Do bats stutter?

Have a look at this news article on bats and stuttering. That's how you sell your research. Bats seems to have simple forms of speech capabilities, but whether this leads to a better understanding or treatment of stuttering is far fetched. But it might be interesting to study whether some stutter, indeed. Here is the text:

SAN ANTONIO, Nov. 5 (UPI) -- Scientists in Texas hope the study of bat brains may eventually lead to better hearing aids or new treatments for human speech disorders like stuttering.

Using ultrasonic microphones, researchers at the University of Texas and Texas A&M have discovered bats combine sounds into a basic sort of syntax that they use to communicate and express their individuality, The San Antonio Express-News reported Monday.

"There are no animals that can kind of speak," says Michael Smotherman, a neurophysiologist at Texas A&M who is trying to identify the areas of the brain the bat uses to coordinate sounds into songs.

Smotherman hopes his research will lead to better understanding of stuttering a dysarthria, a speech disorder characterized by poor articulation.

At the University of Texas in Austin, bat researcher George Pollak is trying to understand how the bats process the social communication sounds they hear and how they recognize individual calls.

Pollak says his research could lend itself to developing hearing aids that differentiate and screen out background noise.

Recovered and persistent kids show abnormalities

I have already spoken about the important brain imaging work by Soo-Eun Chang from Christy Ludlow's group at NIH, and the department of Speech and Hearing Sciences at the University of Illinois at Urbana-Champaign. Let me put it up again as it is very important. They looked at the brain of children who do not stutter, who recovered from stuttering, and who did not recover:

Previous imaging studies in adults with persistent stuttering found left white matter deficiencies and reversed right-left asymmetries compared to fluent controls. We hypothesized that similar differences might be present indicating brain development differences in children at risk of stuttering. Optimized voxel-based morphometry compared gray matter volume (GMV) and diffusion tensor imaging measured fractional anisotropy (FA) in white matter tracts in 3 groups: children with persistent stuttering, children recovered from stuttering, and fluent peers.

The results:

Both the persistent stuttering and recovered groups had reduced GMV from normal in speech-relevant regions: the left inferior frontal gyrus and bilateral temporal regions. Reduced FA was found in the left white matter tracts underlying the motor regions for face and larynx in the persistent stuttering group. Contrary to previous findings in adults who stutter, no increases were found in the right hemisphere speech regions in stuttering or recovered children and no differences in right-left asymmetries. Instead, a risk for childhood stuttering was associated with deficiencies in left gray matter volume while reduced white matter integrity in the left hemisphere speech system was associated with persistent stuttering. Anatomical increases in right hemisphere structures previously found in adults who stutter may have resulted from a lifetime of stuttering. These findings point to the importance of considering the role of neuroplasticity during development when studying persistent forms of developmental disorders in adults.

Let me rephrase in common language:

1) Brains of both recovered and persistent stuttering children show structural abnormalities.

2) Right side abnormalities in volume increases found in adults are absent in (recovered and persistent) stuttering children.

3) Stuttering in children is associated with left side abnormalities, and persistence specifically associated to white matter abnormalities.

Let me lean out of the window by saying that

1) The existence of right side abnormalities in volume increases in stuttering adults but not in children strongly suggests compensatory activities that made some right side regions grow.

2) These regions are mainly to blame for relapse in adults because they are more or less hard-wired.

How should the others behave?

I got an email from a student in speech sciences and she was asking about my opinion on what listeners should know when engaging in a conversation with someone who stutters.

1) There are no golden rules; different pws prefer different behaviour.

2) It would be good if they knew the basic facts about stuttering, e.g. high heritability, likely neurological cause, not due to nervousness, high variability of dysfluency from completely fluent to severe blocking, inability to say exactly what you want to say and so on.

3) Better understanding of stuttering itself automatically leads to better behaviour.

4) I am against rules on behaviour as they tend to make people mechanically following them.

5) The pws can do most to ease any tension and he/she has also a responsibility here. Unless you want to be the helpless victim. And after all, most have never seen someone like you before, so you should inform them that you won't bite them. :-)

6) It is practically impossible to educate the whole world.

What is your opinion?

