Part of the problem

Here is an analogy that captures an important aspect of stuttering: the swallowing-a-pill analogy.

When you drink water, you swallow the water without a problem. When you have to swallow a pill, you might choke on the pill. Being aware of swallowing makes us choke.

Being aware of stuttering makes the stuttering worse.

Guitar calls Lidcombe critics ridiculous

Barry Guitar launched a frontal attack on those who are doubting Lidcombe in this radio interview on NPR. The journalist Jane Lindholm asks Guitar why some doubt the evidence base of Lidcombe due to small sample siz. He says that "This is the most ridiculous critique you can imagine". Check at 7:30 minutes. He refers to 100 studies showing efficacy with gold standards. He says that critics don't want to see 100 studies but 1000s studies. He also says that other treatments have no evidence at all that they work.

He falls into the common traps:

(a) equating perceived success in an outcome trial with success of the method itself. (it could well be that other treatments are as effective, and success is not due to Lidcombe specific issues.)

Fraud and weak research

Maybe you heard of the scandal where a study "established" a link between vaccination and autism, and parents (mostly mothers) in the UK went nuts and stopped vaccination. This study has now been severely discredited.

Ora made me aware of an interesting article about the quality of scientific research in the psychological and social research area. See Lehner's article.

An interesting article in the New Yorker magazine about a phenomenon in scientific studies. 

Before the effectiveness of a drug can be confirmed, it must be tested and tested again. Different scientists in different labs need to repeat the protocols and publish their results. The test of replicability, as it’s known, is the foundation of modern research. Replicability is how the community enforces itself. It’s a safeguard for the creep of subjectivity. Most of the time, scientists know what results they want, and that can influence the results they get. The premise of replicability is that the scientific community can correct for these flaws.
But now all sorts of well-established, multiply confirmed findings have started to look increasingly uncertain. It’s as if our facts were losing their truth: claims that have been enshrined in textbooks are suddenly unprovable. This phenomenon doesn’t yet have an official name, but it’s occurring across a wide range of fields, from psychology to ecology.

I suggest you read the first page (screen) and then stop and think hard what might account for this effect, before you read the rest of the article.

More of the Australian gold standard

Here is an article for all those that claim that Lidcombe never claims to work magic.Even if you argue that the journalist got it wrong and they don't claim cures, you must wonder how the journalist came to the idea of "cure". This fits well into the last post where the therapist suspected the child's family to be the cause of the "non-cure", because she too was indoctrinated with the "cure". Here is the article.

Online remedy for stuttering
Nick Galvin
May 2, 2010

Relief may be at hand for millions of people around the world who stutter, thanks to the pioneering work of Australian experts.

The Australian Stuttering Research Centre in Sydney has won a federal grant of nearly $5 million to develop a system that sufferers can access via the internet. The simple program has cured pre-schoolers in 12 weeks.

''Parents ask kids every now and then to say what they just said without the stutter,'' centre director Professor Mark Onslow said. ''It works amazingly well but the problem is that there aren't enough speech pathologists to deal with all the kids who are stuttering.''

Tom: You have been out-handicapped

As you might know, I am an active member in Toastmasters, and regularly participate in contests. Last Saturday, I participated in the Area contest (after the club contest) but I didn't make it to the first three of eight. All eight were very good speeches. I spoke about The King's Speech. An Indian guy won with a speech on Mr Impossible who tells us not to try, and he had polio as a child leaving him with difficulties in walking. He had a very good theme, and comes across as a very nice guy and relaxed speaker. After the contest, someone came to me and said that he liked my speech, but said that I should move and speak of other topics than stuttering, which I agree with, and he finished off by saying: "Tom, great speech but you have been out-handicapped". ;-)

In any case, everyone liked my speech, so here it is:

You helped me find my voice

In this grave hour, perhaps the most fateful in our history, I send to every household of my peoples, both at home and overseas, this message, spoken as I were able to cross your

Lidcombe never fails, only parents do

Here is a comment from a mother in which she says the therapist blames them for the relapse, because Lidcombe works so it must be the parents:

