Wednesday, November 22, 1995

More on SLPs

I just want to make sure my posting is not misunderstood. IN NO WAY do I mean to imply
that SLPs are not in the best position to become stuttering therapists,
should they wish to do so (as most or all SLPs on this list obviously have).
They are probably also in the best position to diagnose speech problems.
The way I'd like to frame the discussion is "is there room for some who
are *exclusively* stuttering specialists", probably with an overlapping
but different background, and "how do we (both PWS and SLP) guard against
malpractice from both these hypothetical specialists and SLPs that choose
to treat stuttering.

To use an analogy, civil engineers are certainly best suited to become
good architects, yet, while overlapping, an architect's background
focuses on different aspects of construction. Good construction inevitably
requires BOTH sets of skills. Both professions have bodies that guard
both ethics and quality. A good architect also knows when to send
a client to an engineer and vice-versa.

Tuesday, November 21, 1995

Questions about the SLP profession

We talked about a stuttering specialization for SLPs. Now I want to ask
something that is bound to generate some heat ... can one become
a "stuttering specialist" WITHOUT becoming first an SLP? I am
interested in both issues of potential effectiveness as well as legality and
peer recognition.

First of all, I believe that there are already people in the profession
who are not SLPs and some are well known (am I right?). Whether or not
they are well regarded by SLPs is not the issue (or is it?). I simply wonder
whether it is really necessary to learn about other speech and hearing
impediments in order to become an effective stuttering therapist.

My reasons for asking are both "academic" and personal. On the academic side
is my belief that stuttering is fundamentally different from, say, aphasia,
and, as I expressed in other posts, studying neurology and psychology might
be actually more relevant to the stuttering problem. My personal reason
is simply that I have given thought to becoming a therapist but I am
exclusively interested in stuttering. Yes, one can pay "one's dues", but,
as anyone at my stage in life will attest, I feel I have already spent
most of my life "paying dues" and, at 50, I have very little patience
for dealing with stuff that doesn't go right to the core of what interests
me.

Granting that, to some extent, we always bring all of our background to bear in all our endeavors, how much of a typical SLP's academic and (non-stuttering)
therapy background REALLY comes to bear on stuttering therapy? How much
is "paying dues" (if you are only interested in stuttering)?

Blocking and the "Valsalva maneuver"

(In objection to blocking being caused by a stoppage of air-flow)

I once heard Bill's (Bill Parry) presentation. I was and still remain skeptical.
To me the "block" is in the "control system" that moves the
articulation along from one phoneme to another. It doesn't come
from "cutting off air". To use an analogy, suppose I am playing the
saxophone. One could stop me from going on with the music simply by plugging
up the air duct (Valsalva, if I understand correctly) or by paralizing my
fingers. But wouldn't sound still come out if I kept blowing with my
fingers paralized? That's where the analogy breaks down. In the case of speech,
"finger movement" would feed back (my educated guess) and determine how
much blowing is being done. So the whole system comes to a grinding halt,
but NOT because something just plugged up the air duct. I realize this
is mere speculation, and I am not sure if any therapeutic consequences
would come out of this, but it would be great to devise and experiment that
puts the issue to rest.

There is actually an observation that, IMO, puts the issue to rest. Some
blocks come with "sound" behind them! Unless I am dreaming, I have often heard
stuff like hmmmmmmmmm, hmmmmmmm, hmmmmmmPOLICY, for someone blocking
on the "P" of "policy". So air is actually flowing, just like it would be
for the "finger paralized" sax player.

I have pointed this out a few times on the list and never got an answer.
Will somebody please either agree with me or tell me why I am wrong?

One last point. I do NOT mean to carry the analogy to imply that some
form of vocal cord "paralysis" is the fundamental cause. Again it's the
sequence of articulatory commands from the brain that gets "stuck"
(my opinion and that of many).

Monday, November 20, 1995

Stuttering in a foreign language

In this post I was asked several interesting questions by Larry Molt. I will paraphrase his questions and post my answers

Yes, even though initially I was not recognized as a stutter I did experience stuttering exactly the same way I experienced it in Italian.


Yes, I experienced the same stuttering patterns (block etc.)


No, stuttering did not happen to the same extent as in Italian and it also went unrecognized because it was misinterpreted as a difficulty in speaking a foreign language. As you conjectured, I was also speaking slower, with shorter phrases, more pauses etc. probably reducing demand on my speech and therefore reducing stuttering.

Eventually the reason for lessened stuttering vanished with increasing "fluency" (yes, I was struck by the same conundrum!... more stutter the more "fluency" in the new language). Interestingly the first statement is true to this day. In my mind English, at this point, is actually easier than my native language, but I still do have a slight accent, and when I have one of my now rare blocks, people tend to think that "I'm hunting for the word". Given different situations I've had to choose between being thought of as
"just off the boat" or as a stutterer..

I think my experience does match yours (ironically, stuttering more with increased "fluency" in the foreign language). Interestingly it was also confirmed
in an acting class I took. As I was learning a part, I was better able to
avoid stuttering than when I had completely "interiorised it" and had begun
"being" the character I was portraying. The director asked me why I had chosen
to "make" the character stutter! He was baffled when I told him it had not
been an "acting" choice.