Progress by death

In physics, we have the saying "Progress is not achieved by changing people's mind but by people with wrong ideas dying out!" or "Professors with disproved theories never change their mind, they die out." At the core of this effect is the mental bias people have for the theory they believe in. The mental bias is stronger the more you have invested. Just imagine a professor at the age of 50 spending 25 years of his or her life working a specific method or theory, and it is not working. I rarely see them give up, because they have too much at stake. There are some exceptions, but then they never had very strong beliefs.

And the same is true in stuttering. Very little people will change their mind, for example that stuttering might have a physical basis despite overwhelming evidence.

Should we go to China?

A reader wrote in response to my last post on the 2008 ISA conference in China:

Be interested on your views on China, read your blog. I am just a bit concerned about China - still seems to me to anything but a free country. I have a problem supporting an international meeting where your blog would probably be banned if you said anything critical of the government.

I agree that China is not a free and democratic country, and they would probably ban my blog if I said something critical. Especially, regarding my views on the Tibet and Taiwan issues. However, if I were the China ruler, I would probably also restrict freedom of speech and especially of movement of people around China with force if needed. China needs a smooth and slow transition from a state-planned economy and society to a more open society with a market economy. I suspect that the rulers follow this path even though they (have to) publicly endorse communism. But I could be wrong. Also, China is not a lawless dictatorship, and there is a rule of law in that you cannot easily be arrested without reason or evidence, thrown to prison and executed. Though the laws themselves obviously restrict political freedom and the people have no power to influence them. Russia is in a similar situation. I strongly believe that with the market-based economy leading to a greater exchange with other societies and improvements of quality of life the democratic forces are getting stronger and win in the long-term. So in a sense, I agree with both sides: keep on pointing out human rights abuses, and keep on controlling society to ensure a smooth transition.

Regarding support for a conference in China, politics does not play a direct role in my view. The conference is about people meeting up: stutterers, therapists, researchers, and others. It is a sign that China is opening up. (Of course, the Olympics is coming in 2008.) The conference could also have a significant impact for Chinese stutterers. It is important to talk about stuttering in the Chinese media, too. China has 1.3 billion people, 13 million stutter, and if only 1% reads my blog, I have 130'000 readers as opposed to 150 per day! :-)

To conclude, I support a conference in China but will not shy away from voicing my dissent on human right issues. What's your opinion?

北京2010 年 (Beijing 2010)

The next world conference of the International Stuttering Association is going to be in Beijing in 2010. I am convinced that they will produce a great conference. I have always been amazed by the sheer endless determination and intelligence of the Chinese people (apart from some political lapses... some of which might be understandable given the historical baggage). I wonder how traditional Chinese medicine treats stuttering. I have never been in China, but I definitely plan to go one day. So maybe the conference would be a good excuse. Here is the text from the ISA website:

It's official, the next World Conference of the International Stuttering Association will be held in Beijing, China in 2010. Yes, the newly formed Chinese Stuttering Association will host this world event in cooperation with the China Rehabilitation Research Center, Beijing Normal University and the China Medical Academy so it is sure to be a another well organised, well atttended, exciting and informative event following on from the previous ISA congress successes in Croatia, Australia, Belgium, South Africa, Sweden, Germany, USA and Japan so start planning ahead now to be part of this inspiring event. If you have any way you can assist our Chinese organising committee please contact the head of the conference organisaing committee, Zong-Shan Li at lzsh@ibcas.ac.cn. More information when it comes to hand.

Ben's brother stutters

This is a really cool song with a very cool BritPop/Rock sound. Check out Ben's brother's website and MySpace. I am wondering whether someone of them is stuttering or not. I am convinced they will hit the chart, if they haven't already. Just look at their very professional website, they are surely getting pushed by a record company.

Thx to Einar for the tip!

Wikipedia entry

I changed the Wikipedia entry on stuttering to reflect the latest empirical evidence from brain imaging.

