Walking, talking, and sharing in the French Pyrenees with Paul

If you enjoy walking in wild natural environments, eating good food, and sharing your experiences with other like-minded people, this is for you!

In 2016 Paul Brocklehurst and Blanca Rubí are hosting a week-long retreat in the Pyrenean mountains, close to the French-Spanish border. Our aim is to provide opportunities for small groups of up to 10 people, all of whom have a connection with stuttering, to walk, talk, and share experiences in the midst of one of the most spectacular and beautiful natural environments that Europe has to offer.

There are still spaces free on the walk and talk. Both PWS and their partners welcome.

No, a quick cure for all is far away.

The author of this article is completely misinterpreting the likelihood of a cure: read here.

But of course that will prevent virtually no mainstream journalist and desperate pws to jump on the bandwagon.

Let me clarify the stuttering mouse hype:

1) this mutation as far as I understand occurs in 5% of all people who stutter. So even if those people could be cured, the remaining 95% would not.

2) even if the mutation is proven to cause it and we would know the causal link between mutation and neurobiology vulnerable to jams in the brain, there is no guarantee that the damage done by the mutation change be counteracted.

3) even if an antidote to the mutation can be found, e.g. by providing the body with the missing proteins that the mutation did not produce, the protein might have been critical for proper development of neurobiology and thus will only help children who are developing their neurobiology but not adult brains. A bit like it is too late to use better cement once the house is built!

4) even if an antidote exists, it is not clear whether it has side effects.

Nevertheless,

1) a hype for a cure, even if completely misguided, could lead to political pressure to put much more money into stuttering. Why are you financing stuttering research, you terrible politicians??? Do you want to be responsible that little stuttering kids are cured?

2) it is the first example of proving that genes are correlated with stuttering behaviour and untangling the causal link will definitely help us understand at least 5% of stuttering.

"Stuttering" mice make us fluent?

They managed to create a stuttering mouse, or let be more precise they created a mouse that has the same gene mutation than a subclass of people who stutter and that shows an abnormal "speech" pattern.

This is significant as we are moving out of the soft psychosocial research arena with weak research standards to a more rigorous research arena with full-time scientists who have been trained to this kind of stuff for many different disorders.

I predicted this development at the discovery of the gene mutation.

Read the article in Cell here.

BREAKING NEWS: The era of sub-typing has started!!!

OK, I am a bit late at responding but there are exciting new developments in the genetics and brain imaging of stuttering. And you should listen to StutterTalk's Peter Reitzes interview with Denis Drayna, but listen carefully and rewind a few times as he throws around all kind of protein names.

The essence is: We have found another protein complex (affected by other gene mutations) that disturbs the normal functioning of a nerve cell in very similar aspects as the previously found protein complex. Imagine you find that the postman has a limp and then you find that the postman's car is slow so you can argue that it is about the slowness of the mail delivery that is at the core of the problems. And that is also what Dennis suggested: at least some stuttering might be part of issues with "moving things around in the nerve cells (which can be quite long)" which are suspected causing all kinds of neurological disorders.


And I am happy to hear that they do what I asked them to do: Only brainscan people with the same mututation! This is the way forward in my view.

Of course we need to be careful:

• not all stuttering is driving by this.
• neurodevelopmental issues could affect similar areas but are driven not by gene mutation 
• Dennis knows much more about but again we have to wait years until he publishes it. ;-)

Will I meet you in Antwerp on February 27th?

What Causes Stuttering with Dr. Soo-Eun Chang

Check out Peter's interview with Soo-Eun Chang, who is a neuroscientist from the Speech Neurophysiology Lab at the University of Michigan and specializes in brain imaging young children: here.

If I get time, I will listen to the interview in full and make comments. After only 5 minutes of listening, I already have a different take on some statements! ;-)

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

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

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

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

I often criticize the Australian but they did the right trial to look into it. An article on An investigation of the role of parental request for self-correction of stuttering in the Lidcombe Program. by Donaghy, Harrison, O'Brian, Menzies, Onslow, Packman, and Jones gives the answer I expected: nothing.

METHOD: Thirty-four parent-child dyads were randomized to two treatment groups. The control group received standard Lidcombe Program and the experimental group received Lidcombe Program without instruction to parents to use the verbal contingency request for self-correction. Treatment responsiveness was measured as time to 50% stuttering severity reduction. 

RESULT: No differences were found between groups on primary outcome measures of the number of weeks and clinic visits to 50% reduction in stuttering severity. 

CONCLUSION: This clinical experiment challenges the assumption that the verbal contingency request for self-correction contributes to treatment efficacy. Results suggest the need for further research to explore this issue.

So what really drives the treatment outcome?

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

Amino acid supplementation seems to have worked for one reader

I get many emails from readers telling me about significant changes in fluency. One of them is John and he agreed to share his story with us. Read below about his search for an explanation to his sudden fluency. He would be happy to discuss via email: john@1123interactive.com 


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

What drives treatment success according to Heather Grossman

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

I overall agree with this assessment.

Stuttering linked to rhythm perception deficiency

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

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

New DNA bank

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

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

Rehan Nasir from "Hello I stutter" visited me in Luxembourg

Rehan Nasir from the Hello I stutter blog visited me in Luxembourg last year... sorry I am a bit with my posts! ;-) We had a good discussion, a summary of which you can read in this post, and here is his email and story.

Tom,

I wanted to sincerely thank you for meeting up with me in Luxembourg last week. I really enjoyed the tour of your city as well.

I thought a lot about what you told me -- getting out of my comfort zone, breaking the associations that I've had for so long, and testing out theories with regards to speaking (as in, what's going to happen? I don't know -- but I won't die). So thank you very much for that insight. I will definitely write more about them on the blog, helloistutter.com
I wanted to finally send along a guest post (send some of your readers my way!) -- it actually does deal with a lot of what you said. Although it happened weeks ago (I've been slowly coming out for months now). I think you'd be proud of my determination.

