Stuttering therapy

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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]

Contents

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. [16]

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. [31] 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. [31] 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] [36] A growing number of speech–language pathologists encourage their clients to participate in support groups. [35]

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. [35]

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. [40] [41] 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. [42]

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

Related Research Articles

<span class="mw-page-title-main">Aphasia</span> Inability to comprehend or formulate language

In aphasia, a person may be unable to comprehend or unable to formulate language because of damage to specific brain regions. The major causes are stroke and head trauma; prevalence is hard to determine but aphasia due to stroke is estimated to be 0.1–0.4% in the Global North. Aphasia can also be the result of brain tumors, epilepsy, autoimmune neurological diseases, brain infections, or neurodegenerative diseases.

<span class="mw-page-title-main">Receptive aphasia</span> Language disorder involving inability to understand language

Wernicke's aphasia, also known as receptive aphasia, sensory aphasia or posterior aphasia, is a type of aphasia in which individuals have difficulty understanding written and spoken language. Patients with Wernicke's aphasia demonstrate fluent speech, which is characterized by typical speech rate, intact syntactic abilities and effortless speech output. Writing often reflects speech in that it tends to lack content or meaning. In most cases, motor deficits do not occur in individuals with Wernicke's aphasia. Therefore, they may produce a large amount of speech without much meaning. Individuals with Wernicke's aphasia are typically unaware of their errors in speech and do not realize their speech may lack meaning. They typically remain unaware of even their most profound language deficits.

Stuttering, also known as stammering, is a speech disorder characterized externally by involuntary repetitions and prolongations of sounds, syllables, words, or phrases as well as involuntary silent pauses or blocks in which the person who stutters is unable to produce sounds.

A communication disorder is any disorder that affects an individual's ability to comprehend, detect, or apply language and speech to engage in dialogue effectively with others. This also encompasses deficiencies in verbal and non-verbal communication styles. The delays and disorders can range from simple sound substitution to the inability to understand or use one's native language. This article covers subjects such as diagnosis, the DSM-IV, the DSM-V, and examples like sensory impairments, aphasia, learning disabilities, and speech disorders.

Speech disorders or speech impairments are a type of communication disorder in which normal speech is disrupted. This can mean fluency disorders like stuttering, cluttering or lisps. Someone who is unable to speak due to a speech disorder is considered mute. Speech skills are vital to social relationships and learning, and delays or disorders that relate to developing these skills can impact individuals function. For many children and adolescents, this can present as issues with academics. Speech disorders affect roughly 11.5% of the US population, and 5% of the primary school population. Speech is a complex process that requires precise timing, nerve and muscle control, and as a result is susceptible to impairments. A person who has a stroke, an accident or birth defect may have speech and language problems.

Cluttering is a speech and communication disorder characterized by a rapid rate of speech, erratic rhythm, and poor syntax or grammar, making speech difficult to understand.

Speech delay, also known as alalia, refers to a delay in the development or use of the mechanisms that produce speech. Speech – as distinct from language – is the actual process of making sounds, using such organs and structures as the lungs, vocal cords, mouth, tongue, teeth, etc. Language delay refers to a delay in the development or use of the knowledge of language.

Auditory verbal agnosia (AVA), also known as pure word deafness, is the inability to comprehend speech. Individuals with this disorder lose the ability to understand language, repeat words, and write from dictation. Some patients with AVA describe hearing spoken language as meaningless noise, often as though the person speaking was doing so in a foreign language. However, spontaneous speaking, reading, and writing are preserved. The maintenance of the ability to process non-speech auditory information, including music, also remains relatively more intact than spoken language comprehension. Individuals who exhibit pure word deafness are also still able to recognize non-verbal sounds. The ability to interpret language via lip reading, hand gestures, and context clues is preserved as well. Sometimes, this agnosia is preceded by cortical deafness; however, this is not always the case. Researchers have documented that in most patients exhibiting auditory verbal agnosia, the discrimination of consonants is more difficult than that of vowels, but as with most neurological disorders, there is variation among patients.

