If I stutter, what help is out there for me?

This article first appeared in the Fall 2009 issue of the CSA Newsletter.

Jaan PillJaan PillMany treatment options are available for people who stutter. What follows are my personal opinions on this topic — based on my experiences, which may well differ from your own.My personal views do not represent the views of the Canadian Stuttering Association, of which I’m a co-founder. CSA neither endorses nor rejects any particular approach to dealing with stuttering.

I stuttered severely as a child starting at age 6. At times, I could not get out any words at all. The “h” sound, in particular, often stopped me in my tracks. Sometimes, after a prolonged struggle to say “hello,” I would hang up the phone without having said a word. On many (but not all) levels, I lived outside of the mainstream of life, and felt discouraged about my prospects.

I had stuttering-modification therapy in Montreal in my early twenties. I attended a Toronto fluency-shaping clinic at age 30. At age 41, I spent three weeks in Edmonton at an integrated program which included fluency-shaping.
I’ve tried many things that did not work including the Doman-Delacato patterning “therapy” and Neuro-Linguistic Programming. I believe strongly that an evidence-based approach is essential when considering the options available to us. Show me solid evidence that a given approach works on a long-term basis, in everyday situations, for a majority of stutterers. Show me results published in peer-reviewed professional journals. Otherwise, I am not interested.

PFSP

I attended a stuttering-modification clinic in Montreal in the 1960s, where I learned to reduce my tendency to avoid speaking situations. This change in behaviour was helpful, but I continued to stutter. In 1976, I attended a three-week Precision Fluency Shaping Program (PFSP) program in Toronto, at the Speech and Stuttering Institute. Right after the clinic, I still avoided public speaking, but was otherwise relatively fluent.

A week or two later, however, most of my fluency skills flew out the window, as I was speaking with a friend on the phone. Fortunately, enough skills remained in place to enable me to graduate in 1983 from a teacher-training program. My early years of teaching were restricted to small special education classes.

In July 1987 – eleven years after the Toronto PFSP clinic – I attended the Comprehensive Stuttering Program at Edmonton’s Institute for Stuttering Treatment and Research, after which I felt comfortable with public speaking for the first time in my life. The CSP program integrates fluency shaping, stuttering modification, and cognitive-behavioural skills. (The Toronto PFSP clinic now also includes self-talk and other attitudinal components.)

After the CSP program, I practised my fluency skills daily for several years. Each day, I recorded two five-minute practice sessions, and played back the recordings. I regularly analyzed how well I spoke in everyday situations. I also recorded phone calls and conversations, and analyzed two-minute segments to ensure I was applying the skills correctly. A typical exercise involved fluently asking for “half a pound of Edam cheese” at a cheese counter at Toronto’s St. Lawrence Market. Words beginning with the “h” sound had often stymied me in the past.

This time around, I had at least one relapse, but I recovered quickly. My speech has been fine since then – including in presentations and in my work as a teacher. I like to say I learned fluency as a second language. In the end, I succeeded in learning this language because my willingness to work hard (which had always been there) met a set of instructions that enabled me to reach my destination.

Both PFSP and CSP teach fluency-shaping skills, but there are differences. When I attended the Toronto clinic in 1976, PFSP clients were taught to prolong all the syllables in a sentence the same length of time. As a result, some clients ended up with a robotic-sounding speech pattern. The CSP program, in contrast, taught differential prolongation of syllables, in which some syllables (the stressed syllables in a word) are prolonged slightly longer than others. This resulted in a more natural way of speaking. I’ve been informed that the robotic speech pattern characteristic of PFSP in the 1970s is no longer in evidence.

There’s a third intensive clinic – the Stuttering Treatment Clinic at the Ottawa Hospital Rehabilitation Centre – which combines the CSP and Ann Meltzer’s Essential Pause program. I have not attended the clinic but am impressed with what I’ve learned about it. The Ottawa clinic offers semi-intensive 10-week programs as well as the intensive three-week format.

About one in five people who stutter who attend an intensive fluency-shaping clinic will fail to attain long-term gains. That is, what worked for me may not work for others. As well, not every person can attend a three-week clinic. Weekly therapy, conducted by a speech therapist with training and experience in treatment of stuttering, is a valid option. Please contact CSA if you’d like names of therapists in this category living in your area.

Self-help

In 1988, I helped to form a self-help group in Toronto. The group enabled me to adjust to the new level of fluency I’d acquired in 1987. Adjustment to fluency had been a major issue for me. On many levels, self-help groups can be a great help. I’ve summarized the benefits of self-help in two articles (Pill, 1988, 2004).

Altered auditory feedback devices

Brands of altered auditory feedback devices on the market include the SpeechEasy, the Fluency Master, and the Fluency Enhancer. So far, no large-scale studies have been published in peer-reviewed journals documenting the long-term effectiveness of such devices. To my knowledge, the biggest study currently under way is by Larry Molt at Auburn University in Alabama.

A small-scale study by Jennifer O’Donnell, Joy Armson, and Michael Kiefte (2008) found that five of seven people showed some instances of reduced stuttering when using the SpeechEasy in everyday speaking situations. Three of the seven subjects had relatively stable amounts of stuttering reduction during long-term use.

Another small study, with eleven subjects, by Ryan Pollard and others (2009) concluded that there’s no significant long-term improvement in speech for users of the SpeechEasy, based on data acquired over a four-month period in everyday situations. Some individuals found the device helpful, and others saw no benefit. [Ed note: this article is discussed in the article review section]

Lidcombe Program

For parents of young children who stutter, it’s useful to know that the Lidcombe Program, developed in Australia, is highly effective in treatment of stuttering in preschool children, as indicated in research reported in the British Medical Journal and other peer-reviewed professional journals.

The earlier a person gets effective treatment for stuttering, the better. You can find a list of clinicians trained in this program by doing a Google search for “Lidcombe referral list.” It’s also useful to keep in mind that the program may not necessarily be the solution for every young child who stutters.

If you know of very young kids who stutter, please let their parents know about this treatment. You can find additional information by doing online searches for the following sets of keywords: Montreal Fluency Centre; ASRC Lidcombe; Lidcombe program; and British Medical Journal Lidcombe.

Barry Guitar’s widely used textbook on stuttering (Guitar, 2005), which can be found online, offers a valuable survey of treatment options. Abstracts of articles from the Journal of Fluency Disorders can be found at the ScienceDirect and PubMed websites.

References

Guitar, B. Stuttering: An integrated approach to its nature and treatment, third edition (2005). Baltimore: Williams & Wilkins.
O’Donnell, J.J., Armson, J, & Kiefte, M. The effectiveness of SpeechEasy during situations of daily living. Journal of Fluency Disorders, 2008, 33: 2, 99-119.
Pill, J. Einer Boberg’s contribution to the self-help movement. Journal of Speech-Language Pathology and Audiology, 1998, 22: 4, 385-398.
Pill, J. Self-help and the international scene (Plenary Session, Invited Speakers). Theory, Research and Therapy in Fluency Disorders: Proceedings of the Fourth World Congress on Fluency Disorders, 2004, pp. 12 –20. International Fluency Association.
Pollard, R., Ellis, J. B., Finan, D., & Ramig, P.R. Effects of the SpeechEasy on objective and perceived aspects of stuttering: A 6-month, Phase I clinical trial in naturalistic environments. Journal of Speech, Language, and Hearing Research, 2009: 52, 516-533.