Here goes:

I'm someone who stutters, and I'm someone who also likes to ride my road bicycle. But when I came to Saudi Arabia more than three years ago for work, I didn't know anybody who also rode. And since I was a covert stutterer, I didn't really ask around too much either. I would occasionally go on solo rides on the wide open roads we have in our small town, but I missed the camradarie of riding with even one other person.

SLTs that stutter

Oli writes:

I am an SLT student and a person who stutters. I run a website with details of SLTs/SLPs who stutter (here) to encourage others who stutter to consider it as a career. I noticed that, in a recent post, you mention a speech therapist who stutters and wondered if you knew of any others. Perhaps you would consider posting a link on your blog or asking your readers if they know of any.

Can you travel to Knoxville? Calling on all pws, cws, and children who have recovered!

Can you help Tiffani?

Calling all people who stutter, children who stutter, and children who have recovered from stuttering! My name is Tiffani Kittilstved, I am a person who stutters and a PhD student researching stuttering at the University of Tennessee in Knoxville, TN. 

For one of my PhD projects, I am recruiting local adults and children who stutter as well as children who have recovered from stuttering. Our general age group for kids is 7-12 but we are somewhat flexible in those ages (younger and older may be accepted, decisions will be made case by case). The purpose of my research is to better understand speech processes and how they are affected by stuttering. We use EEG technology, it is non-invasive and completely safe. The experiment involves sitting in a sound proof booth for about 1 hour and listening to tones/speech and discriminating whether the speech/tones that you heard are the same or different. It is a very simple task. The participant will be hooked up to an EEG machine via a cap that has electrodes built into it. This will record brain activation/deactivation in specific regions and allow us to understand what happens in the brains of children who stutter during speech perception tasks and how that differs from children who have recovered from stuttering. 

Participating in this research project will involve compensation and only cost you a couple hours of your time. So if you, or someone you know stutters (an adult or child) or has recovered from stuttering (child) and is in/will be in the Knoxville, TN area, for at least 2 hours, please contact me! My contact info is tkittils@uthsc.edu. Thank you!!!! 

Best, Tiffani Kittilstved

Test Mindool

Here is an example of an embedded Mindool into a blog post. Please click on list or procon to get one example.

Suvery on Multilingualism: Need input from SLTs

Graduate student Kimberly Martins writes:
As a Speech-Language Pathologist, you are invited to participate in an online survey research project collecting information on clinical practice in the evaluation and treatment of multilingual people who stutter around the world. This is an opportunity for you to contribute your professional experience working with this important population within the past two years. Completing the survey should take about 15 minutes. The survey is anonymous. You do not need to complete this survey in one sitting. If you need to, you can stop working on the survey, even close your browser and turn off your computer. Then return to the survey at a convenient time by clicking on the Survey Name below in this invitation to resume where you left off and complete it when you have the time. I appreciate your willingness to participate. Feel free to share this invitation with colleagues. 

Click here: Stuttering and Multilingualism Survey

The most important conclusions from the Franken study on early-childhood intervention

Here is my summary of the Franken study (see here and a StutterTalk interview) after a first reading. Add your comments if you disagree!


The two most important clinically relevant statements are

1. If your child has been stuttering for six months, does not have any obvious speech and language development issues and is treated by a specialist, it has a three-in-four chance to fully recover within 18 months of treatment.
2. It is not important whether your child receives direct (Lidcombe) or indirect (DCM) treatment.

Breaking News: The Franken study is out with the result I expected - No long-term difference between Lidcombe and Demand & Capacity early childhood treatment!

The Franken study is out. Agents told me about it several weeks ago! ;-)

It has by far the greatest sample size ever (200 kids!). They found no long-term difference between Lidcombe and Demand & Capacity early childhood treatment: here.

Anyone claiming that Lidcombe is the better treatment or the only one "scientifically" tested is "unscientific."

IFA conference starts tomorrow! I do podcasts, talks, and book selling!

I am leaving today for the IFA conference in Lisbon, the capital of the Southern European country of Portugal. A great way to meet people from around the world: clinicians, scientists, and people who stutter.

In cooperation with StutterTalk and the conference organizers, I will be recording podcasts from the conference, together with Chris Constantino. We will do daily wrap-ups but also conduct interviews with individuals. Peter Reitzes will do the editing work and put them on StutterTalk. I already did a trial podcast interview with Jelena on Stuttering Treatment in Serbia.

My interviewees include the main organizers Kirsten and Hilda, Nan Rantner (on early childhood intervention), Per Alm (on the causes of the moment of stuttering), Paul Brocklehurst (on the impact of long-term meditation on stuttering), and more.

I will also give two talks: Obstacles in measuring outcome of early childhood intervention (check out the Mindool on possible obstacles - you can add and like ideas!) and A novel biopsychosocial model catering for the complexity of stuttering.


The second talk (of which you can find an older version here) is closely related to my just published book on an improved version of the biopsychosocial model (more on my website BPS2.0, and in a published review article with Gilles Michaux entitled How the tower of information leads to an integrated framework for biopsychosocial ideas, see here.)

I will also bring copies of my new book to the conference. Here is a little teaser of the front and back cover!


So I hope to meet some of you at the conference!

#SaveYourPatience for Stuttering Awareness

Martin Sommer, neurologist and scientist from Goettingen, wrote to me:

I would like to inform you that we are launching a campaign #SaveYourPatience with English texts on youtube videos, therefore accessible to an English-speaking audience. 

You can find them here. 

The aim is to promote awareness for a specific need of people who stutter, using a novel publicity approach. You can help us a lot by sharing the youtube videos as much as you can. There are five videos that will be launched sequentially from May 1 to May 5, 2015. 

Best regards, and thanks for your enthusiasm and for keeping your blog always updated, 

Martin Sommer for the German Stuttering Association (Bundesvereinigung Stottern & Selbsthilfe) 

Join me to the IFA congress held in Portugal in July!

