Presentations are now on-line

The presentations from the Antwerp conference are on-line: here.

You can also find my workshop: here.

And the title, abstract and summary:

3. Title:

From genes to social context: Understanding and treating stuttering in a biopsychosocial framework

4. Abstract:

Genetic, neurobiological, behavioural, cognitive, and social factors contribute towards the dysfunction and handicap experienced by people who stutter, and are also key to an improvement of the condition. In an upcoming book, we propose an overarching

Meet up with TSB readers in Zuerich.

Yesterday, I met up with Lukas and other people in Zurich who stutter. They invited me for dinner. Thanks! We had a lot of discussions on stuttering, on my upcoming book, on disadvantages of covert and overt stuttering, and on finance.

I will soon put up a picture of three of us... unfortunately the others had already left.

Joseph Agius: Using humour

Joseph Agius does what I want therapists to do, namely to talk about aspects of therapy. He chooses the topic of humour. His talk is quite funny. For example, he asked therapists whether they use humour in therapy (result: 95), and he asked patients (result: 20% use humour)

He then switched to gelotophobia, the fear of being laughed at, and how pws differ to fluent speakers. They only seem to be relevant to situations where stuttering is relevant.

He went too fast through the slides, so I cannot catch up, but he mostly shows how humour is affecting stuttering/psychosocial functioning and therapy. Some techniques are shifting perspective, exaggerating, word plays, and self deprecation.

Emergent topics, Neurogenic stuttering: Theys find that neurogenic stuttering is due to lessions across a network

She focuses on patients with neurogenic stuttering after strokes.

Many case studies are known.

She talked about prevalance, functioning, MRI scans, and aim to find the lession locations

She had N=37, 17 neurogenic stutterers and 20 controls.

9 areas of the left hemisphere showed differences between control strokes: all important for speech production. She suggest that the location lessions are part of a network that disintegrate and leads to stuttering.

Due to limited coverage, other area might not appear in this study. But her results are consistent with most current understanding of the neurobiological basis.

Interesting avenue, but i am not sure whether you can 100% relate to developmental stuttering. I asked whether there are differences in people who stutter since childhood and those due to a stroke. She said that some patients especially with Parkinson behave differently, but many are similar to "normal" stutterers.

After the talk, I had the opportunity to have an in-depth discussion on her research. An interesting aspect is that most patients are HAPPY to stutter as it is a sign that they improve because the stroke led to a temporal inability to speak.

Emergent topics, Vanhoutte: no results yet

She talked about speech motor, research done with her supervisor van Borsel.

She talks about preparatory loop and executive loop, and that timing is not right.

She studied temporal aspects of speech perception and production using EEG. They did silent reading of action words to get a clean experimental signal. These action words trigger a response in relevant motor/sensory regions, and that's how she can study motor perception...

She did not present any results... so it's a bit of a no talk... :-(

Emergent topics, Emotional reactivity & regulation: Ntourour finds difference

Katerina Ntourou talks about a similar topic than Haley. She wants to study emotional reactivity and regulation.

She tortured kids for science. She showed them toys, asked for the favourite one, and locked it away in a box! And she then gave them 10 keys to open the box, and they ALL didn't work!!! How did she pass through the ethics committee? :-)

Anyway, she then studied differences between fluent and non-fluent group. She found differences, but she went too fast at the end. I was a bit surprised that she said she found differences between the two groups look similar. I couldn't fully absorb it because it was all too fast..... :-(

I am somewhat concerned about the experimental set-up to measure emotional reactivity and regulation. It does not seem to be a very well controlled variable nor is the environment. As a past child who stuttered, I most likely suffered from social anxiety, and hated having to communicate with new people. Had I been tested in such a situation, the social anxiety would have made me more aroused quickly.So I am not sure about what exactly is measured. But as I said, it went too quickly, I would need to see it in detail.

Emerging topics from Antwerp, Autonomic arousal: Arnold finds nothing.

Hayley Arnold showed us research she conducted with MacPherson on the autonomic arousal in pws as compared to fluent subjects. We know that autonomic arousal may negatively impact speech motor control. So maybe pws have a higher arousal and so this might increase stuttering or might prevent them from recovering.

She did not find any significant differences between children who stutter and those who don't for different tasks elicitating autonomic arousal. Also, arousal seems to start BEFORE stuttering events. I don't find this surprising at all. Kids are getting anxious because they have to speak and then this makes their stuttering worse...