There is little evidence of structural differences in the brains of stutterers. However, differences in auditory, linguistic and motor functions have also been proposed to account for the disorder. Research is complicated by the possibillity that differences noted between stutterers and non-stutterers are the consequences of stuttering rather than a cause.^[11]

to

"There is clear empirical evidence for structural and functional differences in the brains of stutterers. Research is complicated somewhat by the possibility that such differences could be the consequences of stuttering rather than a cause, but recent research on older children confirm structural differences thereby giving strength to the argument that at least some of the differences are not a consequence of stuttering.

I am sure someone is going to undo it again because it doesn't fit with their views. But I gave the references to the two new research articles by Watkins et al and Chang et al. I also noticed that they take out a link to my blog when I include it for further reading!!

Get a daily update on stuttering research!

If you want to get the latest research articles without reading my terrible comments and including those that I find boring, you can search "stuttering" at the PubMed website. The website has all published articles from the last decade or so.

You can even register at the website, and get an daily update for a search on stuttering. Just go to the site, register, confirm your email, do a search on "stuttering", "Save Search", and link to an email alert.

The taboos of the stuttering community

Every community has its taboo topics or words. Taboo topics are aspects out of our reality that are best not to be spoken about, certainly not to be discussed. Here are a few statements where you can get in trouble for even suggesting them for debate though they are not obviously wrong and at least debatable. In Japan: "The Japanese army is responsible for forcing Chinese women into prostitution during World War II." In Germany: "Not all Nazi policies were bad, e.g. the construction of Autobahns or the sense of community and purpose." In the US: "There is not reason why the US should have a special relationship with and blind support of Israel." In China: "The Taiwanese and Tibetan people should be allowed to decide their own destiny". Even in the no-taboo porn industry, there is a taboo topic: STDs!

Also in scientific debates we have taboos as the Watson and Larry Summers sagas show. You cannot ask the following questions without fear of being sacked. Here are a few examples: Do Blacks have on average a lower IQ and Jews on average the highest IQ among races? Are there innate differences between males and females that could help explain the high representation of male university science professors / Nobel Price winners and CEOs?

Do not expect a reasonable debate on any of these topics. The pattern is generic. First, the questioner is labeled a racist, Nazi-sympathiser, unpatriotic, sexist, or anti-semitic. Second, therefore these people are evil and stupid. Third, therefore they must be wrong. End of debate.

What are the taboos in the stuttering "community"? Let me know what your thoughts are. Here are a few candidates:

- Many stutterers prefer not to listen to people who stutter, and do not want a partner who stutters.

- Stuttering is a handicap, and stutterers cannot do every job.

- There are stutterers who did bad things. For example, we have Ben Johnson, the Canadian super sprinter who was convicted of doping. He is never mentioned as being a famous stutterers. How about criminals, serial murderers, and rapists.

- Most research in stuttering, especially those conducted by therapists, is a complete waste of time, and those low-quality researchers should be told about this rather than being congratulated for "the hard work they have done".

- Stuttering can be completely explained in scientific terms.

- Stuttering medication could well be helpful to people who stutter.

- Treatment for children is still not proven beyond doubt to be effective in the long-term.

- The majority of those who talk at conferences and claim that they cured themselves never actually stuttered severely.

- There is nothing physically wrong with *some* covert stutterers.

- The use of the word "holistic" is a reliable measure for poor quality in thinking.

- It is a good and necessary thing to take on crackpots and undertake every action possible to limit their ability to spread their message.

Taboo word No. 1: Cure, cure, cure, cure.

European Symposium on Fluency Disorders

There is a new conference coming up in Belgium in April 2008: the European Symposium on Fluency Disorders: see here for more information and a detailed program of speakers. The conference is organised by Kurt Eggers who works as a lecturer and clinician at the Lessius University College. I met him at the Oxford Dysfluency Conference in 2005, I think. He is currently doing a PhD on the role of temperament in stuttering and his PhD supervisor is Luc de Nil.

I will attend. It is only 2 and a half hours away from Luxembourg. The most interesting speakers for me are Luc de Nil with a summary of past brain research, and Nicole Ambrose on possible genetic factors for subtyping. Some talks are given via video conference link which is an interesting concept. I'll be curious how it works out!

