer to hear less in more depth from own work and repeated several times in different ways! This is especially true for all the brain imaging work, where people throw in all kinds of brain regions from different methods, one every 30 seconds, and I just get confused and have no time to digest. Too many details, especially because the terms are not second nature to me. But I cannot imagine that the speech therapists present actually understood what was said, and that the professional neuroscientists remember it all.

Soo-Eun's philosophy seem to be roughly: Stutterer's brains react to stuttering, and it therefore makes sense to look at younger brains to reduce the effect of brain plasticity. Not only compare with controls, but also compare the group of recovered and persistent early teens. Expect that even recovered teens show abnormalities, because strokes in recovered adult stutterers often make stuttering re-appear, and because the brain is well able to compensate for a deficiency to restore function if not normal structure. They choose 22 boys from the age of 8 to 12. Interestingly, she said that they choose to exclude nearly 50% due to other issues like ADHD. This is an important piece of information. I should have asked why they did not just scan them, and then analyse separatedly. As far as I followed, the two major results are: 1) Replication of white matter difference in a major fibre tract similar to what Watkins et al. and other studies found. Appararently, it is a major fiber tract supporting auditory and motor integration. 2) No replication of some gray matter differences from adult scanning results. (Remember: white matter are the neurons' tentacles connecting between neurons, and gray matter are the neurons themselves.) She also talked about the difference between recovered and persistent kids, but went too fast for me to digest or write down details. But recovered kids always seemed to be different to controls and persistent kids. So we should really be more precise when using the word recovery. We need to distinguish between functional recovery and structural recovery. Recovered kids generally seem to be fluent (functionally recovered) but still not normal (structurally).

After the talk, Peter Howell noted that some kids from the age group 8-12 are actually recovering from stuttering, and they might distort the grouping of recovered and persistent kids. He said nearly 50%, which sounds very high to me. But it might be true, and is good news for the Lidcombe treatment trialers to get more results out of nothing! :-) However, I guess they control this effect by monitoring these kids and if recovery is happening to do a further group analysis.