I will be at the IFA congress at the beginning of July in Lisbon in Portugal.

I will give two presentations, one on my biopsychosocial model and one on obstacles to measure treatment efficacy in early-childhood intervention.

I will also do interview and discussion rounds for Peter Reitzes' StutterTalk with attending scientists and clinicians. I plan to call them Hard Talk in the spirit of BBC's Hard Talk!

I hope to meet you in Lisbon!

And if you are from overseas and plan to add a European tour to your Congress attendance, visit me and Jelena in Luxembourg! We have a spare room...

To finish off, here's a picture of Lisboa.

Marie-Claude's nouveau livre sur le bégaiement

Marie-Claude Monfrais-Pfauwadel a écrit un livre sur le bégaiement entitulé surprise surprise "Begaiement, Bégaiements" chez De Boeck-Solal. Elle dit dans un courriel:

C'est un gros bébé qui m'a demandé un certain temps de gestation ! Mais ce n'est pas fini. Avec l'éditeur nous mettons en place une plateforme numérique dite NOTO à laquelle tout lecteur du livre aura accès grâce à un code personnel dans chaque ouvrage. Cette plateforme contiendra la version numérique du livre, mais aussi des chapitres augmentés, des vidéos, des cours, des articles des tutoriels que je vais poster au fur et à mesure. vous serez avertis de toute nouvelle publication par ma propre page Facebook Begaiement, Bégaiements et vous voyez s'afficher au dessous une nouvelle adresse mail dédiée à mon courrier professionnel Enfin je mets en place chez DeBoeck une nouvelle collection (Fluences et disfluences) de petits livres monographiques de 100-150 pages dédiés à l'un ou l'autres des aspects des bégaiements et de sa prise en charge...... Si le coeur vous en dit, je serai ravie de vous éditer dans cette grande maison qu'est DeBoeck qui est distribuée dans toute la francophonie. Et donnez de vos nouvelles ! cela me fera toujours très plaisir. Bien à vous tous Marie-Claude Monfrais-Pfauwadel Pour les courriers professionnels, merci dorénavant d'utiliser l'adresse mail suivante begaiement.begaiements@gmail.com

Dave Rowley died but our memories have not!

I heard that Dave Rowley died. I have known him for several years, and we met many times at conferences. He once invited me to Leicester to give a lecture on stuttering at his department and encouraged me to present at Oxford until Elsevier took over the reign and prevented him from offering me the reduced fee. He even asked me if I would help him organise the conference in the early days when his assistant dropped out, but his usual indirectness prevented me from only realizing it later! He was always a great fan of my blog, a regular and secret informant about the dodgy underground movements of the stuttering community, and liked to discuss stuff with me. I guess also because his calm personality could not make him say what I said but what he believed too! My condolences go to his family and those close to him!

Please leave your memories on Dave in the Comments Section.

Here is also Norbert's article:

Dave Rowley

A gorgeous spring day in London.

But there are news that turn the brightest day to dust.

Dave Rowley has suffered a heart attack. It was so severe that he did not survive.

Some of you may not know who Dave is. Only a few years ago, Dave retired as a Senior Lecturer at De Montfort University, after many years of teaching speech and language therapists their trade.

He has always had an interest in stammering which led him to a close collaboration with Lena Rustin, one of the founders of the Michael Palin Centre. They looked at the situation of stammering therapy from the two points of the clinician and the researcher – and decided to do something about this.

The result was the Oxford Dysfluency Conference (ODC), one of the biggest, and most important international Conferences about stammering anywhere in the world. It is only held once every three years, and last year he and Sharon Millard organised the 10th Conference, as inspiring as ever.

The Conference is also held in a warm atmosphere, calm, in quiet seclusion at St Catherine’s in the Thames meadows, away from the bustle of Central Oxford. It’s a restful place, with beautiful architecture. To me, the Conference has always been a reflection of Dave’s character.

I’ve had a number of quiet talks with him in Oxford last summer – all my talks with Dave would be quiet, and calm. He was relaxed, at peace, not easily unsettled. In the middle of any Conference crisis, he would be the calm centre.

He’s found happiness in Croatia and has uprooted himself and was building a new home there, a future snatched from him and from Suzana, and from all his friends.

There will be many appreciations of Dave, of his life and his achievements, in the days to come. But on this sunny Spring day, my thoughts are with Suzana and with his family. And I’m sad I won’t be able to take him up on his invitation to visit him in Samobor.

Norbert Lieckfeldt
12 April 2015

Censorship at the British Stammering Association Facebook page

Wow, I have just witnessed censorship on the British Stammering Association Facebook page. I saw this post and suddenly it was gone.

Interestingly, on another occasion some time ago, Norbert Liekfeldt has blocked me as a Facebook friend for my Facebook posts. Norbert has a problem accepting other people's views if they clash with his own ideology. Especially when they are politically incorrect according to him, which is not ideal for a neutral manager.

As you know, I am for full transparency and open debate. That's why I will post the screenshot here. Things need to be discussed (even if politically not correct) not suppressed! This has been a major disease of the last decade in the UK.

A very important question to Onslow and Packman

Onslow and Packman write in a response to the controversy of Lidcombe becoming the state-sanctioned treatment of choice:

"Indeed, if such evidence emerges for the efficacy of another treatment for early stuttering, we would encourage Speech Pathology Australia to approach the Australian government to consider it also for taxpayer-assisted support."

Here is the key question to them:

The Franken study has shown that there is no difference in efficacy between Lidcombe and a second treatment approach Demands And Capacities. So I ask:

As Lidcombe is effective (according to you) and the Franken study shows a similar efficacy for Demands & Capacities, does that constitute enough evidence to use Demands & Capacities in Australia too?