So CONGRATULATIONS for the courage of presenting NULL results! Signs of great science! Watch out those who always find something... :-)

Blogging from Antwerp

I am sitting in the lobby of Lessius College right now. Let me blog up the conference day of yesterday.

The conference started rather abruptly with Ludo Max's first slide showing us a typical box-arrow diagram of a brain function model: the standard model for motor control. Some people were probably a bit shelled shocked. In the past I spent some time understanding the different parts of the model, and I understood then after 20-30 minutes. But in the lecture, I didn't have enough time to regain complete understanding. But Ludo's strategy is pretty straight-forward. Test the different arrows of the model. And that's what he has done. Over the last years, he has rigorously tested the different parts of the system in people who stutter. I took part in one of them when I visited lab in Connecticut a few years ago. He explained the different experiments quite nicely. And he kept returning to the theme that pws learn slowly but they eventually get it. I liked his talk. But I am still not sure exactly what the results are telling us. Maybe the slow learning is a symptom for an on average inferior processing capacity in certain brain regions, but I am not sure slower learning caused stuttering to manifest itself. I asked about subtypes, and he agreed that this is an issue but it is not clear how to resolve this currently, on which I agree. He made an analogy with Eskimos' having tens of words for snow to discuss more subtle aspects of snow. But here, our great scientist is the victim of an urban myth: they don't! :-)

Marilyn Langevin's talk was a good example of what is wrong with clinician-turned-researcher research. She is a good, and foremost confident, speaker, and probably also a good therapist. But the informational content of her speech was low. She presented an outcome study of low standards and many potential flaws. I don't have time to list all the flaws, but here are a few: (a) low sample size, (b) highly biased overt measurements, (c) great fluctuation in sample (one person was highly dysfluent in year 1 sample and fluent in year 2 sample, so the fluency in year 2 is a result of treatment?? right... ) (d) potential sample bias (many did not reply to questionnaire) (e) focus on counting stuttering syllables. I challenged her on this, and she said that we should be happy with this due to the lack of funding and difficulty of getting data. Well, I never understand this pseudo-argument. Surely you cannot justify lowering standards, right? Either you can ensure good standards, or YOU JUST DON'T DO IT. I am especially sensitive to this area as I analysed the outcome data of a fluency shaping therapy with 300 or so patients: that is 300 not 10-15. And everything else was done more rigorously, and still I don't even fully trust these results. Unfortunately, this outcome got little exposure, and I am not even sure where Prof Euler published it. He did present it at an Oxford Dysfluency Conference.

The worst of it all was that she repeated words like "as a scientist", "the p-value", and "in science". Let me be clear, she is not a real scientist for me. She should have talked for 60 minutes about WHAT SHE DOES IN THERAPY, and not how badly she does research because a lack of funding and mishandling of statistics and set-up. I want to know about her experience as therapist.... drop "science" and focus on what you are good at!

Norbert Lieckfeldt spoke about clients' expectation of therapy. I was unable to attend, as I was preparing my own speech/workshop in the afternoon. He kept on saying after the speech that pws and parents want foremost better social functioning rather than fluency. He also supported this by some research from a communication research project. But I pointed out to him that in many other communication disorders parents KNOW that their kids' dysfunction is permanent and that's why they focus on better psychosocial adaptation. But in stuttering, parents and pws experience great fluctuations in fluency, and that's why their goal is also based on more fluency. Only later when many attempts of permanently more fluency failed do they switch to improving psychosocial adaptation.

Then we had the poster sessions. Unfortunately, I was busy with my talk.

The afternoon session was for young researchers. That was also one of the criticisms I gave for the last conference. I am happy they follow this path. All three speeches presented interesting topics. I am not going to discuss them here...

Then I had to go to my workshop. I had about 20 people in the audience. That's probably a good number because my room was on the third floor, and the others on the ground floor, first floor, and second floor. So I had to fight with gravity. I was not very happy with my delivery. I had too much to say in one hour, and left many concepts under-explained. I had two good questions at the end. I was happy they got my idea, namely to unify all frameworks into a single one. A Dutch researcher mentioned a similar model than mine, but when we talked afterwards, we realized that it was quite different.

