Stuttering therapy explained

Stuttering therapy is any of the various treatment methods that attempt to reduce stuttering to some degree in an individual.[1] Stuttering can be seen as a challenge to treat because there is a lack of consensus about therapy.[2]

Before beginning therapy treatment, an assessment is needed, as diagnosing stuttering requires the skills of a certified speech–language pathologist (SLP).[3] Some of the available treatments focus on learning strategies to minimize stuttering through speed reduction, breathing regulation, and gradual progression from single-syllable responses to longer words, and eventually more complex sentences. Furthermore, some stuttering therapies help to address the anxiety that is often caused by stuttering, and consequently worsens stuttering symptoms.[4] This method of treatment is referred to as a comprehensive approach, in which the main emphasis of treatment is directed toward improving the speaker's attitudes toward communication and minimizing the negative impact stuttering can have on the speaker's life.[5] Treatment from a qualified S-LP can benefit stutterers of any age.[6]

In addition, people may learn to start saying words in a slightly slower and less physically tense manner. They may also learn to control or monitor their breathing. When learning to control speech rate, people often begin by practising smooth, fluent speech at rates that are much slower than typical speech, using short phrases and sentences. Over time, people learn to produce smooth speech at faster rates, in longer sentences, and in more challenging situations until speech sounds both fluent and natural. When treating stuttering in children, some researchers recommend that an evaluation be conducted every three months in order to determine whether or not the selected treatment option is working effectively. "Follow-up" or "maintenance" sessions are often necessary after completion of formal intervention to prevent relapse.[7]

Approaches

There are different approaches to stuttering therapy. There is no cure for the condition.[8]

Depending the child or adult, therapy is generally a management of speech comfort, and/or teaching techniques to speak in a controlled way.

Therapy for children

Treatment of stuttering in children younger than six years of age focuses on the prevention or elimination of stuttering. Families play an important role in the management of stuttering in children: therapy is usually characterized providing an environment that encourages slow speech, affording the child time to talk, and modeling slowed and relaxed speech.

The Lidcombe Program

Lidcombe therapy has involves a parent or some significant person in the child's life being trained and delivering treatment in the child's everyday environment.[9] In the program, family members are to provide an environment in which the child receives praise for fluent speech in the child's daily speaking and negative correction of stuttering. Some of the most effective preschool intervention programs call for direct acknowledgment of stuttering in the form of contingencies such as "that was bumpy" or "that was smooth".

Fluency shaping

Fluency shaping therapy focuses on changing all of the speech of the person who stutters. This type of therapy involves teaching the stutterer to use a speaking style that requires careful and prominent self-monitoring; examples of such therapy include one in which the stutterer slows his speech down or speaks in a controlled tone. This type of approach can reduce stuttering, although in children its effectiveness decreases if stuttering persists after eight years of age.

People who stutter are trained to reduce their speaking rate by stretching vowels and consonants, and using other disfluency-reducing techniques such as continuous airflow and soft speech contacts. The result is very slow, monotonic, but fluent speech, used only in the speech clinic. After the person who stutters masters these skills, the speaking rate and intonation are increased gradually. This more normal-sounding, fluent speech is then transferred to daily life outside the speech clinic, though lack of speech naturalness at the end of treatment remains a frequent criticism. Fluency shaping approaches are often taught in intensive group therapy programs, which may take two to three weeks to complete.

Modifying Phonation Intervals (MPI)

The Modifying Phonation Intervals (MPI) Stuttering Treatment Program is designed to be a computer-aided, bio-feedback program that requires appropriate software (MPI smartphone app) and hardware (a throat microphone headset) which records the phonation intervals, or PIs, from the surface of the speaker's throat.

The app records all PIs as well as speaker-rated speech performance measures.

The MPI Stuttering Treatment Program is based on a series of experimental studies by Roger Ingham and colleagues (Gow & Ingham, 1992;[10] Ingham, Kilgo, Ingham, Moglia, Belknap, & Sanchez, 2001;[11] Ingham, Montgomery, & Ulliana, 1983[12]).

The MPI Stuttering Treatment Schedule is divided into four phases: Pre-Treatment, Establishment, Transfer, and Maintenance. Each phase is designed to be managed jointly by the speaker (person who stutters) and the clinician. The Pre-Treatment phase is directed by the clinician, but the other phases are largely self-managed while also requiring regular validation by a clinician.

