Smooth talking

UGA clinic offers simple, state-of-the-art stuttering treatment

Posted: Tuesday, October 16, 2001

   Experts in the field of speech pathology have found that sometimes being on the cutting edge of science means being able to see through outdated, complex theories to find that the solution is right under your nose.

   In the past two decades, both the treatment for children who stutter and the theories behind the treatment have become surprisingly simple.

   Three to 5 percent of all children and 1 percent of all adults stutter, which holds true across all cultural and linguistic groups. This includes people with hardly noticeable stutters ranging to those with severe, disabling stuttering.

   Stuttering is not a psychological problem, as has been previously thought, but a physical one that recent studies indicate is rooted in neurophysiological wiring, and is most likely genetically inherited.

   And while stuttering might seem kind of cute in a small child -- just another one of the many ways little kids talk while they're still learning proper speech -- speech pathologists caution it isn't like other speech foibles.

   ''There's a big difference between developmentally appropriate speech errors and stuttering,'' said Anne Bothe, who has spent the last 10 years focusing on stuttering research and treatment and oversees the stuttering programs at the University of Georgia Speech and Hearing Clinic.

   ''If you can't communicate effectively, you're hugely limited to what you can do in life,'' said Bothe. ''There are some people whose speech is so drastically affected they have a very difficult time communicating even the most basic information. They feel limited in what they can do personally or professionally. They're marked as different and they have a hard time communicating: that combination can be really difficult for people.''


If you go

   What: First Friday fluency and stuttering screenings

   When: 2-5 p.m. Friday, Nov. 2

   Where: The Speech and Hearing Clinic at the University of Georgia, Aderhold Hall

   Call: (706) 542-4598

   Appointments are available for parents who are concerned about possible stuttering in their young children, for older children or adolescents, or for adults who are looking for more information about their stuttering or about possible treatment options. A stuttering support group is also currently being organized.

The Speech and Hearing Clinic offers programs for both children and adults who stutter. The treatment is usually implemented by graduate students under the supervision of Bothe, clinic supervisor Sue Ford and clinic director Carol Ann Raymond.

   For a long time it was believed that stuttering was the result of psychological problems triggered by trauma or anxiety. Experts instructed parents not to call attention to their child's stuttering because it was believed that parents pressuring children to behave in a certain way was in large part what caused the stuttering in the first place. Needless to say, this advice caused a great deal of hand-wringing and guilt among parents.

   Ultimately, parents were told to ignore the problem and that it most likely would go away in time.

   It is true that about a quarter of young children who stutter will stop without any treatment. But given the high percentage of those who don't stop and the high success rate of early treatment, it's risky to ignore the problem.

   ''Those old theories have been completely disproven,'' said Bothe. ''Now we treat stuttering like any other behavior that you don't want kids to be doing. The parent and the child come into our clinic at the same time to work with a clinician. We're playing and talking -- as far as the child knows, he comes into the clinic to play. When the child stutters we say something like, 'Uh-oh, there was your bumpy speech again, let's try that again.' We're highlighting for the child when he or she stutters. And when the child does speak smoothly, we praise that, saying something like, 'Hey, that was terrific! Did you hear how good that was?' All we're doing is letting the child know what we want, and when he does stutter, helping him to notice it.''

   The treatment is based on the Lidcombe Program, which was developed in Australia in the 1980s. The method has caught on quickly in some countries and is widely used by individual speech pathologists. But the program at UGA is the only research program of its kind in this country. What's special about the program here, says Bothe, is ''that it pulls from what works from lots of similar programs.''

   The method of giving positive feedback for desired behavior and gentle, corrective feedback for undesirable behavior is one that educators and parents have long known to be effective. So if it's that easy, then why do parents need a clinician to implement it?

   ''What we're concerned with is that the parents be taught two main things: One is to be sure that they are really good at identifying when their child stutters. Most parents are good at that, but we want to see them doing this with their children, just to make sure. The other thing we keep track of is the tone of the interaction. We don't want to just tell parents, 'Stop your children whenever they stutter.' They need to understand that there's an important balance between praising the child and correcting the child. Some parents do it very naturally, and some parents tend to be a little too correcting. The clinician can help parents learn how to keep it a positive experience for the child, which is a big part of why it's so successful.''

   Bothe says about 75 percent of all children who have been treated in the last eight years at the UGA clinic have gone on to forget they ever had a problem with stuttering. The remaining 25 percent continue to have very mild stuttering. The treatment is more effective the earlier it's started.

   ''As soon as you notice a preschooler is stuttering, that's when to call a speech pathologist to see about it,'' said Bothe. The program is used for children as young as 2 and a half up to around 8 years old.

   But when it comes to adults, treatment requires a different approach.

   Speech pathologists at UGA are currently one of only three treatment programs in the country that use Modifying Phonated Intervals (MPI), special computer software which helps to make a more tangible form of therapy. This program has actually been in use for quite a while.

   The idea behind it is related to why many stutterers don't stutter when they sing. Studies have found that when the voice box is ''on'' -- making sounds that are more prolonged or connected -- stuttering is less.

   The computer has a small microphone that is attached to the person's throat, picking up on the vibrations of the larynx, or voice box. As the person talks, the sound is routed to the computer with some software that shapes and processes the signal.

   What it shows on the screen is whether the time the voice is ''on'' is either too short or long enough. Boxes on the screen reflect what the person's voice is doing and what the target is -- what they want it to be doing to achieve smooth speech patterns.

   ''Very quickly people get to where they can use good, non-stuttered speech with the computer, or even in the room where the computer is,'' Bothe said. ''The challenge is for them to learn to use it outside the clinical setting in their regular environment.''

   Though Bothe said with confidence that ''everyone, without exception'' who has received treatment in the clinic has seen ''great improvement,'' the percentage of adults who achieve complete recovery is much lower than that of children.

   This is true for treatment programs all over the world. Bothe theorizes that the behavior is more engrained in adults simply because they have been stuttering for a longer period of time.

   ''If you've been talking a certain way your whole life -- for 30 or 50 years -- that's the way your brain and speech production system think speech is done. The system has never known anything else, and it's very difficult to change those patterns,'' she said.

   Direct treatment, which requires an average of two, hour-long visits a week, has about the same duration for both children and adults -- six months to a year. The follow-up phase for children, however, only lasts about a year, compared with at least two years for adults.

   The Speech and Hearing Clinic offers state-of-the-art evaluation and treatment for all kinds of conditions associated with speech, hearing and swallowing problems. The clinic serves the entire Athens community, and charges a minimum fee with a sliding scale.

   The clinic will provide a free screening for anyone who is concerned with stuttering from 2-5 p.m. Friday, Nov. 2 on an appointment basis at Aderhold Hall on the UGA campus. A stuttering support group is also currently being organized. For more information or to make an appointment call (706) 542-4598.



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