Deborah Theodoros has been misinformed about the efficacy of Lidcombe

The Australian Speech and Language Association's president Deborah Theodoros seems to be badly misinformed about the efficacy of Lidcombe as she wrote in her statement on Graig Coleman's concern about making Lidcombe the treatment of choice in Australia:

"early stuttering intervention at a level which is demonstrated to be highly efficacious and supported by the strongest level of evidence."

As I understand she is not an expert in stuttering so someone must have whispered in her ear and she refused, so far, to lend her other ear to an opposing opinion. Her statement is completely overblown. (check also my first response to the debate)

Let's deconstruct her statement: "demonstrated to be highly efficacious:"

This is simply not the case if you look at the long-term data and if you know, like me, the many cases clinicians tell me about where it did not work. Even Onslow, Packman, et al's recognize that

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.

To conclude, the treatment was not "highly efficacious" at all, especially if you compare it to the natural recovery rate of 70%-80%. And due to the small number of 29 children, the statistics are bad. And there was no control group to control for natural recovery, so you cannot actually judge the relative performance to a non-treated group.

The statement "supported by the strongest level of evidence." is, as you can see, completely overblown.

Deborah Theodoros should seek independent counsel on this matter to counter the notion that her statement and her association projects a certain carelessness regarding dissenting opinion. She cannot just hear the arguments of those that have worked hard to create and establish, and then also measure the treatment; a clear conflict of interest. All in good intention but nevertheless Lidcombe is neither "highly efficacious" nor supported by "the strongest level of evidence."

Lidcombe the only effective treatment in Australia?

US cultural imperialism, this time for good reasons, has struck Australia. The Australian government and speech and language association has plans to make Lidcombe the unique treatment option available for clinicians to treat stuttering kids, because it is the most studied and has been proven effective. As we all know, this campaign is very likely led by Prof Onslow and his people. He is very much Mr Stuttering in Australia, and sucks up most of the research funding and probably sits on the research council board to decide on other people's funding. He was also so kind to send me a nice letter from his university's lawyer a few years ago, and was very eager to have a few nice chats with the director of a Dutch researcher who wanted to compare Lidcombe with another treatment option - an episode that she has still not spoken publicly about. I wonder what would happen if she were to write an open-ed in a main Australian newspaper about this episode?

So as you see, we again need the Americans to police the world! Soft power of course. Australia deserves an opinion that opposes the opinion of the lords of the lands down under. A petition by Craig Coleman does exactly this:

Recently, Speech Pathology Australia (the national speech-language pathology association of Australia) submitted a proposal to the Australian Government Department of Treasury that would require Medicare rebates be made available for children who stutter, but only if they are treated using the Lidcombe Program. 

The ramifications for this action are significant. As expected, many speech-language pathologists from the U.S. and abroad do not support this action for several reasons. First, this action gravely limits the scope of treatment for stuttering. Many interventions for preschool stuttering have shown to be effective (Millard, Nicholas, & Cook, 2008; Yaruss, Coleman, & Hammer, 2006; Franken, Kielstra-Van der Schalk, & Boelens, 2005).

So what is my opinion?

To those obsessed by p-values

I have always looked with horror at the near religious and blind application of p-values in hundreds of stuttering research papers.

Here is a blog post discussing p-values:

The journal Basic and Applied Social Psychology has come out with a ban on p-values. To be precise, they've banned the “null hypothesis significance testing procedure” from articles published in the journal. This ban means that authors in the journal can’t claim that an effect they see in their data is “statistically significant” in the usual way that we’re all accustomed to reading.

Australian study screens baby's brains

Here is a report on an Australian research study which screens baby's brains. Those babies have stuttering siblings, which make them more likely to develop stuttering. How successful is this study going to be?

As always in Australia, Mark Onslow is involved. He was probably the person who worked hard to get the money and the people together, something he is good at. The outcome of his studies is not always so good unfortunately. First, the outcome study of Lidcombe early childhood intervention was problematic and a review a few years later was unable to locate all the kids who actually had taken part in the treatment. Second, there was a long-term study on stuttering on a large scale, but I haven't heard of the results at age 5, for example, even though the study should have those data. Long-term studies are always sensitive to many factors, e.g. people leaving, money running out, people using interests.

Lidcombe is dead: long live any treatment?

It took Peter years to get Marie-Christine Franken on StutterTalk. So enjoy the podcast! And it took her years to have the 2007 comparative study between Lidcombe and Demands&Capacities analysed and published: a true source of frustration to me as this is such a key piece of research to dispel claims of supremacy by Lidcombe. Already in 2012, they had the data but it took more than 2 years to write it up and get it published.

The listener will note that Marie-Christen is a bit scared of misspeaking and of her findings... She might be an overly cautious person by nature, but if a friend of a friend told you that she actually got bullied from someone in a distant land and was concerned about her job security, you can understand why she behaves the way she behaves.

The key statements are

• The large-scale study started in 2007 did not find a significant overall difference between the two treatment approaches: Lidcombe and Demand and Capacities treatment.
• She expects the study to be published within months.
• She refutes that it is only ethical to use Lidcombe.

How the tower of information leads to an integrated framework for biopsychosocial ideas

I have published an article with a friend of mine on a new framework on how to classify all drivers of human behaviour and experience. I have specifically designed it to include all possible drivers of stuttering behaviour in one single framework, and it turned out to be generic to all behaviour and disorders. More details on our website bps2.com.

Here is the abstract:

The biopsychosocial model is the prevailing conceptual model in relationship to which clinicians organize their analysis, evaluation and intervention. Since its promotion by Engel, little work has been done to provide a more solid conceptual basis for the relationship between the biological and the psychosocial processes in sickness and in health. We propose such a framework, using the perspective of life forms as information gathering and utilizing systems. We derive the simplest non-trivial model, the four domain model, which consists of the physical domains determining human processes: the environment, the body, the confined memories, and the communicable memories. We then re-visit Engel's case study to contrast our model with his systems approach, and apply it to issues in psychosomatics and the mind-body connection.

