Tim Poe: Not stutterer but mental issues??

And the story continues... He is apologizing for his lies, but insists that he did not lie. Does he have a mental disorder making it difficult for him to distinguish between reality and lies? Or is he just putting on a show?? He didn't seem to stutter in the interview either.

Does Tim Poe fake his stutter?

EVERYONE is asking the question..

Tim Poe has told lies about his life as a soldier, and provided a fake picture. He never got the Purple Medal for war injuries. But he seems to have been involved with the Army in some respects. No doubt the full story will emerge very soon.

So let's study his stuttering. As I wrote, I have never heard of a similar story, i.e. a non-stroke brain injury with such clear symptoms and no other apparent deficits at first sight. However, as his injury story is wrong, this fits with my observation that this case would have been unique. But he could have gotten an injury from somewhere else, too.

The real question to me is a) whether he stutters or not, and b) did he exaggerate his stuttering. I have to say that at first sight he sounds rather authentic. He stutters at the right places. However, as I replayed his speech over and over again, I noticed that his non-stuttered speech is very very smooth and controlled. And his stuttering is rather short and does not propagate into tensed non-stuttered speech. So he does not seem to feel a lot of emotional stress during the stuttered syllables. But he did have secondary symptoms during the stuttered syllables. So I am wondering about whether a middle-of-the-road theory is possible. He is a stutterer, knows how it feels to stutters, but has exaggerated his stuttering. Maybe he stuttered as a child. Or he is just a very good actor. Or he really did stutter as severely, and just invented the rest of the story to feel better about himself. And by telling that lie in a small social circle, for example with his fiancée, he might have had to keep it up as he entered the contest and then it just got bigger.

I have no idea. Except that he can sing. And his confident and calm singing must be the result of many many years of practise. His story that his therapist told him to sing in the shower and then he discovered his voice is not adding up, in my view.

And did he also learn to play the guitar while singing in the shower?? ;-)

But who cares... he is famous... and we are not!

P.S. I just listened to an interview with his fiancée. She sounds genuine, but just knows him from after the "injury". Either he had another brain injury and mixes up stuff. Or he completely made up the story...

Even neurogenic stutterers can sing

Check out the performance of this ex-soldier who got brain damaged. He stutters but he can sing like all people who started stuttering at a young age. I do not actually know of a similar case in the literature. And it shows that speaking and singing is not the same neurological pathway. Would be interesting to see his brain scans? I am convinced his damage is in one of the loci that Catherine Theys showed us at the Antwerp.

Treating stuttering with pharmaceuticals might harm you

A reader's comment on Holger's suicide:

I think it was the medicine that made him commit suicide not the stuttering itself. i really feel sad about him. I also used some medicines to cope with my stuttering. It really helps i was almost %100 fluent but it had serious side affects, i started to have memory loss, sexual disorder, i was always tired and sleeping too much so i quit, when i quit i get into depression and at some point i did not care if iam dead or not. before this drug i was always baffled when i heard someone committed suicide it seemed impossible for me to do it but after what i go through with the medicine i understood how those people feel. So if you ever think about taking drugs consider it twice. it really messes up your brain chemistry and i assure you that thats much worse than stuttering.

And another who tried it:

My conclusion is, right now, it's not the solution, but may have some positive effect on some people. My stuttering has been greatly improved by getting over the fear of it and accepting it. I believe you have written about this before, and perhaps part of why you joined toastmasters and participated in other activities. When I took the job that I have now, I knew that I would be faced with speaking often and in front of large groups. I had a lot of fear about that. However, now...the fear does not have as much sting as it used to have. 

The European Fluency Specialization

For speech and language therapists who want to specialize in stuttering:

CALL FOR APPLICATIONS COURSE 2012-2013 (download here) 

The ECSF consortium would like to announce that the registration for the 2012-2013 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.

Visual Outing...

An interview with me appeared in the biggest weekly t'Revue: here in German language.

A bit of a visual outing as I allowed them to publish pictures while I am stuttering. Pictures that will be seen by ten thousand people. And the pictures were filling the upper half of two pages! A bit like a Playboy spread! ;-)

Holger Stenzel is dead

I received the sad news that Holger Stenzel is dead. He was well-known in Germany and with international experts for his keen interest in stuttering medication and his self-reports on using medication. Holger was also a great source for my blog, and constantly kept me informed on stuttering medication.  Check out these few posts where I talked about Holger.

He once came to visit me in Luxembourg. I was certainly impressed by his level of understanding on the functioning of neurotransmitters in the brain. His day job was as an independent electrician. He tried a few medication and wrote about his experiences, but none was ultimately very effective. He had high hopes for Pagoclone. Too high hopes, which ultimately left him deeply disappointed and probably without a fall-back option, I think. Which should also be a lesson for those that create those high hopes...

I am really sad to see him gone. Especially, as his sudden death was of course not an accident, but his own decision. Which makes me wonder whether stuttering played a crucial role or not. We will never know.

Holger, Vielen Dank für Deine Arbeit und Deine Unterstützung. Durch Dich war ich und alle meine Leser immer gut informiert! Wir werden Dich nicht vergessen und an besseren Therapien und Verständnis des Stotterns arbeiten: Medikament oder nicht!

Stuttering-language connection?

I have always questioned the connection between language and stuttering. Clearly, adults who stutter do not seem to show any language deficits. I have not observed a deficit in myself, nor in others. Studies showing a connection therefore must suffer from statistical error (correlation by chance), sample error (clinicians only see the extreme cases, i.e. children suffering from multiple deficits), and measurement errors (language ability measured wrongly), if I am right.

Here is an article by Nippold from the University of Oregon questioning the connection.

PURPOSE:

This article explains why it is reasonable to question the view that stuttering and language ability in children are linked, the so-called "stuttering-language connection."

METHOD:

Studies that focused on syntactic, morphologic, and lexical development in children who stutter (CWS) are examined for evidence to support the following claims: 1) that CWS, as a

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.