Hi, my son has been on the Lidcombe therapy for 3 months seeing a SLP almost every week in that time. We saw a big improvement for the first few weeks but after that his stutter pattern has returned to how it was before, some days really bad and then a gradual decrease to hardly any problems and then over the next week it becomes worse again. It seems now the therapist is at a loss at to what to do and seems convinced something is happening at home to make it keep getting worse and then better which is insulting. She has blamed my husband because hes in the army and works away alot, then it was my eldest son because he left for uni, nursery, and now she seems to be pointing the finger at me, saying he has to much of an attachment to me (surely if this was the case I wouldnt be able to leave him at nursery). Im so frustrated with the whole experience and feel were no further towards helping him that we were before we started the course. I hope other people have a better and more productive experince from this course. I feel it is more suited for children with less severe stutters xx

I am not going to the Oxford Dysfluency Conference

Some good news for some! I decided not to go to the Oxford Dysfluency Conference. It's just too expensive. First, I was not given the reduced fee unlike at all other conferences in the past including Oxford. Apparently, Elsevier is not allowing this. And then they charge 20% VAT, because Elsevier organises it and not Dave Rowley as part of his university. Claiming back VAT is about as easy as understanding stuttering. So I would end up with a bill of over 1200 Euros for 3 days. Too bad. It was a nice place, and an OK conference.

The only person non-sensitive to the price are those who are paid for by government and on blind travelling grants. I also heard that others from less well-off countries or therapist not funded by their department are unable to attend.

In general, conference organisers like Elsevier are destroying real science and draining the system out of money with expensive conferences and journals.

Death to Elsevier and long live Plos and privately-organised conferences! There is a BSA conference one week later. Maybe I am attending it, and try to get a few people together to talk science.

Breaking News: Chinese dopamine genes not-confirmed

Finally some evidence that stuttering research is actually following the scientific method. In a highly unusual move, Drayna's team has actually tried to replicate a study rather than churn out new stuff. They looked at the Chinese gene study, and could not replicate the study.

Kanstantsin made me aware of this new study (that was probably finished years ago but only now published! So the wider community was deprived out this valuable information despite Drayna being funded by the publicly-funded NIH). He writes:

Drayna is one of the authors. of "Evaluation of the association between polymorphisms at the DRD2 locus and stuttering."

They basically tried to replicate the 2009 study from chinese group (I think you blogged about it). [Yes, I did in More Genes from China!] "Association between dopaminergic genes (SLC6A3 and DRD2) and stuttering among Han Chinese."

On the origin of our feared letter

I had an interesting thought. I am currently revising a late draft of my upcoming book, and I have a section on stuttering. I was writing about associations with different letters that stutterers might acquire. So for some the letter /d/ might be a problem for others the letter /m/.

Then I realized that /d/ is the first letter of /daddy/, and /m/ of /mommy/. So I was thinking that maybe we develop an association between a stuttering event and the letter that we most or first used as a child in speaking our first words.

So a child might first say /mommy/, and obviously she will first experience delays of speech initiation on the letter /m/. And the brain will look for correlations, and realize that when I have to say /m/, I am likely to have issues. So the brain stores an association between the letter /m/ and a stuttering event. My guess is that if you fear /d/, you might have been a daddy child! Or in other languages, /p/ for /papa/.

Students: here is a final year project: test my theory!

1. find stutterers 
2. ask them about their feared letter.
3. ask them whether they were mummy or daddy children.
4. find stutterers from different countries where daddy does not start with /d/ or mother not with /m/.
5. analyse data: especially compare countries.

Stuttering WWII general

Nathan found a stuttering WWII US general:

This was never mentioned on any famous PWS list. Apparently there was an American WWI and II general who stuttered significantly. Here is the Time Magazine article. The stuttering isn't mentioned until page 3.

A stutterer reads the news: Please support Alex's campaign!!

I got a request from Alex von Gudenberg, who created and leads the only healthcare-approved clinic for stuttering in Germany. They have launched a campaign for more public awareness. Please support his campaign. They have asked for the news to be read by a person who stutters! Luckily only one day! ;-)

Dear fellow stutterers,

I am the director of the Institute of the Kasseler Stuttering Therapy (KST) and was a severe stutterer.