After the day, I went to have drinks with Jelena, Paul, Max, and others who I am not sure want to be publicly associated to me! ;-) With one of them, I discussed the standards of research in the field. And we discussed the leaking of emails regarding the quality of PhDs from Australia. We also discussed my blogging style, and ways of changing it were gently suggested. ;-)

Then, two of them left for the official dinner for the conference VIPs. As Kurt Eggers noted this morning to the whole auditence: "I hope you all enjoyed yourself yesterday evening. We did, too!"

In the evening,

Battle of conferences?

Check out this new conference in Rome: website. I am not very impressed by the scientific committee and some of the key speakers. Looks like the Italian have gotten some funding and choose to invite the wrong people! ;-) We now have four conferences in the next four months. WOW. That never happened before. The one in Antwerp (I am attending), in Rome, in France, and in the US. I heard that this new conference is attracting some speakers that have cancelled for the other conferences. Are we starting to see a battle of the conferences? Might be a good thing..

German book on stuttering therapy

Einar recommded a book to me from his German therapists. So if you speak German, check it out: here. Please note that Einar still stutters, but seems to be a happy communicator. Actually, he sometimes talks far too much! ,-)

Clearer thinking within the Lidcombe community

Finally, reason seems to have come to the Lidcombe community in the words of Ann Packmann's article Why does the Lidcombe Program “work”? Mary Kingston, the editor of the newsletter Lidcombe News, quite neatly summarizes the Lidcombe community's mental bias by asking Ann to answer how Lidcombe works and not whether Lidcombe works. She does not even contemplate the thought that Lidcombe could not work!

Ann answers the how question with "I don't know" and the whether question is very much watered down to a level that I can more or less agree with. She says many things that  I have been preaching all those years...

It's time that the Lidcombe community tones down its claims, and listen to Ann's words. And maybe it's also time that Ann and Mark Onslow should switch posts. She should be professor and he senior research fellow. ;-)

Here are her words together with my comments. Take the time to read carefully!

.... It is a topic that has intrigued me for years, as I am sure it has most

Final Program of 3rd European Symposium Fluency Disorders

3^rd European Symposium Fluency Disorders

March 9 & 10 2012

Lessius University College Antwerp

The finalized program is available on the website.

Alcohol and stuttering

A readers asked me how drinking affects my stuttering. I had a very clear answer. I am a teetotal and I just don't know! ,-)

Generally two things happen. You can get more relaxed, you think much less about what other people think about you, and your motor control goes down. So I expect moderate drinking to ease stuttering, and severe drinking to let you loose motor control.

To be honest, I am not sure about research findings. People taking any drugs (psychoactive substances) report changes in fluency, but it seems to be different for different people.

So share your experience with us! Any drug is allowed! ;-)

Between acceptance and improvement

A friend posted on facebook: "if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid" I invented a reply: "if you let a fish be a fish, he will never become a lion!"

Both statements are relevant for stuttering. I receive many emails from readers asking for advice, and I am drawn between both statements.

People who stutter have clearly a neuroanatomical weakness in the brain that makes us stutter. Nature did not gave us the ability of effortless speaking. Yet, we want to climb that tree, and feel frustrated, inferior, unfairly treated, and angry. Why should we react in such a way when we are not at fault! We should not judge ourselves with those who have "normal" brains.

However, acceptance is very close to resignation, and might prevent you from achieving your potential. I very strongly believe that the majority of the negative psychosocial reaction to stuttering is due to our interpretation of life, and not due to the stuttered speech. Our abnormal brain region does make us fear, doesn't make us be embarrassed, and doesn't prevent us from speaking up. We learned that as children as a natural reaction. We must strive to be a lion even if it's unachievable. Only then can we improve.

So a clear advice is that you should work on reducing your psychosocial reaction and accept that you are a fish. I can clearly say that my handicap now at 38 is far less than at 18 even though I still stutter (and probably not less).

TED Talk on Stuttering

TED is famous for interesting thought provoking speeches. Many side TEDs have developped over the years, for young talents and for regions for example. This TEDxNewy talk is on Lidcombe treatment by Sarita Koushik. I know her, because we meet at the Oxford Conference some years again, and were part of the happy party gang. She is a nice person, but I must say that she has unfortunately been indoctrinated by the Lidcombe way of doing research. Her talk is very much in-line with the highly doubtful statistical approach to evidence based practise. Her research involves finding the optimal treatment schedule, and very likely a fata morgana due to huge statistical fluctuations. You already need 100 kids to just test efficacy of treatment. So how do you compare between groups of different treatment length??? I am nearly convinced she is chasing a phantom...