If you want a complimentary copy, please send me an email: tom dot weidig at gmail dot com

Check out and support Dylan's work!

My name is Dylan Madeley, and I've struggled to come to terms with two different aspects of my life. The first one set me on a path of frustration and retrying, constant self-improvement, bouts of social isolation, and has ultimately played a huge role in defining who I am today. The second one is stuttering, which I've lived with since about age five. In both cases, I spent some time running away in one form or another; in both cases, I have felt more whole as a person by accepting them and being more open about them. I live in a suburb north of Toronto with two chinchillas, write and copy edit for Auxiliary Magazine, and in my spare time pursue a career as a novelist. I have written one manuscript of minimum 50,000 words each year since 2008.

Since this blog has a stuttering/cluttering focus, I'll share my views about how these two things relate to each other. I took up creative writing a few years after developing a stutter, and my dad inspired me to tell stories. While I can't reach into my thought processes at the time, I strongly suspect that here I was with very real and seemingly insurmountable communication difficulties, immediately setting me apart from every other kid I knew (for years, the only other two stutterers I had ever met were two guys who also attended Sick Kids for speech therapy). The written word has its own challenges, vast and not perfectly understood by me at a

Ice Bucket Challenge Hijacked for Stuttering

Lecture material from Antwerp Stuttering Conference

You can find my presentation here. I talk again about how we need to find a common framework encompassing all elements that drive stuttering behaviour.

All other presentations are on this webpage listing all the speakers and parallel sessions here.

World Conference on Cluttering

If you are interested in cluttering, check out the website of the 2nd world conference on cluttering: here.

Fear of public speaking is the most common phobia among fluent people!

Source: BestMastersInCounseling.com

Facial expressions may lead to miscommunication during a business video meeting

Michael Yunat from GetVIOP suggested the below "infographic, where we demonstrate how facial expressions may lead to miscommunication during a business video meeting." More here.

Press release from The Stuttering Foundation

For Immediate Release

Contact: Greg Wilson

greg@curleycompany.com

571-239-7474 

Picture caption: Stuttering Foundation President Jane Fraser (second from left) honors authors Scott Damian, Dr. Alan Rabinowitz, Anna Olswanger and Vince Vawter during its National Stuttering Awareness Week gala at the Lotos Club in New York City.

Download picture  

                                                                   

Stuttering Foundation Honors Four Courageous, Inspirational Authors

NEW YORK (May 13, 2014) — To celebrate National Stuttering Awareness Week, May 12-18, the Stuttering Foundation (www.StutteringHelp.org) honored four authors whose recent books are widely acclaimed by both critics and readers alike.

Stuttering New York

I am back from my US / New York. Jelena and myself, we met a few people from the stuttering community. First of all, a big thank you to Ora, a long-term reader of TSB and a person who stutters, and Dan for their hospitality. I met Ora the last time I was New York when he had responded to my call through the TSB blog to meet up with people from the NY stuttering community.

I also met up with Eric Jackson, the ex co-host of StutterTalk and his fiancee. He is currently doing a PhD in stuttering (what else?), and they took us to a concert at Williamsburg. We didn't have enough to talk through details.

We also met up with Chaya, who is a person who stutter and an SLT. 

And finally, the American Institute for Stuttering (AIS) (many thanks to Carl Herder) invited me to give a presentation / lead a discussion round on stuttering research. I presented my framework that allows to describe all aspects of stuttering, and I talked about my neurologically based demands and capacity theory. But it was not a monologue (or at least I hope so!) with many questions and comments on theories of stuttering. Again, not enough time really. It was so noisy, and I asked Carl if he could close the windows, and Heather said: they are closed, it's Manhattan! ;-)

ELSA Youth Meeting this summer: Deadline is soon!

For young people who stutter and are under 28, go to a free youth meeting in the Netherlands. I was there and I really enjoyed it. Made friends for life. Check out the ELSA website.

Meet me on my US trip

I will be in the US from April 11th to April30th.

Meet me in New York, Tucson, or San Diego area! I am always happy to meet readers, especially if they stutter! ;-)

Contact me via email! My gmail address is tom DOT weidig!

Discuss with me at AIS in NY on April 17th

Come to the American Institute for Stuttering on Thursday April 17th from 6-7:30pm in New York. They invited me to talk about research in stuttering. There will probably be a round table discussion on the latest understanding, what the future might hold, and how it could impact treatment!

Stuttering: a short animation film

Check out Bertrand and Timmy's animation film about stuttering. I met them at the Antwerp stuttering conference.

Let me know what you think, and help the creators with your feedback!

Friday key note speakers at Antwerp ECSF Conference

I am sitting here in the entrance hall close to the reception desk of the Antwerp Conference.

Here is my report on the three Friday key note speakers:

The first keynote speaker was Ann Packmann. Her speech was about Exploring the relationship between treatment and causal theory in stuttering. She also presented her model of the moment of stuttering, developed by herself and Attanasio. She started out with talking about how one needs to find the cause for a heart issue and back pain before treating it. Unfortunately, that was not a good example, because many people now recognize the biopsychosocial aspects of these issues. Back pain and heart issue can certainly come from or be modulated by psychosocial causes, and treating the physical cause might not be enough. he then talks about  verbal communication & complexity theory. She correctly says that speaking is the most complex thing humans do and which sets them apart from other primates. She goes into complexity theory

Guest Blogger Richard Harkness: Stuttering's Primary Paradox and How it Tricks Us

Here is a guest post by Richard Harkness. If you want to be a guest blogger, please contact me.

Stuttering's Primary Paradox and How it Tricks Us (Richard Harkness) 

Some readers might remember me from workshops I've presented on the brain basis of stuttering and neuropatterning at National Stuttering Association (NSA) conventions in San Diego, Denver, Buffalo, and Atlanta. My most recent project was completing the new neuropatterning Home Course [http://neuropatterningforstutterers.com].