<span class="mw-page-title-main">Speech–language pathology</span> Disability therapy profession

Speech–language pathology (also known as speech and language pathology or logopedics) is a healthcare and academic discipline concerning the evaluation, treatment, and prevention of communication disorders, including expressive and mixed receptive-expressive language disorders, voice disorders, speech sound disorders, speech disfluency, pragmatic language impairments, and social communication difficulties, as well as swallowing disorders across the lifespan. It is an allied health profession regulated by professional bodies including the American Speech-Language-Hearing Association (ASHA) and Speech Pathology Australia. The field of speech-language pathology is practiced by a clinician known as a speech-language pathologist (SLP) or a speech and language therapist (SLT). SLPs also play an important role in the screening, diagnosis, and treatment of autism spectrum disorder (ASD), often in collaboration with pediatricians and psychologists.

In human development, muteness or mutism is defined as an absence of speech, with or without an ability to hear the speech of others. Mutism is typically understood as a person's inability to speak, and commonly observed by their family members, caregivers, teachers, doctors or speech and language pathologists. It may not be a permanent condition, as muteness can be caused or manifest due to several different phenomena, such as physiological injury, illness, medical side effects, psychological trauma, developmental disorders, or neurological disorders. A specific physical disability or communication disorder can be more easily diagnosed. Loss of previously normal speech (aphasia) can be due to accidents, disease, or surgical complication; it is rarely for psychological reasons.

Delayed Auditory Feedback (DAF), also called delayed sidetone, is a type of altered auditory feedback that consists of extending the time between speech and auditory perception. It can consist of a device that enables a user to speak into a microphone and then hear their voice in headphones a fraction of a second later. Some DAF devices are hardware; DAF computer software is also available. Most delays that produce a noticeable effect are between 50–200 milliseconds (ms). DAF usage has been shown to induce mental stress.

<span class="mw-page-title-main">Electronic fluency device</span> Devices intended to improve the fluency of persons who stutter

Electronic fluency devices are electronic devices intended to improve the fluency of persons who stutter. Most electronic fluency devices change the sound of the user's voice in his or her ear.

Fluency refers to continuity, smoothness, rate, and effort in speech production. It is also used to characterize language production, language ability or language proficiency.

Speech shadowing is a psycholinguistic experimental technique in which subjects repeat speech at a delay to the onset of hearing the phrase. The time between hearing the speech and responding, is how long the brain takes to process and produce speech. The task instructs participants to shadow speech, which generates intent to reproduce the phrase while motor regions in the brain unconsciously process the syntax and semantics of the words spoken. Words repeated during the shadowing task would also imitate the parlance of the shadowed speech.

Speech and language impairment are basic categories that might be drawn in issues of communication involve hearing, speech, language, and fluency.

Auditory feedback (AF) is an aid used by humans to control speech production and singing by helping the individual verify whether the current production of speech or singing is in accordance with his acoustic-auditory intention. This process is possible through what is known as the auditory feedback loop, a three-part cycle that allows individuals to first speak, then listen to what they have said, and lastly, correct it when necessary. From the viewpoint of movement sciences and neurosciences, the acoustic-auditory speech signal can be interpreted as the result of movements of speech articulators. Auditory feedback can hence be inferred as a feedback mechanism controlling skilled actions in the same way that visual feedback controls limb movements.

Frank H. Guenther is an American computational and cognitive neuroscientist whose research focuses on the neural computations underlying speech, including characterization of the neural bases of communication disorders and development of brain–computer interfaces for communication restoration. He is currently a professor of speech, language, and hearing sciences and biomedical engineering at Boston University.

The temporal dynamics of music and language describes how the brain coordinates its different regions to process musical and vocal sounds. Both music and language feature rhythmic and melodic structure. Both employ a finite set of basic elements that are combined in ordered ways to create complete musical or lingual ideas.

<span class="mw-page-title-main">Verbal intelligence</span>

Verbal intelligence is the ability to understand and reason using concepts framed in words. More broadly, it is linked to problem solving, abstract reasoning, and working memory. Verbal intelligence is one of the most g-loaded abilities.

<span class="mw-page-title-main">Stuttering pride</span> Social movement

Stuttering pride is a social movement that repositions stuttering as a valuable and respectable way of speaking. The stuttering pride movement challenges the pervasive societal narrative of stuttering as a defect, repositioning stuttering as a form of vocal and linguistic diversity that enriches our language, ideas, and art forms.

References

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