Stuttering modification

Stuttering modification therapy, also known as traditional stuttering therapy,[2] was developed by Charles Van Riper between 1936 and 1958.[13] It focuses on reducing the severity of stuttering by changing only the portions of speech in which a person stutters, to make them smoother, shorter, less tense and hard, and less penalizing. This approach attempts to reduce the severity and fear of stuttering, and strives to teach stutterers to stutter with control, and not to make the stutterer fluent. Therapy using this approach tends to recognize the fear and avoidance of stuttering.

Contemporary devices

Contemporary devices used to reduce stuttering alters the frequency of the speaker's voice to mimic the "choral effect", a phenomenon in which person's stutter decreases or ceases completely when she is speaking with a group of others, or slows the rate of speech through delayed auditory feedback.

Delayed auditory feedback devices, such as Speech Easy encourage the slowing down of speech by replaying the speaker's words into their ears. The stutterer is then forced to slow their rate of speech to prevent distortions in the speech that is heard through the device. This is not effective for all people who stutter, and is shown to wear off over time.[14] In a 2006 review of the efficacy of stuttering treatments, none of the studies on altered auditory feedback met the criteria for experimental quality, such as the presence of control groups.[15]

There are specialized mobile applications and PC programs for stutter treatment. The goal pursued by the applications of this kind is speech cycle restoration: I say, I hear, I build a phrase, I say, and so on, using various methods of stutter correction.[16]

The user interacts with the application through altered auditory feedback: they say something into the headset's microphone and listen to their own voice in the headphones processed by a certain method.

The following stutter correction methods are typically used in applications:

Medications

No medication is FDA-approved for stuttering.

The best studied medication in stuttering is olanzapine, whose effectiveness as of 2004[28] had been established in replicated trials. Olanzapine acts as a dopamine antagonist to D2 receptors in the mesolimbic pathway, and works similarly on serotonin 5HT2A receptors in the frontal cortex.[29] At doses between 2.5 and 5 mg, olanzapine has been shown to be more effective than placebo at reducing stuttering symptoms, and may serve as a first-line pharmacological treatment for stuttering based on the preponderance of its efficacy data.[30] However, other medications are generally better tolerated with less weight gain and less risk of metabolic effects than olanzapine.

The investigational compound, ecopipam, is unique from other dopamine antagonists in that it acts on D1 receptors instead of D2, owing little, if any risk, of movement disorders. A 2019 open label study of ecopipam in adults demonstrated significantly improved stuttering symptoms with no reports of parkinsonian-like movement disorders or tardive dyskinesia which can be seen with D2 antagonists.[31] In addition, ecopipam had no reported weight gain, but instead has been reported to lead to weight loss. In a preliminary study, it was well tolerated in subjects, effectively reduced stuttering severity, and was even associated in a short-term study with improved quality of life in persons who stutter. Further research is still warranted, but this novel mechanism is showing promise in the pharmacologic treatment of stuttering.

Diaphragmatic breathing

Several treatment initiatives use diaphragmatic breathing (or costal breathing) as a means by which stuttering can be controlled.[32]

Psychological approach

Cognitive behavior therapy has been used to treat stuttering.[33] Also sociological approaches has been explored regarding how social groups maintain stuttering through social norms.[34]

Self-therapy and community groups

Community groups

Stuttering support/community groups have gained prominence and visibility and can be an important part of the process for stutterers,[35] A growing number of speech–language pathologists encourage their clients to participate in support groups.[36]

Research shows that participating in support groups and self-help sessions with others who stutter may reduce the negative attitudes associated with stuttering.[37] Becoming part of stuttering groups may help reduce the feelings of loneliness, fear, shame and embarrassment that comes with years of stuttering.[38] Participants of group sessions show lower internalization of stigma regarding stuttering. They have lower levels of negative feelings about themselves. Moreover, the goal of helping others who stutter in the group has been linked to better psychological well-being.[39]

Studies in the United States involving members of support groups of the National Stuttering Association have found that 57.1% of survey respondents said that the support group had affected their self-image "very positively", with no respondents indicating that it had a negative impact.[36]

McGuire Programme

The McGuire Programme is a stammering or stuttering treatment programme/course run for people who stammer or stutter (ages 14+) by people who stammer. There are no licensed speech therapists involved. It was founded in 1994 by American Dave McGuire in Holland.[40]