What I call the primary paradox, more than any other aspect of stuttering, accounts for the tremendous confusion that has always surrounded this perplexing disorder. It's easy to fall into this pothole.

The paradox is this: If PWS (Persons Who Stutter) can be fluent in some situations, why can't they be fluent in all situations? That is, why can most PWS speak fluently when speaking alone or to a pet--but stutter when aware of a human listener? And why can most PWS speak fluently when chorus reading (reading aloud in unison with someone else)? What could explain this except some kind of emotional or psychological issue? (This seeming paradox can be explained neurologically-by the excitation feedback component of stuttering-as discussed in The Two Components of Stuttering [http://neuropatterningforstutterers.com/?page_id=1056].

Arya Kumar Sinha believes that stuttering is totally curable.

Arya Kumar Sinha wrote to me that stuttering is curable. Read his email to me. I am not sure about his "By the laws of physics .Many-worlds interpretation , which successfully explained , loopholes of quantum physics , and today Dr. Stephen Hawking is a great supporter of this theory."

Hi Tom , I am Arya Kumar Sinha. I would like to contradict the view that is propagated in your web-site like stammering is not curable. My view is that : stammering is totally curable. I will place good arguments in favor of it. I am from India. At one point , I used to stammer severely with block/repeat on "A" "E" "I" "M" O" "U" "P" "D" "R" "L". From there , today i have achieved total fluency. I can speak fast like any normal speaker , without a single block on any letter. Why stammering is curable : The argument is : 1) Consider flipping of coin . P(head) = P(tail) =1/2. Similarly if we assume 2 states of stammering , then P(cure)=P(non-cure)= 1/2. So I rule out your 1st argument that stammering is not curable, by showing that there is equal possibility of both the cure/non-cure states. Its perfectly up to you to choose one. Both of these states exist in nature. 2) A computer i.e the logical processing area of a computer is composed of 3 parts. 1) Software 2) Operating system 3) Hardware. A programming error/bug appears if there is malfunction/error in the software part or OS or hardware. If in case of stammering there was a hardware error . then the individual would face it , while singing or while talking to himself. But in such cases a stammerer finds himself totally fluent thereby signalling that there is

100% guarantee that Anna Deeter does NOT make you stutter-free in 3 days!!

A TSB reader sent me the following email. If you have been in contact with her, contact the authorities!

You might be interested to take a look at Carl Herder's FB posting on Anna Deeter, an unlicensed speech therapist in California who's offering speech therapy in the guise of "training". Not only that, but a "I offer 100% success guarantee that at the end of the 3-day STUDY COURSE they will be stutter-free!! 

Carl is urging people to let the California licensing authorities know of her illegal activities.

Her program costs only $8000.

I suggest to Anna Deeter that she should charge the $8000 only after the person is cured. I am sure if she offers a 100% success guarantee, she is willing to wait for three days for the $8000! I would be very happy to give her the money for a cure!!!!

IFA Conference: July 6th-8th 2015

Here some information about the next IFA conference:

IFA’s 8th World Congress will be held at Catholic University in Lisbon, Portugal, where Jaqueline Carmona and Goncalo Leal are looking forward to serving as co-convenors. IFA’s Meetings and Conferences Committee received an array of excellent bids from Argentina, Australia, India, Portugal and USA. After careful consideration, the event was awarded to the bidding team from Portugal because their bid is the most advantageous for IFA and is responsive to the feedback received from IFA’s membership. Consistent with that feedback, holding the conference in Portugal will facilitate considerably more affordable congress registration fees. The 2015 IFA World Congress will be an exciting collaboration between IFA, ICA, and the Portuguese team, and will address stuttering, cluttering and other fluency disorders within its remit. This congress will also invite participation from the stuttering community, and will encourage collaboration between professionals and people with fluency disorders. More details regarding the 2015 congress will be published early in 2014, so watch www.theifa.org for more information!

Antwerp Stuttering Conference March 28th & 29th 2014

Check out the Antwerp Stuttering Conference on March 28th & 29th 2014: here.

I will be giving a workshop on how stuttering fits into a biopsychosocial framework. You find the 2012 version here.

I hope to see you there!

Let's meet up in New York, Tucson, or San Diego!

I will be in

New York (April 11th-18th),

Tucson/Arizona (April 18th-27th), and 

San Diego/California (April 27th-29th)!

If you live around there and want to meet up, send me an email tom . weidig @ gmail . com !!

Happy New Year to all of you!

I have not been very busy with my blog lately. I mainly posted links to events, and did not do a deeper analysis. Let's hope I have more time this year. Facebook has been taking up most of my time, and Luxembourgish politics. It's fun to see how that all works, but that phase of exploration is finite.

I am currently working on my book on the biopsychosocial model, and also in relationship to understanding stuttering better: check out the link.

Who can organise a cheap IFA congress?

IFA has sent around this email to its members seeking candidates for organizing the IFA congress 2015. I very much appreciate that IFA is seeking to organize a cheap conference where many different parties can participate, even those from less wealthy nations and those who are self-paying.

IFA’s Meetings and Conferences Committee has been working on a proposal for the 2015 World Congress to be held in Canada. However, we have been unable to contain costs to the extent that was requested by IFA members in the feedback received from the 2012 IFA survey.

Therefore, we are expanding our options with 21 months available for planning. We have received an expression of interest from a southern European country. For the sake of openness and inclusiveness, however, we would like to hear from any other groups that might be willing to host the 2015 IFA World Congress. Others who hosted the IFA’s World Congress have reported that it is a wonderful way to contribute to the mission of IFA and to “show off” your part of the world while gaining international attention.

Minimum requirements are:
·         Conference facilities for 250-300 delegates
·         Large main conference room plus two rooms for parallel sessions/posters
·         Good connection to international airport
·         Affordable/modestly priced accommodations nearby

To facilitate timely communication, please contact any member of the committee with your preliminary questions as soon as possible. We will need to receive your completed proposal by November 15, 2013.

