The Stuttering Brain

Those of you who read my blog regularly (if indeed any of you exist) may have noticed that I've recently added a list of books I'm reading. One book, in particular, stands out as different among the rest in my list: The Lidcombe Program of Early Stuttering Intervention: A Clinician's Guide by Mark Onslow. It is a textbook detailing the Lidcombe Method for treating stuttering in preschool-aged children. I am particularly interested in this because my 5 year old son has struggled greatly with stuttering, and the exact cause of stuttering is still a mystery to this day. There are many theoretical approaches to dealing with stuttering, but all of these are based on presumptive theories relating to the assumed causes of stuttering. Lidcombe is an atheoretical method for treating stuttering. That is to say - the method is not based upon a theory as to the cause of stuttering. It is simply based on clinical research regarding methods that are proven successful in eliminating stuttering in young children - regardless of the cause.

The Lidcombe approach, although it has been thoroughly researched and shown to be very successful with children under the age of 6, is not the typical stuttering treatment a child would receive here in the United States. Only a small number of clinicians here in the U.S. use this approach. Lidcombe was developed primarily in Australia, and is a popular choice for clinicians in Australia, New Zealand, South Africa and the United Kingdom. It is a bit radical in it's direct approach, yet it is very simple to implement. It is pure operant conditioning, based upon B.F. Skinner's model of reward, punishment and extinction. With Lidcombe, to summarize briefly(read the book to really learn how to use it), the parent (the clinician simply teaches the parent how to implement the therapy, and then subsequently attains objective measures of treatment progress) in both structured and non-structured conversation offers the child acknowledgment and praise when statements are uttered fluently (i.e. stutter-free) and acknowledges the "bumps" when a child stutters unambiguously, followed by a request to try the statement again. One key factor in making this pleasant for the child is that the positive verbal contingencies must outnumber the negative at least 5:1. This whole idea of directly addressing the stutter with a child flies in the face of many past passive approaches, which were to never acknowledge or address the issue with the child for fear it will make them self-conscious and therefore struggle all the more. In fact, many experts thought the idea of operant conditioning for stuttering was completely abhorrent when the research first began in this area. Yet, for some unknown reason, it works! Perhaps very young children have enough brain plasticity to figure out on their own how to control the stutter once they are encouraged to do so.

Here in the US, one is more likely to receive treatment that is based somewhat on the demands and capacities model - changing conversational and environmental stressors to promote fluency - as well as fluency shaping techniques - teaching stutterers to elongate vowels and and speak with relaxed, slow speech. These techniques have shown success with stutterers, but there are quite a few who are not helped by these methods of treatment. Of the number of children who spontaneously develop stuttering in the preschool years, a full 20% will never recover - despite therapy - and will go on to become adult stutterers. Boys are more often affected than girls, and the risk for boys to become lifelong stutterers is 4 times greater than that for girls. Many of the 80% who recover, do so spontaneously without therapy. That indicates that the failure rate for therapy is much greater than 20%. As the mother of a 5 year old boy who stutters, I know the odds are not necessarily in his favor, but I refuse to give up and settle for one approach that only has shown limited success. I am committed to learning all I can about the supposed causes of stuttering, and I plan to implement this Lidcombe operant therapy at home while my son still receives more traditional therapy once a week at our local elementary school.

Another area in which I plan to do more research and reading regarding stuttering help is in the relatively new field of educational kinesiology (Edu-K.) This is the study and application of natural movement experiences to facilitate learning. It focuses on the performance of specific physical activities that activate the brain for optimal storage and retrieval of information. It has been shown to help with ADD, ADHD, Sensory Integration Disorder as well as basic focus and concentration in both children and adults. I theorize that stuttering has both behavioral and physiological components. It only makes sense, then, to try to treat both. I first began to look into this area when I read in a journal article, What Causes Stuttering?, by Christian Buechel and Martin Sommer. The article explains that PET scans and fMRI imaging have shown in multiple studies that the right hemisphere of the brain is hyperactive in adult stutterers when they produce stutter-free speech; wheareas the left hemisphere is more active when producing stuttered speech. This leads to the hypothesis that the right hemisphere language areas try to compensate for a deficit in the left, and that perhaps the 80% of people who recover from stuttering are those who are able to use their right brain hemispheres for language production. This discovery prompted me to ask, "Is there a way to improve right hemisphere functions and cross-communication between the two hemispheres of the brain?" Indeed, there are exercises and activities that have been shown to improve cross-communication between the left and right hemispheres of the brain as well as other aspects of brain function, and I plan to learn more regarding the research in this field. I have a few books I've ordered on the way. I'll update my blog when I learn more.

I've told my husband I am on a mission to help our son overcome his stuttering. He has already shown significant improvement in the past few months - most of it before we started traditional therapy, and I have my theories regarding his seemingly spontaneous improvement. Hopefully, I will have more information to support my theory once I have read more about Edu-K.

For more information and all the cutting-edge theories and research regarding stuttering, check out the blog, The Stuttering Brain, from which I borrowed the title for this entry. I also have included it in my list of blogs on the left-hand column of the page.