By chance we created a campaign against discrimination of stutterers in Germany, which is becoming quite successful. The film maker Henning Burk, a stutterer himself, did a report for a TV station (3SAT) about stuttering in our institute when The King's Speech started. He had the idea to ask for stutterers to read the prime time news in the two major German channels to achieve more tolerance and attention for stutterers.

It started more as a campaign without real chances of realisation. But now a website with information and on-line signing of the petition exists: HERE.

Stutterers in major German cities supported this campaign by collecting signatures at the movie theatres, in addition to press releases and TV appearances in support of the idea. The German media (radio, TV, print media) jumped it.

About 1000 people have signed so far.

Therefore I wonder, if this might have potential for a worldwide campaign. It does not seem too ambitious to get Colin Firth and David Seidler and other as supporters.

What do you think of this idea?

Best wishes from Germany

Alexander von Gudenberg

(You can also email him: AWvGudenberg at Kasseler-Stottertherapie.de)

Slate Columnist Nathan Heller stutters

Nathan Heller has made me aware of his article on The King's Speech in Slate. Nathan works there as a columnist, stutters himself, and is a fan of my blog!

If you want to hear an intelligent and insightful review on The King's Speech: check out his article.

Amnesia cures stuttering?

Stuttering Stanley asks:

Tom, do you think that if a stutterer had sudden total amnesia, he or she would cease to stutter? I ask because I surmise that if I have times where I am fluent, then why can't I find a way to ALWAYS be fluent? Doesn't that indicate that I have the capacity to be 100% fluent? Maybe if I forgot about stuttering...it would disappear?

My answer is the following. If you have a total amnesia (where I include semantic memory but also associative memory), you will be like a young child at onset. You have a brain that is prone to abnormally long and frequent jamming or delays of speech initiation. These delays will feel long but just like a mechanical failure in the sense of accidentally hitting a chair because you had a glitch in your motor code for walking. You will not feel any fear or nervousness. And your jamming will probably only be noticeable in very stressful or demanding situations. And you will not have any secondary behaviour. However, over time you will feel the functional handicap and the social reaction. Coupled with your knowledge of what is normal speech and what role you want to play in society as a person, you will start to react to your jam-prone system and develop secondaries. You will add tension to get out what you want to say more quickly. You will also learn to fear certain words and situations. This associative learning will then trigger more stuttering and nervousness.

To sum up, your neurobiology is still there, and the information content that you have lost in amnesia will be filled again with learned behaviour, fears, and beliefs. BUT THEY WILL LIKELY TO BE DIFFERENT TO YOUR ORIGINAL LEARNED BEHAVIOURS, FEARS, AND BELIEFS.

You can be 100% fluent but only if you manager to control your jamming in two respects: (a) you take measures to reduce the neurobiological jamming, such as staying calm in demanding speaking situations, sticking to pauses, shortening your sentences, and so on (b) you take measures to prevent yourself/your brain from launching a reaction to jamming that is counter-productive to speaking fluently.

Wireless neurostimulation for stuttering?

Manik sent me a link to a venture capital enterprise, Microtransponders, which developped the SAINT™ System, a wireless neurostimulation technology platform to treat neurological disease. He is excited about a possible application to stuttering. Nature has already published an article on treating tinnitus in an animal model.

The website, technology, and research looks solid, and should not be rejected off hand. I will write to them and ask whether they have ever considered stuttering. I am not exactly sure how a treatment for stuttering should work. As far as I am aware, stimulation has only increased and never decreased stuttering. However, every new approach should be checked for.

Let us assume the technology works, would you accept having implants, even if very small, implanted in your brain? I can only see severe stutterers considering this option.

Another article on the King's Speech

A reader asks me to post this link to an interesting article (apart from the science part which is not wrong but very fuzzy.)

You are an inspiration and a hero to the stuttering community, and a
role model for children who stutter. PWS trust you to be independent,
fair, and not influenced by anyone.

You showed that PWS are not hopeless victims, but smart and driven.
You have hundreds if not thousands of loyal readers who support you
and thank you. But you also have a few enemies.