Thank you in advance for your prompt attention to this request that promises to result in an exciting 2015 IFA World Congress.

Kind regards,
Hilda Sønsterud, on behalf of the IFA Meetings and Conferences Committee

What happened to this study?

Is anyone aware of the outcome of the dopamine study apparently completed in 2010 in the US: see here.

Senna herb gives fluency?

Blog readers often approach me to share their fluency "wonders". I cannot take away their experience, and believe that they indeed have had significant fluency gains. I can only disagree with their interpretation. I find that their stories follow a similar pattern: A takes X for Y. Suddenly, A experiences much greater fluency and is amazed that he/she can speak so fluently. Interestingly, they do not report 100% fluency but only a significant reduction of fluency. This pattern suggest to me that an underlying neurological issue is still present but that a change in brain chemicals (including being more relaxed or depressed) significantly influence fluency. I also want to warn you that I cannot check their stories or check their backgrounds. They could of course just try to manipulate me in promoting the substance because they have commercial interests in it. Anyway, here is the story:

About 6 months ago I had stomach issues so someone suggested to try senna herb it's known as a laxative for the stomach to make your bowl move after drinking the tea. So I bought the leaves from the Internet and started making it into a tea I started with not alot about 5 grams and 200 ml of water boil it for 5 min and drink it.. After 2 weeks or so I noticed a strange thing I started stuttering and blocking less.. M
aybe it was just a placebo effect. But continue using it the stuttering was i would say improved by 90% I would talk to people and not stutter, I would phone people and not stutter. I would have the occasional here and there but all in all it's such a big improvement.. Now the science part the stuff that makes u have diarrhea is senneniods in the senna herb that is what scientist have discovered. I am pretty sure it's not that that makes u stutter less. If scientists can remove the sennionds from the herb. I am sure there is something in this herb that doesn't make you stutter, if u cut down in it u will stutter again I tried leaving the herbs for 2 weeks and the stutter came right back. I hope someone can do research about this wonderful herb surely smth in it a chemical helps stuttering, I have given it to a friend who stutters as well after a while his stuttering was improved by 80%. Thanks thus was my experience with senna herb

Portuguese Stuttering Association: National Conference

On the 26th October, the Portuguese Stuttering Association will organize its VII Stuttering NAtional Conference. The program will be the following: 9:30- Opening session I and my stutter: life testimonies of people who stutter Speakers: Paulo Guerra, José Pedrosa, Tiago Almeida, Carlos Ferreira. Stuttering and employability Speakers: Maria Amélia Marques, André Carmo, Joana Caldas Success in therapy: What does it mean? Speakers: Iris Bonança, Brito Largo, Jaqueline Carmona, Gonçalo Leal, Mónica Rocha Rapporteur: Helena Germano SHGs and the online forum: The experience in Portugal Speakers: Rosa Paula Neves, José Carlos Domingues, Joana Caldas, André Caiado, Jorge Silva Commentators: Daniel Neves da Costa, Brito Largo 18:00- Closing session Registrations: members, relatives and students: 10 €, Professionals: 20 € Information and registrations on www.gaguez-apg.com

Please help researchers in Boston

Please contact Shanqing Cai (scai@bu.edu) to participate in a scientific study on the Rhythm Effect in Stuttering. It is very important that we help others:

The Speech Laboratory of Boston University is looking for volunteers who stutter to participate in an NIH-funded research on persistent developmental stuttering. Persistent developmental stuttering is a disorder of speech fluency characterized by frequency involuntary disruption of the normal flow of speech by syllable or sound repetitions, prolongations and blockages. It usually starts during early speech development between the age of 2 and 6 and persists into adulthood. This study focuses on the rhythm effect, also known as the metronome effect, which refers to the dramatic decrease in dysfluency when a person who stutters speaks to a regular rhythm. By using a combination of psychophysical and MRI techniques, we aim to elucidate the neural basis of this potent fluency enhancing effect in stuttering, which may also provide further insight into the basis of this disorder.

A letter from Africa

I received a letter from Dieudonn Nsabimana about an initiative on stuttering:

Background: Africa has a population of approximately 10 million people who stutter. Using the universally accepted incidence of stuttering What is the issue or challenge? Still now, People in Africa are not sufficiently informed about stuttering. Because of this lack of information, people who stutter are still mocked and humiliated. For now, almost all resources on stuttering are in internet in English language but 92% Africans people do not have access on internet And still now, there is also little information about any appropriate treatment for stuttering and almost, people who stutter in Africa, do not have access on stuttering therapy How we will solve those problems? AFRICA STUTTERING RESEARCH CENTRE have launch and have objective to promote research, to train Africans Speech & Language Therapists and to educate on stuttering in Africa About research, for moment a study on stuttering treatment from African Traditional Healers will be launched soon and a study of challenge and strategies on Telepractice in africa will be launched About stuttering treatments, Currently, Telepractice is only the therapy method that can be accessed by people who stutter in Africa. Call for applications Volunteer Speech & Language Therapists have launched and nine Therapists from America state have accepted to give stuttering therapy the PWS in Africa, first group will be treated stuttering, in this month of October About educate on stuttering issues in Africa, we have a project for translating, multiplication and distribution the many resources exist on stuttering For now we would like to translating, multiplication and distribution the fee books and brochures for America stuttering foundation The books and brochures will be translated in Swahili language. Swahili is most widely spoken African language. Swahili is spoken in 11 Africa countries and more than 120 million speakers. That makes Swahili the largest African language. Soon as possible we will be launched a fundraising campaign for raising money for translating, multiplication and distribution the books and brochures on stuttering in Swahili language, in 11 Africa countries What you can do for us: -You can interest Speech & Language Therapists in your community to be involved in research and stuttering treatment in Africa -When we launching our fundraising campaign, we would like that you can interest your community to be involved .fundraising campaign will be online fundraising on website Your contribution can help achieve a solution and I will be really appreciated all your great advice All the best, Dieudonne Nsabimana Kigali-RWANDA

Invitation to Second World Conference on Cluttering in Eindhoven

If you are interested in cluttering, Yvonne van Zaalen is inviting to the second world conference:

You receive this email because of your interest in fluency disorders. In 2014 the second World Conference on Cluttering will be organized by the International Cluttering Association (ICA). Let us all put the intriguing disorder of cluttering and cluttering-stuttering on the map. A good step in doing so is to forward this email to other Speech Language Pathologists that might be interested to learn more about cluttering. If you receive this message more than ones, that means that colleagues around the world are familiar with your interest in fluency disorders, especially cluttering. I hope you will take that as a compliment.