Scottish international rugby union captain, Kelly Brown, is a graduate of the course.[41] Singer Gareth Gates attended the programme's workshops and subsequently qualified as a speech instructor himself.[42] Stammering awareness activist[43] Adam Black, also a graduate of the course, received a British Empire Medal in the 2019 New Year Honours list where his work raising awareness of stammering was recognised.[44] [45] [46] [47]

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) may be used to help people who stutter. CBT may be partially effective in helping clients reduce their secondary behaviors, anxiety, and cognitive distortion.[48] [49] Cognitive behavioral therapy is a collaborative process that requires the client and the therapist working together to explore the buried feelings of frustration, avoidance, anger, and self-doubt. Younger children who stutter are more benefited by CBT as compared to adults who stutter. Research at the Michael Palin Center has shown that CBT is a powerful tool for children who stutter.[50]

Pharmacologic therapy

Several pharmacologic, i.e. drug-based, methods to control or alleviate stuttering events have been studied, but each has either proved ineffective or have had adverse effects. A comprehensive review of pharmacologic interventions for stuttering showed that no agent leads to valid improvement in stuttering or in secondary social and emotional consequences.

See also

External links

Notes and References

  1. http://www.nidcd.nih.gov/health/voice/stutter.htm Stuttering
  2. Prasse . JE . Kikano . GE . Stuttering: an overview. . American Family Physician . 1 May 2008 . 77 . 9 . 1271–6 . 18540491.
  3. Web site: Stuttering . Asha.org . 2014-05-12 . live . https://archive.today/20131120151347/http://www.asha.org/public/speech/disorders/stuttering/ . 2013-11-20 .
  4. Web site: Stuttering . Nidcd.nih.gov . 2014-05-12 . live . https://web.archive.org/web/20140404214740/https://www.nidcd.nih.gov/health/voice/Pages/stutter.aspx#treated . 2014-04-04 .
  5. Web site: Stuttering . https://web.archive.org/web/20100616043053/http://asha.org/uploadedFiles/public/TESStuttering.pdf . dead . 2010-06-16 . 2014-05-12 .
  6. Web site: ASHA – Treatment Efficacy for Stuttering. https://web.archive.org/web/20100616043053/http://www.asha.org/uploadedFiles/public/TESStuttering.pdf. 2010-06-16. dead.
  7. Web site: Stuttering . Asha.org . 2014-05-12 . dead . http://arquivo.pt/wayback/20091016041011/http://www.asha.org/public/speech/disorders/stuttering.htm . 2009-10-16 .
  8. https://stamma.org/about-stammering/there-stammering-cure Is There a Stammering Cure?
  9. http://www3.fhs.usyd.edu.au/asrcwww/downloads/LP_manual_English_Oct2002.pdf Manual for the Lidcombe Program of Early Stuttering Intervention
  10. Gow, M.L, & Ingham, R.J. (1992). The effect of modifying electroglottograph identified intervals of phonation on stuttering. Journal of Speech and Hearing Disorders, 35, 495–511. Retrieved on 2015-03-22.
  11. Ingham, R.J., Kilgo, M., Ingham, J.C., Moglia, R., Belknap, H., & Sanchez, T. (2001). Evaluation of a stuttering treatment based on reduction of short phonation intervals. Journal of Speech, Language, and Hearing Research, 44, 1229–1244. Retrieved on 2015-03-22.
  12. Ingham, R.J., Montgomery, J., & Ulliana, L. (1983). The effect of manipulating phonation duration on stuttering. Journal of Speech and Hearing Research, 26, 579–587. Retrieved on 2015-03-22.
  13. Kehoe, T. D. Speech-Related Fears and Anxieties . No Miracle Cures:A Multifactoral Guide to Stuttering Therapy. Retrieved 2009-08-30.
  14. https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=d6a1801278b57c455f47f69dc9c5336c755d9e83|Systematic review of delayed auditory feedback effectiveness for stuttering reduction.