Crackpot award for Bodehamer

I have decided to continue my crackpot awards: see here, and here. But I am now going to include anyone who proclaims theories on stuttering that are completely ignoring well-established neuroscience facts on stuttering from the last 10 years. I mainly think here about structural and functional brain differences in young and adult people who stutter, and about genetics. Bob Bodehamer is a "good" example:

The cause: There could be several causes for blocking including genetic predispositions and/or developmental problems. However, our concern is not primarily about the first cause of blocking. Our concern is with what has continued the behavior. We believe that it is the meanings placed around those early experiences of struggling to speak that have become well learned which continues the behavior. This explains how most children grow out of stuttering while some don't - it is about the meanings that the child placed around the behavior.

This statement is just plain non-sense in the light of the most recent research. He permits that these first blocks could be triggered by genetics, and these blocks are enough to learn bad habits which results in long-term stuttering. So what happens to the genes afterwards? Are they self-destructing and not play a role anymore? Also, brain scans clearly show that the brain structure of adults and young people who stutter is different than fluent speakers. There is a physical manifestation. People who stutter do not have misplaced meaning, they have misplaced brain structures. In fact, what is happening is that the physical cause STAYS THERE even for children who recover, and provokes learned behaviours for those who don't.

He should stop playing the theoretician. Science is not theology, his day job as a Southern Baptist pastor. The empirical reality informs the theory, and not the other way around. I just hope he at least does not think that the Earth was created 7000 years ago. If he wants to contribute constructively, he should acknowledge that stuttering has a clear physical component. And no-one is disputing that the effects are also learned behaviour. And here is where he can use his NLP to minimize the effects, but I doubt it is any more effective than other treatments.

Shameless advertising

This is just so bad and fits perfectly with what I alluded to in my tirade on media portrail of stuttering: see here.



I am wondering whether she is still using the device. Would be great to have her write a post on this! So if anyone knows her, let her know that I would love to hear from her.

Trial Start: DCM vs Lidcombe

Good news from Marie-Christen Franken! She has now received funding for a large-scale trial to compare the demands & capacities treatment to the Lidcombe treatment. And they have already enrolled children.

They have already published a pilot study: see here. Based on a relatively small sample and no long-term outcome measure (both are essential for a good trial!), they could not see a difference between both treatments:

This pilot study compared two treatments for stuttering in preschool-age children.Thirty children were randomly assigned to either a Lidcombe Program (LP) treatment or a Demands and Capacities Model (DCM) treatment. Stuttering frequencies and severity ratings were obtained immediately before and after treatment (12 weeks). The stuttering frequencies and severity ratings significantly decreased for both treatment groups. No differences between groups were found. Parents of children in both groups were cooperative in many respects, and there were no differences between them on scales that measured their satisfaction with the two treatments. The findings suggest that randomized controlled trials of LP versus DCM treatments are feasible, and they underline the need for experimental analyses of the two treatments. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe the principles and methods of Lidcombe treatment for early stuttering; (2) delineate principles and methods of Demands and Capacities Model treatment; and (3) summarize results of an investigation that compared these programs' relative effects in a pilot study.

I am very curious what will come out. My guess is no big difference between both treatments. Though I am concerned that the statistics and research design like in the Lidcombe trial will be flawed. Another interesting twist would be to have a third non-treatment arm.

Meeting Marc Shell at Harvard

As you can see Marc Shell has changed a bit over the years. I guess this is what happens when you become a professor of comparative literature at Harvard University. Marc even has his own wikipedia entry, and of course he stutters. He recently wrote a book on stuttering, literature and his own experience called Stutter.
I met up with him on my East Coast stop-over from my California trip back to Europe. Boston was my first stop. The day started badly. I had arranged two meetings with two professors and they both canceled at the last minute, but then agreed to meet up upon my insistence. In the morning, I had a meeting with a professor at Harvard Business School who also wrote a book on venture capital, like myself. Mine is called Exposed to the J-curve. In the afternoon, I was supposed to meet up with Marc at 4:30. In the mean-time, I was sitting in a coffee shop at Harvard Square soaking in the atmosphere with free WiFi. And I played chess against the scrubby "chess master" outside in order to uncover him, but much to my surprise he was a true chess master with international rating and I lost all my games and money! I also have international rating and played in the World Junior Championship for Luxembourg but I am not at master level. Then I went to the English department, but Marc Shell didn't show up. I was just about to leave when the secretary run after me and called me back.

