Dominic Barker Trust Open evening : presentation by Tammy

Good evening, I am Tammy Davidson, the fortunate recipient of the Dominic Barker Research studentship. I am a speech and language therapist who trained in South Africa and I have worked as a clinician in both South Africa and the United Kingdom over the past eight years. My interest in Speech and Language therapy started at a young age as my younger brother had ADHD and a specific language impairment, which also later resulted in dyslexia. This meant that although he was very bright, he initially had difficulty learning to talk and had difficulty learning to read and write, and had many years of speech and language therapy. He now works for an international electronics company travelling round the world as an expert in his field, so I saw first hand the benefits of speech therapy! After doing a medical Bachelor of Science degree, I started studying speech and language therapy at the University of the Witwatersrand in South Africa. My interest in stuttering began in my third year of the SLT course when I had the opportunity to take part in the Successful Stuttering Management Program which was run at our university. I later did my final year research dissertation on this program.

Stuttering is a complex and diverse subject. There have been so many theories and treatments over the years but still so much is unknown and so much is debated. Research has found that about 5% of the population stutters at some point in their lives, but eventually after spontaneous recovery and recovery due to clinical intervention about 1% of the population is left with a persistent stutter. Some children who stutter will get better without therapy and some children who wouldn’t get better by themselves do get better with speech therapy.

The Lidcombe programme is a behavioural treatment for young children who stutter. A recent randomised control trial of the programme showed that after early therapy intervention with this program just more than half of the children’s speech improved significantly compared to the children who did not get treatment. This is excellent news! But just under half the children who had the therapy did not stop stuttering! It is also understood that there seems to be a critical age range where this treatment is effective. It appears that the older one gets the less likely therapy is to be successful and although there are some therapy techniques that are useful to adults, many, if not most of the people who undergo stuttering therapy as an adult relapse, and do not attain fluent normal speech. This is a significant number of people. It appears that about 10 to 15% of people who stammer will persist in stuttering and be unable to change the underlying speech motor problems sufficiently well to make their speech stutter free. It appears that there may always be adults, who despite having therapy, will continue to stutter. For many years anxiety has been linked to stuttering. People who stutter often report that anxiety makes their speech worse. Many people who stutter seem to believe that it is their fault that they stutter, that they may have psychological problems, even though research is now showing that stuttering is likely to be caused by neurological and genetic problems.

Even though the relationship between stuttering and anxiety has been written about since the 1930s, no-one yet knows whether anxiety causes stuttering or stuttering causes anxiety. This means that it is very difficult to target therapy at the correct problem in adults. In Isobel’s study: Communicating in the real world: accounts from people who stammer, some of the people she was interviewing blamed themselves, saying that their nervousness caused their stammering. Her research found that people who stammered were limited in their lives; their stammering affected their choice of career and that they missed many social opportunities like making friends and forming relationships. Isobel’s participants also reported that fear of stammering was instrumental in the persistence of their communication problems.

At the moment, therapy techniques vaguely target working on anxiety, but none of this is researched. We need to research this area to prove that it is useful and helpful. It appears intuitive that therapy targeted at this area must be helpful, but many years ago leeches were applied to the lips of the mouth to cure stuttering. An alternative treatment was to cut the root of the tongue and remove a wedge of the tongue because it was known that stuttering was a result of the tongue being too big for the mouth. This practise was common and it did stop stuttering…. but only until the wound healed sufficiently. In the past, PWS were asked to speak with stones in their mouths to improve their speech, today we would not dream of requesting that our clients do that in therapy. Without good focused research we cannot truly know if our interventions are useful, and as we discover more about the causes of stuttering, our interpretation of previous research moves forward.

If the relationship between stuttering and anxiety could be accurately defined, we can work out if, and then how to target it in therapy, which would hopefully result in two things; the possible reduction of stuttering in speech, and the ability for PWS to better engage with the social opportunities and other aspects of life that PWS have found so limiting.