Is my child a stutterer?

Hi Woody,

My 3 1/2 year old child, is beginning to show occasional signs of "stuttering"
that go a bit beyond "normal" hesitations for that age. I am not overly
worried and he has shown no signs of frustration. He LOVES to talk and
his chatter is incessant and quite fun to hear. In the past I would have
just waited, but, given the information you have put on the list, I do
view him as "at risk" and I would like to have him undergo whatever
therapy might be appropriate at this point.

Is there any clinic/SPL in the San Francisco Bay Area, that would approach
this type of therapy along the lines you have been developing?

I'll appreciate any suggestions.

Thursday, November 16, 1995

Stuttering in biligual children

Does the "capacity and demands" model imply a higher incidence of stuttering in bilingual children?

I am betting my own child's life experience on "no"! I think "demand"
refers to "speech mechanics" performance, not a knowledge of alternative
ways to say things. He is simply learning that mother says "milk" and
"papa'" says "latte", so when he talk to me he asks for "latte".

If I can use an analogy, would you worry about cognitive overload if you had
a vacation house and you child had to learn to find his way around two houses
instead of one? He would learn that the kitchen is on the left in house A and
on the right is house B. "Demand" would be equivalent to asking him/her to
move faster in either house...

I sure hope I am right...!

Wednesday, November 15, 1995

Why I joined the NSP

Ira Zimmerman commented that people who have largely overcome stuttering should perhaps form a separate organization (NSP stood for National Stuttering Project - the name was later changed to NSA)

granted that one could claim that "everything" we do is to meet some
need... I joined the NSP more to see if I could help than to find
"support" for a problem I felt I had largely overcome. Maybe this
was presumptious on my part, but it was my original motivation. It
turned out that I still received much more than I gave. Some of
what I received can be described as follows:
1. A sense of "coming home", embracing where I had been. Note that
until then I had always avoided other stutterers...! Interestingly I
had fully accepted (or so I thought) MY stuttering, but hearing others
stutter brought back too much pain... until I joined the NSP. This
was perhaps one more phase of healing I didn't know I needed.
2. Absolutely wonderful new friends. People like John Ahlbach and John
Harrison! And many others.... I see them rarely now, but when
I do it's like meeting family.
3. New and continuing insights on stuttering. Some that I am still
applying to myself, and some I can share with others (including
this list). On and off I toy with the idea of becoming a Stuttering
Therapist.
4. Surely much more than I am aware of.

"If you stutter you are not alone" is the NSP motto. I did grow up
"alone" and I wish I hadn't. The stuttering of each one of us takes
different paths, but none of us has to face it alone, ever again. I thought
I'd join to give support and embrace those who were still
struggling. It turns out that I embraced my "child" and that everyone
embraced me. Are you still puzzled Ira?

Bilingual stutterers

In response to a comment about the possible deleterious effect of bilingualism on suttering

I am a bilingual stutterer, and now father of a child I am encouraging to
become bilingual.

I was born in Italy and came to the US at 16 for one year, then again
at 20. At first I was not recognized as a stutterer in this country, but,
as I became better and better in English stuttering became evident
again. What I think happened is very simple: my hesitations in a foreign
language simply masked my stuttering. I must confess that for a while
I found this very convenient... it was much better to be thought of as
foreign struggling with english than as a stutterer!

I have also felt that Italian requires somewhat faster vocalization for
the same rate of speech, as words are generally a bit longer, so I retained
the feeling that I stuttered a little less in English. This observation is
however clouded by the fact that I have worked at overcoming
stuttering and I no longer view it as a problem in my life. The same
might have happened if I had stayed in Italy.

I am the father of a three year old, whom I consider "at risk" for
stuttering.nevertheless I decided to speak to him only in Italian. He hears
English from everyone else. I don't view this as extra potentially
deleterious "pressure". To him it's just an alternative way to say things and he seems
to be enjoying it.

Monday, November 13, 1995

Specializing in stuttering therapy

To a therapist claiming that it's not "good" to simply specialize in stuttering (he'd rather work on a broad range of speech problems).

Why not if it DOES work? There is something to be gained from "holistic"
approaches, in fact MUCH to be gained, when the areas considered have a
fundamental bearing on each other. The "specialist" in stuttering might
well have to be a generalist in neurology, psychology, phonology etc.

I feel that sometimes we are stuck with classifications that are based
on old fundamental misunderstandings about problems. The appropriatedness
of classifying stuttering with many other phonation problems should be
revisited in light of what we are beginning to understand.

Please note that I speak as a stutterer, not a SLP, and I have no specific
knowledge to make me doubt that you have personally been very successful in
working with stutterers. I can only say that, as a consumer, and given
the simple fact that so much therapy is ultimately unsuccessful, I would feel
much more comfortable knowing that my therapist or my son's therapist is
totally focused on, and knowledgeable in, the peculiarities of this stubborn
problem.

Thursday, November 09, 1995

The scientific value of testimonials

In response to a comment by Ira Zimmerman stating that there is no scientific backing for most claims of "recovery".