We had a good discussion on stuttering and on stuttering research. We especially talked about how more money could be channeled for stuttering research. Though I have to admit that at first it was a bit surreal to watch Marc Shell in action when the discussion turned from daily talk to intellectual. His words were chosen in such a way that my mind went blank. I mean I heard his words but didn't understand what he was saying. When science meets the arts... I noticed that his words are more loaded with specific meaning. So when I say functional I mean something that has a function, but he probably gives it a more specific meaning in the context of a given theory. He also comes up with many interesting subtle connections and ideas which make logical sense but are often not necessarily of relevance to explain the basic aspects of a phenomena.

Phase III Pagoclone trial delayed?

I know how interested every here is in stuttering medication, especially Pagoclone and its clinical trials. Some time ago, I posted a press release from Indevus about their intention to start a Phase III clinical trial in the first half of 2007: see here.

However, as of October 2007, I do not know of any evidence that the Phase III trials have already started, except the existence of waiting lists for the trial. (If you are currently part of such a trial, please let us know.) I can only speculate on this delay. First, any kind of project is often delayed by a few months for any reason. And therefore there is no reason to be concerned. Second, Indevus might have become more hesitant, and are having second thoughts. Such a re-evaluation might be in terms of efficacy, or in terms of a business decision. A re-evaluation also often happen irrespective of efficacy concerns after changes in management, the board of directors, or general strategy. For example, if Pagoclone only applies to a minority, the profit estimates might be severely affected. Such trials are very expensive, often in the tens of million dollars. On the other hand, an approved drug would have significant revenues. Indevus might also underestimate the potential market even as a "minority" drug, and therefore find the risks too high. One concern might also be their cash burn rate, i.e. they spend money without getting money back soon, and they might be looking for a partner like a venture capital fund or another pharmaceutical company to share the risks: see this intriguing conference call one year ago. As I said, I am only speculating by putting myself in their situation, based on public knowledge and based on my understanding of corporate thinking.

We will find out in the next months. However, should Indevus decide against a Phase III trial, which I hope they won't, do not expect a press release. Indevus has already stopped Pagoclone as an anti-anxiety drug and for premature ejaculation, I believe, and a third U-turn would reflect badly on them. A more likely scenario is that they postpone and delay release as long as possible, and the news appears somewhere in an annual report on page 130 in terms of a lack of provisions for Pagoclone. For example, the year-end 2007 balance sheet will be audited in March. So, the longer the trial is delayed, the higher the probability that they have indeed changed their mind.

On a side note, a detailed article on the Phase II clinical studies has not been presented at any conference or published in a peer-review journal, as far as I know. The only information comes from the Indevus press-release and conference calls to analysts: see here. However, at some point, such an academic discussion with a closer look at the data must happen.

Let's hope that this post is a storm in a teacup! Let me know when some of you are participating in a Phase III trial.

Trying out medication: Week 4

Here is the four-week report on taking Zyprexa: see here and here for earlier reports:

Four weeks into the Zyprexa Zydis and so far, so good. The first week or so was very tiring indeed, my energy levels were sapped and I was very sedated. After about 10 days my energy levels resumed and I felt fine. My facial ticks/secondaries are all but gone, as I don't have to struggle so much to get the words out. In the past my stomach used to get into knots from forcing out the words, this has also stopped as the words seem to flow better. I no longer think about speech all the time, its a refreshing change after 30+ yrs as my mind seems clearer and I can focus more. I am less anxious in speaking situations. I am still a stammerer, don't think that this drug is a "magic cure" because its not, what it enables me to do is relax and seems to make the speech timing improve as I don't have the blocks anymore when initiating speech. Weight gain has been slight - I would say about 5-6lbs, however my weight fluctuates by 2-3lbs per week up and down anyway, and I can exercise off this weight gain without any worries. To sum up....."So far so good"........ My doctor said that when he saw me after 3 weeks, he could see an improvement in my speech and my eye contact. I will be having a blood test at 6 week and may well increase the dosage to 10mg as long as the sedation effect is not too much. I imagine that this treatment works better on some sub-types than others, and its working so far. I will let you know what the blood tests show in 2 weeks.