Yvonne van ZaalenChair of the ICA (ica2thworldconference@gmail.com)

Breast feeding may protect against stuttering???

Today, every single "science" news outlet jumped on the story that breastfeeding may protect against persistent stuttering: see a Science Daily post based on direct sources.

This is a hyped-up science story. Typically, a student does a study of ridiculously low sample size using a questionnaire asking about 100 questions. Then magically a strong correlation comes up. The PR department of the university gets to know about it, and off we go with a press release. If they are lucky, it's also a female student, so they can at the same time satisfy politically correctness and show that girls do great science!

The truth is of course that 95% of this kind of research is completely irrelevant, for various reasons. The biggest one is that the more variables you look for, the more likely one is correlated by chance. And even if you only look for a few variables. Ten students looking for few variables has the same effect combined with the publication bias. Only the one of the ten students finds a strong correlation by chance, and only their research gets paraded around.

And of course nutrients play a great role in giving the infant brain and its DNA the needed resources to create the best possible brain from what the DNA has in store. 100s of things can get wrong in an infant's brain development. But this story just does not make sense to me even on a theoretical level.

Here some sanity checks:

1) If this is really the case and as more girls recover, are we now suppose to believe that boys gets less breastfeeding. Of course not. So why do more girls recover if breast feeding is a key factor?

2) Millions of kids did not get breastfed, do they stutter? No! Do have they neurological deficits?? Not that I am aware of.

To conclude, the research is likely irrelevant, and its marketing damaging, and in my view unethical. Nicoline Ambrose who is known for sound research should have known better. At best, I accuse her of being naive about the media and not having reigned in the PR department of the University of Illinois at Urbana-Champaign for over-blowing this piece of research. Now, millions read this and are misled! :-(

Controversial honoring of Theo Schoenaker at the ISA-congress 2013

Robert van de Vorst wrote to TheStutteringBrain to make us aware of the controversial honoring of Theo Schoenaker who holds views that clash with science. Make up your own mind!

Controversial honoring of Theo Schoenaker at the ISA-congress 2013: Stuttering a neurosis?

By Robert van de Vorst

Recently, on the 10th of June in Lunteren, Theo Schoenaker has been honored for his pioneering work in the field of stuttering (see here). For those unknown with his work, Ton and Theo Schoenaker were the first to offer group-therapy for adult people who stutter in the sixties, under the name ‘Doetinchemse Methode’ (1966-2001). In 1974, Schoenaker emigrated to Germany where he became profoundly influenced by the Individual Psychology developed by Alfred Adler.

In short, based on a psycho-analytical approach, Schoenaker believes that (all) stuttering is a psycho-somatic disorder, a neurosis. He seems thereby to contradict evidence of stuttering as a neurobiological developmental disorder, including subtypes and genetic predispositions.

Visit me in Luxembourg

To all those that will attend the ISA Congress in Lunteren (The Netherlands), I will be there this Saturday and Sunday to attend a meeting of the consumer and self-help group of the International Fluency Association (IFA).

And as Luxembourg is less than 4 hours car drive from the venue, for any one coming from far take the opportunity to visit me in Luxembourg! My email is tom.weidig at gmail.com!

Switch to a new Reader of my blog feeds!

Keep in mind that Google Reader will be switched off from July 1st onwards. So if you haven't yet done so, use an alternative reader and transfer your links RSS feeds!

Enzyme related to Stuttering determined

I am in exam stress, but check out this article. Chemists have unravelled the internal structure of a protein linked to stuttering in 5% or so of the stuttering population.

This information is useful in understanding how the structure of this "abnormal" protein might cause neuro-anatomical difference in people's brains. But proteins complex 3D beasts that change their structure with temperature and pressure, so any clear cut statements might be difficult to reach unless in a few exceptions.

Post-doctoral position in neuroimaging of stuttering

To all scientists, check out Soo-Eun Chang's job opening for a postdoctoral position in neuroimaging of stuttering: see here. She is moving to the University of Michigan this summer to a position that was endowed for research in stuttering at a medical school, which is a very special opportunity!

Here is the job opening:

The University of Michigan Department Of Psychiatry is seeking candidates for a postdoctoral research fellow position in a brain imaging laboratory that studies the neural bases of stuttering and other related speech-language and developmental disorders.

And become a friend of her group's Facebook page, here.

Specialist course on stuttering

Check out the ECSF course if you want to do a specialist course in stuttering:

CALL FOR APPLICATIONS COURSE 2013-2014

The ECSF consortium would like to announce that the registration for the 2013-2014 course cycle is open. The ‘ECSF’ is a one-year program, providing both the knowledge and the clinical skills, to assist speech-language therapists in becoming European Fluency Specialists. The program is a well-designed combination of lectures, clinical practice and home assignments. If you are already working as an SLT, this specialization course is compatible with your current workload. Lectures are provided during two intensive weeks, scheduled during the academic year. These modules are combined with follow up sessions in the home country of the participant. The local sessions take place outside the intensive weeks. Preparatory reading and home assignments form an integral part of the course. The specialized clinical training, under supervision of a fluency specialist, can begin after the first intensive week. Application procedure and application forms can be downloaded here.