I am one of those people who tends to talk about stuttering as *mainly* a thing
of the past, and has given "testimonials" on his recovery process. I think
both Ira and Jason bring up good points.

The fact is, I DON'T know if I got better because of my efforts, or aging
would have done it for me anyhow. I DON't know if what I have been doing would
have been equally successful had I started off with much more severe
stuttering. When I talk about my "success" I can't help having a nagging
feeling that, in spite of what I think, my problem and, say, Ira's, were
quite different. My very first contribution to this list was in fact
a thread that dealt with the possibility of two different "kinds" of stuttering
(I mean both recognized as developmental but arising from different
causes, although "appearing" to be the same problem on a continuous severity
scale). I even asked if there were bimodal distributions on any stuttering
"metrics".

The best answer I got was Woody's, who stated that, in his experience, "severe"
stutterers often seemed to make rapid progress in therapy, only to relapse,
while "mild" stutterers made much slower but stable progress. I think there is
something really worth looking at here....

All this being said, I, John and others are simply data points. If somebody
claimed to have improved by making back-flips, that would be a data point
too. It's up to whomever wants or can to use these data points and make
some rigorous science out of it. So, no, my own testimony IS NOT GOOD ENOUGH,
but together with that of others it may enable some useful model to be built.

I really wish I could have been part of a rigorous test. If anybody thinks that
they can do something with me now... come and take me, I'm yours!

Thank you, Ira, for reminding us that just because we say it is.. it doesn't
make it so.

Wednesday, November 08, 1995

The brain and the hardware/software analogy

I just want to make the point that the hardware/software analogy with
some kind of "fixed" brain on which some kind of "programming" (presumably
environmental/psychological) is imposed, is VERY limited and perhaps even
misleading when it comes to language development.

First of all, when it comes to neural nets, both biological and artificial (my
field) program and hardware cannot be separated. The "program", which can only
be defined as interaction with the outside world, becomes inextricably connected with the hardware. In a regular computer you could erase the program, and the
hardware would remain, unchanged, and ready for a different program. Even with
the very simple neural nets we build, it is not possible to separate the two.
Changing the program means modifying the connection strengths between neurons
AND adding or eliminating neurons and connections. So what are we changing, the
software or the hardware?

Second, the way this kind of "programming" is realized in the brain is itself
the result of "primitive hardware", it therefore not immune from the results of genetic coding. Early hardware + early interactions become new hardware, which
then becomes sensitive to new interactions (...a different level of "programming").. and so on.

I often stand in awe on how similar we all are in light of the extraordinary
complexity of our development. The point is that evolution has built a very
robust system, capable of building two eyes, two legs, a single nose etc. under
an extremely varied set of conditions. The same goes for our speech apparatus, a far more complex system than any single organ. I am baffled at the resistance
I keep seeing re-emerge to the notion that some "organically" based process
within this system might not be up to snuff. Even ignoring the abundance of
genetic studies that show a clear link (but why ignore it?), it is the amazing
specifity of the problem (even though each one of us "dances" around it in
different ways) that convinces me of a fundamental organic cause.

I am equally convinced that psychology DOES play a role. Faced with an obvious
problem, we try to overcome it or work around it. Our particular psychological
makeup can either help us or make things worse. Fear, self-confidence,
determination, acceptance, all play a role in how, if ever, we are able to
CONTINUE the kind of "programming" I discussed above. Even though our neural
pathways, at least at the level of basic systems constructed early on, are far
less plastic, we still CAN improve. Stuttering has ceased being an issue for me. I don't know if my early pathways have been modified, or if I built some good
workarounds, or if that unwelcome continuing program called "aging" had in
store some relief for me anyhow. I do know that I have worked at it, and that
my particular psychology has helped, but I might have done better sooner if
somebody had given it a little push once in a while.

Learned behaviors and evolution

In response to a note remarking that learned behaviors (such as acquired musical skills or maladaptive stuttering behaviors) could be passed on by evolution.

I haven't read "The beak of the Finch", but I do know that Darwinian evolution
does NOT allow for such a mechanism. This was precisely the debate between
the Darwinians and the Lamarkians (sp?). The former explaining evolution via
chance occurrences the latter as guided by environmental "drive" or "need".
A mechanism for the former was found (the genetic system) but not for the
latter (still, I believe). But this does NOT mean that it is conceptually
impossible. We are, after all, the result of evolution, and we are now doing
precisely that, when we do genetic engineering. The point is that we are now
able to figure out, at least in a few cases, what genetic changes are required
in order to produce desired results. It is very difficult to imagine how
nature could do that simply at the level of the body i.e. without the
social/scientific evolution that allows for our ability to build "models" of the genetic system.

Computer "do" that only in the sense that the programmer knows (or should
know) how to change the code in order to obtain desired effects, but even
they often find it hard to do (ever heard of bugs?). In terms of neural nets
or artificial systems that learn and evolve without conventional programmer's
help, the ability to combine both kinds of evolution (chance and goal direction)
is an open area of research (one I am involved in, by the way).