The second brain paper

The second article is now in press at NeuroImage. The main author is Soo-Eun Chang, a post-doc in Christy Ludlow's group at NIH (National Institute of Health) in Bethesda close to Washington DC. She is a speech and language pathologist by training. I had the pleasure to meet up with her and Christy for lunch on Wednesday before I took the plane back to Old Europe. Our discussion topics included their work and stuttering medication.

Here is their abstract of Brain anatomy differences in childhood stuttering by Soo-Eun Chang, Kirk I. Erickson, Nicoline G. Ambrose, Mark A. Hasegawa-Johnson, and Christy L. Ludlow:

Previous imaging studies in adults with persistent stuttering found left white matter deficiencies and reversed right-left asymmetries compared to fluent controls. We hypothesized that similar differences might be present indicating brain development differences in children at risk of stuttering. Optimized voxel-based morphometry compared gray matter volume (GMV) and diffusion tensor imaging measured fractional anisotropy (FA) in white matter tracts in 3 groups: children with persistent stuttering, children recovered from stuttering, and fluent peers. Both the persistent stuttering and recovered groups had reduced GMV from normal in speech-relevant regions: the left inferior frontal gyrus, and bilateral temporal regions. Reduced FA was found in the left white matter tracts underlying the motor regions for face and larynx in the persistent stuttering group. Contrary to previous findings in adults who stutter, no increases were found in the right hemisphere speech regions in stuttering or recovered children and no differences in right-left asymmetries. Instead, a risk for childhood stuttering was associated with deficiencies in left gray matter volume while reduced white matter integrity in the left hemisphere speech system was associated with persistent stuttering. Anatomical increases in right hemisphere structures previously found in adults who stutter may have resulted from a life-time of stuttering. These findings point to the importance of considering the role of neuroplasticity during development when studying persistent forms of developmental disorders in adults.

We'll find out whether Neanderthals stutter

Check out this interesting article: Neanderthals May Have Had Genes for Speech. The scientists have found FOXP2, a gene that in humans is known to relate to grammar/speech, in Neanderthal DNA. It is fascinating that we can now look at ancient DNA.

Once we have singled out the stuttering genes, we can also look at whether Neanderthals have these genes. Maybe they got extinct, because they were stuttering much more that modern humans!!!

Meeting the Inghams in Santa Barbara

The weekend before last I drove up North to Santa Barbara to meet up with the Inghams. They are both professors in speech science at UCLA at Santa Barbara and clearly among the leading scientists in stuttering research. They were so kind to invite me to stay at their place. They have a fantastic house in the hills of Santa Barbara. Roger Ingham showed me around in his BMW with the words "I like it much better than my Ferrari that I had before"... :-)

We had very good scientific discussions but also engaged in gossip. They were not too enthusiastic on medication to reduce stuttering due to lack of good evidence. I was questioning how this fits in with several reports (see previous blog posts) from people who stutter who took a medication and said they improved. The discrepancy might be due the existence of sub types. Or because the gains are not overt, but internal. I argued that stuttering is not just a malfunctioning of communication of the message from the person who stutteres to the listener, but that stuttering also affects the mental creation and therefore quality of the message. People who stutter either spent a lot of efforts avoiding or generating fluent speech or dealing with secondary symptoms and states of anxiety. This leaves them much less room to create good messages. I am so much better at creating messages when I stutter less and am not under time pressure. And, the medication might make this easier. Or, there were no improvements apart from placebo-enduced and due to weak methodology.


I also discussed with Roger Ingham his past, current and future research. He has a multi-million research grant and still works very closely with the brain researchers around Peter Fox in San Antonio (Texas). The Inghams go to Texas and stay there for longer periods of time, though they did not express great admiration for San Antonio's beauty. Regarding research, they are clearly moving in the direction of theory testing using methods like TMS (knocking out brain regions temporarily) to test causality, and dual tasks and fluency-enhancing setups to control the driving variables of stuttering better.