  15. Bothe . AK . Davidow . JH . Bramlett . RE . Ingham . RJ . Stuttering Treatment Research 1970–2005: I. Systematic Review Incorporating Trial Quality Assessment of Behavioral, Cognitive, and Related Approaches . American Journal of Speech-Language Pathology. 15. 321–341 . 2006 . 17102144 . 10.1044/1058-0360(2006/031) . 4 . 24775349 .
  16. Web site: Electronic Devices, Software and Apps. Stuttering Foundation: A Nonprofit Organization Helping Those Who Stutter. 6 May 2011 . en. 2019-11-21.
  17. Kalinowski. J.. Armson. J.. Roland-Mieszkowski. M.. Stuart. A.. Gracco. V. L.. 1993. Effects of alterations in auditory feedback and speech rate on stuttering frequency. Language and Speech. 36. 1–16. 10.1177/002383099303600101. 0023-8309. 8345771. 1. 16949019.
  18. Jacks. Adam. Haley. Katarina L.. 2015. Auditory Masking Effects on Speech Fluency in Apraxia of Speech and Aphasia: Comparison to Altered Auditory Feedback. Journal of Speech, Language, and Hearing Research. 58. 6. 1670–1686. 10.1044/2015_JSLHR-S-14-0277. 1092-4388. 4987030. 26363508.
  19. Burke. Bryan D.. 1969-09-01. Reduced auditory feedback and stuttering. Behaviour Research and Therapy. 7. 3. 303–308. 10.1016/0005-7967(69)90011-4. 0005-7967.
  20. Bothe Anne K.. Finn Patrick. Bramlett Robin E.. 2007-02-01. Pseudoscience and the SpeechEasy: Reply to Kalinowski, Saltuklaroglu, Stuart, and Guntupalli (2007). American Journal of Speech-Language Pathology. 16. 1. 77–83. 10.1044/1058-0360(2007/010).
  21. Picoloto. Luana Altran. Cardoso. Ana Cláudia Vieira. Cerqueira. Amanda Venuti. Oliveira. Cristiane Moço Canhetti de. 2017-12-07. Effect of delayed auditory feedback on stuttering with and without central auditory processing disorders. CoDAS. 29. 6. e20170038. 10.1590/2317-1782/201720170038. 2317-1782. 29236907. free. 11449/179424. free.
  22. Kalinowski. Joseph. Armson. Joy. Stuart. Andrew. Gracco. Vincent L.. 1993. Effects of Alterations in Auditory Feedback and Speech Rate on Stuttering Frequency. Language and Speech. en-US. 36. 1. 1–16. 10.1177/002383099303600101. 8345771. 16949019. 0023-8309.
  23. Zimmerman Stephen. Kalinowski Joseph. Stuart Andrew. Rastatter Michael. 1997-10-01. Effect of Altered Auditory Feedback on People Who Stutter During Scripted Telephone Conversations. Journal of Speech, Language, and Hearing Research. 40. 5. 1130–1134. 10.1044/jslhr.4005.1130. 9328884.
  24. Howell. Peter. Davis. Stephen. Bartrip. Jon. Wormald. Laura. 2004-09-01. Effectiveness of frequency shifted feedback at reducing disfluency for linguistically easy, and difficult, sections of speech (original audio recordings included). Stammering Research. 1. 3. 309–315. 1742-5867. 2312336. 18418474.
  25. Brady. John Paul. 1969-05-01. Studies on the metronome effect on stuttering. Behaviour Research and Therapy. 7. 2. 197–204. 10.1016/0005-7967(69)90033-3. 5808691. 0005-7967.
  26. Hudock. Daniel. Dayalu. Vikram N.. Saltuklaroglu. Tim. Stuart. Andrew. Zhang. Jianliang. Kalinowski. Joseph. 2011. Stuttering inhibition via visual feedback at normal and fast speech rates. International Journal of Language & Communication Disorders. 46. 2. 169–178. 10.3109/13682822.2010.490574. 1460-6984. 21401815.
  27. Chesters. Jennifer. Baghai-Ravary. Ladan. Möttönen. Riikka. 2015. The effects of delayed auditory and visual feedback on speech production. The Journal of the Acoustical Society of America. 137. 2. 873–883. 10.1121/1.4906266. 0001-4966. 4477042. 25698020. 2015ASAJ..137..873C.
  28. Maguire Gerald A., Riley Glyndon D., Franklin David L., Maguire Michael E., Nguyen Charles T., Brojeni Pedram H. . 2004 . Olanzapine in the treatment of developmental stuttering: a double-blind, placebo-controlled trial . Annals of Clinical Psychiatry . 16 . 2. 63–67 . 10.1080/10401230490452834 . 15328899 .
  29. Thomas, K., & Saadabadi, A. (2018). Olanzapine. In StatPearls [Internet]. StatPearls Publishing.