And I am not sure I like her stuttering at the beginning, because she does not actually stutter. What is your opinion?

Mother blames herself for therapy failure

Here is another story of a mother where the Lidcombe magic did not work, and again she blames herself because the scientific outcome studies are so convincing.So it must be her fault:

I am a mother of a boy who just turned four and has been in Lidcombe for over a year.  We have barely missed an appointment in that time and I unless my son has been sick I have always implemented the home treatement.  We live in Australia and attend a private clinic in Sydney... I guess the family history is pretty strong. 

...  Am even a bit nervous writing to you and reading your site, as of course I want to believe my son will speak fluently forever aqnd never know he stuttered.  After another relapse, and my son still being in stage one of the programme after approximately 13 months of non stop weekly treatment I have started to wonder what is going on and if there is other treatment available.  Also

Is Elsevier suffocating yet another stuttering conference?

Earlybird* member of IFA	€574.08
Earlybird* non-member	€693.68
Earlybird* consumer*	€418.60
Student**	€358.80
Conference dinner	€83.72

Have a look at the IFA Congress 2012 page, and see yet again what happens when the organisers are not doing the work themselves but outsource to Elsevier. Let me make a quick calculation: cheapest possible with early bird. The student fee is the cheapest with 360 € plus 80 € conference dinner. So 440 € plus 4 days accommodation (lets say cheapest 50€). So we are at 640 € plus travelling. Let's say from Britain: 150 €. So we end up with roughly 800 €. And that is the very cheapest! Which student can pay that, except if it comes from a research grant.

If you are a consumer (i.e. stutterer) or a therapist, you must pay at least 1000€. If you come from overseas, probably 1500 or more. That pretty much excludes all except the richest countries.

The key is that Elsevier is taking a profit and you have to pay VAT. And they would claim that they have to pay staff and website. But that is a semi-lie as their staff probably handle 10+ conferences each, and most admin is done by the website.

1.5 years to write four pages!

The luxembourgish audiophonological institute has finally managed to produce a leaflet for stuttering kids. It took them about 1.5 years for four pages, even though I have given them a corrected version of their old leaflet.
It's in German and French, and I have to say that at least I cannot disagree with what they wrote, only the infantile font they used. They used to write that stuttering can be due to psychological stress from their social environment but not anymore. Progress has arrived in Luxembourg. See here.

(Thanks to Lukas for telling me about stuff happening in my own country!)

Happy New Year!

I wish you all a Happy New Year. I know I have not been keeping up with my regular posts. The next months will be a bit stressful because I have to read 3000 pages for an exam (CFA Level 3) and I need to get my book published.

But I do have plenty of material for posts and try to make more time for the blog.You can find my prediction for 2012 on StutterTalk. As usual, I am not very happy with my StutterTalk performance. I keep on making grammatical mistakes, phrase my ideas in strange ways, or just have strange ideas. I am just not good at on the spot performance. I also see that at Toastmasters. I really need to work on that part more... The only type of short-term performance I am good at is making jokes on the spot. Or at least, I think I am. But trying to say something intelligent usually fails to be so...

Oh, and if you want to be a guest blogger, just email me!

BREAKING NEWS: ENDO STOPS PAGOCLONE.

I have breaking news for you. Endo, the phamaceutical company owning Pagoclone, will stop the trials on Pagoclone completely and focus on their core business model.

As I have already announced, the Phase II trials did not go well (or well enough).

A few thoughts:

1) Endo spent millions on this. Now you know why pharmaceutical companies need to earn a lot of money on successful drugs because they spent so much on those that don't make it!

2) People need to ask themselves why they were part of the hype. And why they interpreted the Phase I and IIa so positively.

3) Thanks to all those who have worked hard to run the random control trials, especially Jerry Maguire. I never shared their enthusiasm, but in science you need to take risks and try it out.

4) This trial has given us information about stuttering, just not the one we want. Endo now has a large sample of control data. We now know much more about the placebo phenomena in stuttering. That is very valuable information, if it is published in a paper...