There is a article written by a female PWS (I am not sure she knows
much about the causes of stuttering, the way she explained it sounded
fishy to me). Can you post this on your blog.

http://www.timesunion.com/opinion/article/The-king-and-us-myth-and-all-1017358.php

No stuttering mice!

Currently, I am reading articles by science journalists in well-respected newspapers and magazines, telling us about the prospect of stuttering mice. And other highly inaccurate stuff.

I am nearly convinced that there will NOT be a stuttering mouse. The Drayna group claims that single mutations in one of three genes, forming part of a metabolic pathway, causes stuttering in nearly all cases. This finding needs to be replicated for me to believe it.

Consistent with their finding, they (or collaborators) plan to create mutations in mice, and see what is happening. They will most likely find subtle damage in some cell types in some brain regions, but they will not hear stuttering mice. People need to get away from the myth that a gene is coding for a special property. Genes deliver the instruction to create a protein, and in combination these genes can create complex molecules needed by the body. My theory is that the mutation only affects specific brain regions that happen to be responsible a stable communication between language and motor areas. Subtle damage to these regions leads to an unstable, low capacity speech system.

Quality of human discipline research

Ora writes

Beyond the familiar problems we've discussed - such as publication bias, the tendency to publish results which show something, anything, rather than nothing - we have the confounding effect of bad data.

Take a look at this NY Times article.  20 percent of the data is just wrong?!

From Freud to fMRI: Untangling the Mystery of Stuttering

There was a symposium on stuttering with Smith, Drayna, and de Nil organized by Nan Rantner.

This symposium will track current developments in the study of stuttering, the fruit of recent collaborations among researchers in the fields of genetics, speech motor control, and language processing. Until the past decade, much of the research into this common yet poorly understood communication disorder tended to be narrowly focused on accounts within a single discipline, from psychoanalysis to learning theory to articulatory control to hemispheric asymmetry. In this symposium, we will provide examples of the cross-disciplinary research that is changing consensus on the probable basis for stuttering. Recent advances in genetics, brain imaging, and speech motor control will be discussed in terms of their ramifications for better understanding this elusive disorder as well as treating it more effectively.

All are excellent scientists. However, they are foremost experimentalists and clinicians that work within their respective paradigm. Their challenge is to work on a cross-disciplinary theoretical framework on stuttering and I fear they will get slowed down due to a lack of 100% conceptual and theoretical rigour. I discussed with all of them. They are all bright, but no-one of them is an excellent theorist.They are very much in their experimental paradigm, and their talks suffer from 100% conceptual clarity. Ann Smith is the one with the clearest conceptual mind. But even she is in my view stuck in a single functional cause picture, as far as I remember from our short discussion at Oxford.

I find the mention of the name "Freud" in the title complete and utter kitsch. Why do we need to mention his name or work? Can we not focus on the here and now?

Different voice, no stuttering?

 An interesting self-report of a reader. I am wondering whether the change in voice in puberty affects stuttering. In a sense, the brain does not identify its own voice, and you might have the choral effect!! ;-) That's the first time, I hear this:

I've had MASSIVE fluctuations in stuttering around the time my voice changed. These were much more than a period of good or bad days. I was reduced to a complete absence of stuttering. I could not make myself stutter during these periods.

When I was going through puberty, I stopped stuttering for 2-3 months. I was reading fluently in class and I introduced myself in front of roughly 300 people. I was as surprised as my classmates and teacher were. I attribute this to my voice changing and I gradually relapsed. Around this same time I was becoming really popular so my confidence might have increased, but that might have been a side-effect of the fluency. As I was relapsing, the biggest change back to stuttering was when I got an ear infection, that caused fluid build up in my ears reducing my

Why apparent short-term success in Lidcombe treatment

Perti asks me a question about Lidcombe:

I am an SLP student who has been wondering about the Lidcombe program for a while [...] I've just been wondering about the Lidcombe success rates. How come the Jones et al (2005, British Medical Journal) had such a huge difference between the control group and the actual subjects. The field of stuttering is a complex one, as our professor said. One could fill a library with books that are all about stuttering and still none of them is absolutely right about it. The problem is that somehow they managed to pull off such a huge difference between the groups. The same incidents seems to occur with other studies as well like Miller et al (2009, American