Nola Radford, Ph.D, recently wrote an interesting blog post “One Size Does Not Fit All: Let’s Investigate and Cite Lesser Known Approaches to Fluency Therapy.” Dr. Radford’s blog post first summarizes a study she did with the Casa Futura Technologies School DAF, which found more than 50% carryover fluency after using the device in therapy. Then she writes:
“If individuals who stutter are heterogeneous for any number of characteristics, then it is reasonable to assume that no one therapeutic approach will be appropriate for all who stutter.”
I agree…and disagree. All evidence-based (i.e., effective) stuttering treatments are compatible, that is, they can be done together. You can do fluency shaping therapy with an altered auditory feedback (AAF) device while taking thiamin (vitamin B-1) and magnesium while doing CBM treatment for social anxiety. There’s no reason not to do all evidence-based treatments together. None are overly time-consuming or expensive.
There are strong reasons not to do a single stuttering treatment. I’ve heard many times, “I tried this therapy and it didn’t work. Then I tried that therapy and it didn’t work. Nothing works!” Stuttering is a mulitfactorial disorder. It’s associated with overactive speech motor processing, which fluency shaping treats; and with underactive auditory processing, which AAF devices treat. It’s a dopaminergic disorder (triggered by stress, the harder you try to not do it the more the behaviors manifest). There’s a psychological component for many stutterers, who fear speaking in certain situations. Treating one of these factors, without treating the other factors, won’t stop stuttering. You have to treat all the factors at the same time to see results.
In my twenties I completed seven stuttering therapy programs, with little or no effect on my speech. These included Precision Fluency Shaping Program (PFSP), Van Riper-style stuttering modification, and random nonsense from various SLPs. Fluency shaping sort of worked, in some situations, but never when I needed it. In 1992 I built a delayed auditory feedback (DAF) telephone device. Combining fluency shaping with DAF, I was fluent on phone calls and soon developed carryover fluency the rest of the day. I felt that a weight had been lifted off my shoulders and a lifetime of anger disappeared. I hadn’t known how angry I’d been because I’d always been angry, at how people treated me because I couldn’t talk.
But plenty of stutterers stick a AAF device in their ear and talk without fluency shaping techniques. They don’t develop carryover fluency, and some experience adaptation or the device’s effectiveness “wearing off.” AAF without fluency shaping can be ineffective as fluency shaping without AAF was for me.
Thiamin and magnesium appear to be effective for only about one-third of adult stutterers. No one knows why this treatment works for some stutterers but not others. My guess is that small changes can have large effects on systems near optimum; when systems are far from optimum major changes have little effect. In other words, if you have severely overactive speech motor control, severe underactive auditory processing, severe dopamine issues, or severe psychological issues, fixing one of these may not make much of a difference. But you’ve fixed your severe issues, then a small change may be the remaining puzzle piece that makes everything work.
A red flag of ineffective stuttering therapies is when you’re told not to do other treatments. Another red flag is when the therapist says that his or her therapy works for 100% of stutterers, “if they try hard enough.” A third red flag is when a therapist dismisses studies published in scientific journals because science can’t measure “real stuttering.” The fourth, fifth, and sixth red flags are when a stuttering therapy is expensive, time-consuming, and/or requires traveling far from your home. Such treatments are only effective in making money for the therapist.
Read more about evidence-based stuttering treatments in my free e-book, Five Ways To Treat Stuttering.