  30. Shaygannejad V., Khatoonabadi S. A., Shafiei B., Ghasemi M., Fatehi F., Meamar R., Dehghani L. . 2013 . Olanzapine versus haloperidol: which can control stuttering better?. . International Journal of Preventive Medicine . 4 . Suppl 2. S270-3 . 23776736 . 3678230 .
  31. Maguire, G.A., Lasalle L., Hoffmeyer D., Nelson M., Lochead J.D., Davis K., Burris A., Yaruss J.S., "Ecopipam as a pharmacologic treatment of stuttering." Ann Clin Psychiatry (2019 Aug), 31(3), 164-168.
  32. Web site: Two great videos on how diaphragmatic breathing works. American Institute for Stuttering. dead. https://web.archive.org/web/20101115045037/http://stutteringtreatment.org/blog/2009/07/two-great-videos-on-how-diaphragmatic-breathing-works/. 2010-11-15.
  33. Reddy. R.P.. Spring 2017. Cognitive Behavior Therapy for Stuttering: A Case Series. 3137813. Indian Journal of Psychological Medicine. 2010 jan-jun 32(1). 1. 49–53. 21799560. 10.4103/0253-7176.70533 . free .
  34. Web site: Stuttering Habits. Stuttering Habits. https://web.archive.org/web/20170418083207/http://stutteringhabits.com/social-norms-and-stuttering-expectations/. 2017-04-18. dead.
  35. Yaruss, J. S., Quesal, R. W., Murphy, B. (2002). National Stuttering Association members' opinions about stuttering treatment. Journal of Fluency Disorders, 27(3), 227–242.
  36. Yaruss, J. S., Quesal, R. W., Reeves, L., Molt, L. F., Kluetz, B., Caruso, A. J., et al. (2002). Speech treatment and support group experiences of people who participate in the National Stuttering Association. Journal of Fluency Disorders, 27(2), 115–134.
  37. Tichenor Seth E.. Yaruss J. Scott. 2019-12-18. Group Experiences and Individual Differences in Stuttering. Journal of Speech, Language, and Hearing Research. 62. 12. 4335–4350. 10.1044/2019_JSLHR-19-00138. 31830852. 209340620.
  38. Web site: 2020-10-18. Why You Should Talk to Others Who Stutter. 2021-05-31. Stamurai Blog – Stuttering Information, Advice & News. en.
  39. 2013-12-01. Psychological characteristics and perceptions of stuttering of adults who stutter with and without support group experience. Journal of Fluency Disorders. en. 38. 4. 368–381. 10.1016/j.jfludis.2013.09.001. 0094-730X. Boyle. Michael P.. 24331244.
  40. News: Stutterers swear by program but speech experts unconvinced. The Sydney Morning Herald. Vince. Chadwick. 2 February 2013. 13 February 2021.
  41. News: Scotland captain Kelly Brown tackling his stammer head on. BBC News. 5 February 2014. 30 September 2014. Dirs. Ben.
  42. News: Gareth Gates becomes speech coach. BBC News. 12 May 2004. 21 December 2022.
  43. News: Stammering Awareness Day: Campaigner on how events are taking a different approach this year. Glasgow Times. Heather. Carrick. 22 October 2020. 29 October 2020.
  44. Web site: Primary school teacher Adam Black tells how McGuire Programme helped him overcome stammer and land his dream job. Daily Record. Brian. McIver. 29 August 2014. 29 October 2020.
  45. Web site: Adam Black doesn't want to hide his stutter anymore. BBC News. 11 July 2018. 3 June 2019.
  46. News: 'I thought my New Year Honours was a tax return'. BBC Newsbeat. 29 December 2018. 3 June 2019.
  47. Web site: Man learns to control his stutter to fulfil his dream of being a teacher. McDonald. Sally. 29 March 2016. Sunday Post. 3 June 2019.
  48. Reddy. R. P.. Sharma. M. P.. Shivashankar. N.. 2010. Cognitive Behavior Therapy for Stuttering: A Case Series. Indian Journal of Psychological Medicine. 32. 1. 49–53. 10.4103/0253-7176.70533. 0253-7176. 3137813. 21799560 . free .
  49. Blomgren. Michael. Stuttering Treatment for Adults: An Update on Contemporary Approaches. Seminars in Speech and Language. 15 November 2010. 31. 4. 272–282. 10.1055/s-0030-1265760. 21080299.
  50. 2015-06-30. Cognitive Behaviour Therapy with children who stutter. Procedia - Social and Behavioral Sciences. en. 193. 165–174. 10.1016/j.sbspro.2015.03.256. 1877-0428. free. Kelman. Elaine. Wheeler. Sarah.

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