Ask a Question2021-03-14T18:52:49-06:00

Ask a question about stuttering

Childhood treatments

What early childhood stuttering treatments are effective?2021-03-14T18:54:55-06:00

The Lidcombe Program has been proven effective in many published studies. The Westmead Program has been proven effective in two studies. For more information see our e-book Stuttering in Children—From Toddlers to Teenagers.

What treatments are effective for school-age children?2021-03-14T18:56:31-06:00

School-age children can do the adult stuttering therapies including fluency shaping and DAF. The difference between school-age children and adults is who should provide the therapy. A 1996 study divided 98 children (9 to 14 years old) into four groups:

  • Fluency shaping in a speech clinic.
  • Teaching fluency shaping to the parents, who then provided therapy to their children.
  • GILCU with EMG biofeedback. The children went to a speech clinic and used electronic devices, with minimal therapy from the SLPs.
  • A control group didn’t receive any stuttering therapy.

Post-treatment, all three treatments were effective. However, one year later the percentage of children with disfluency rates under 2% stuttered syllables were:

  • 48% of the children who’d had therapy in the speech clinic were fluent.
  • 63% of the children who’d had home-based therapy were fluent.
  • 71% of the children who’d done therapy with the EMG devices were fluent.

The results for disfluency rates under 1% were even more striking:

  • 10% of the children from the clinic-based program.
  • 37% of the children who’d been treated by their parents.
  • 44% of the children who’d used the EMG devices.

This study suggests that parents of school-age children should consider doing fluency shaping therapy at home using electronic devices. For more information see our free e-book Stuttering in Children—From Toddlers to Teenagers.

What medications are effective for stuttering?2021-03-14T18:47:40-06:00

No prescription medications have been found to have more than marginal effects on stuttering. Many have side effects, sometimes severe. For more information see our free e-book Medications for Stuttering.

Thiamin and magnesium have been proven effective in two small studies. For more information see our blog post Should Stutterers Take Vitamin B-1?

Adult treatments

What adult stuttering treatments are effective?2021-03-14T12:11:30-06:00

The first evidence-based stuttering treatment—proven effective in a scientific study—was delayed auditory feedback (DAF), in 1965. With DAF a stutterer hears their voice delayed in headphones a fraction of a second. The delay is adjusted to control the stutterer’s speaking rate. Short delays reduce stuttering about 70% at a normal speaking rate. Longer delays are used in DAF therapy to slow speaking rates and can make even severe stutterers almost completely fluent.

DAF therapy led to the development of fluency shaping therapy in the 1970s. A speech-language pathologist (SLP) trains a stutterer to

  • use relaxed, diaphragmatic breathing
  • release a little air before initiating phonation at a low volume (gentle onset)
  • gradually increase volume
  • slow speech by stretching vowels
  • reduce articulation (lips, jaw and tongue movements)

Fluency shaping therapy can reduce stuttering 70-75% for about 70-75% of stutterers. In other words, fluency shaping doesn’t “cure” stuttering or make anyone 100% fluent, and doesn’t work at all for some stutterers. Combining fluency shaping and DAF has helped many stutterers.

In the 1990s frequency-altered auditory feedback (FAF) was found to be as effective as DAF at normal speaking rates. DAF and FAF can be combined to increase effectiveness.

Modifying phonated intervals (MPI) therapy was developed in the 2000s. Several studies have found it to be highly effective, but the therapy is only available in a few speech clinics.

For more information see our free e-books Five Evidence-Based Stuttering Treatments (25 pages) and What Stuttering Treatments Are Effective? (29 pages).

What medications are effective for stuttering?2021-03-14T18:47:40-06:00

No prescription medications have been found to have more than marginal effects on stuttering. Many have side effects, sometimes severe. For more information see our free e-book Medications for Stuttering.

Thiamin and magnesium have been proven effective in two small studies. For more information see our blog post Should Stutterers Take Vitamin B-1?

I tried speech therapy but it didn’t work for me. What should I do now?2021-03-14T17:34:50-06:00

Find a stuttering specialist who uses evidence-based practice (EBP).

Speech-language pathologists (SLPs) are trained to be generalists, not specialists. They might have had a one semester course on stuttering, or a half a semester, or no classes on stuttering. You might be the first stutterer they’ve ever seen.

EBP means using treatments that have been proven effective in scientific studies. Few SLPs read scientific studies. They do what they were taught in graduate school, if they were taught anything, or do what their friends do.

I’ve been in this field for 25 years and I’ve seen that almost every SLP in private practice puts profit ahead of efficacy. They like therapies that keep you coming in twice a week at $125/hour for months or years. They want you to get a little better but not do so well that you stop coming. In contrast, EBP stuttering treatments are effective quickly.

If a SLP tells you not to do other treatments, find a new SLP. There’s no “one size fits all” stuttering therapy. EBP stuttering treatments can (should!) be combined with other EBP stuttering treatments.

I tried fluency shaping therapy but it didn’t help me. What should I do now?2021-03-14T17:48:23-06:00

Combine fluency shaping therapy with DAF. Fluency shaping was developed from DAF therapy. Fluency shaping alters your brain’s speech motor control. DAF alters both speech motor control and auditory processing. You need both.

Increase force and volume. Read a motor learning and control textbook. You’ll learn that motor learning (physical therapy, occupational therapy, sports coaching) starts with slow, controlled correct muscle movements. When the patient or athlete has mastered the movement at a slow, gentle speed the force and speed is increased. Increasing force and speed makes the brain learn the motor movements (“muscle memory”). In contrast, fluency shaping leaves you at the slow, gentle stage where you don’t retain the new motor skills. Instead of doing your practice sets in a quiet cubicle, go to an empty amphitheater or a freeway overpass or, like Demothenes, to a beach with crashing waves. Project your voice far and loud.

Talk more! Mastering a new set of motor skills requires massive hours of practice. NBA players practice eight hours a day. Ask your employer for a job that requires talking to people. Helping irate customers on the phone eight hours a day would be perfect! Start a hobby that requires talking, for example, teaching English to immigrants.

Use prolonged speech to talk to strangers. I’d pick up the phone when telemarketers called. I tried to keep them on the phone as long as I could, talking very slowly. They’re getting paid by the hour.

I tried DAF but it didn’t work for me. What should I do?2021-03-14T17:21:54-06:00

Adjust the delay correctly:

  • 50-60ms for normal speaking rates.
  • 60-80 ms for “slow normal” speaking rates.
  • 100ms or longer should only be used with fluency shaping therapy (slow, prolonged speech).

Try a better DAF device. Some DAF devices and phone apps sound awful.

Combine FAF with DAF. FAF pitch shifts around -0.5 octaves (a half octave down) are effective and sound good.

Use a better microphone. The microphone should be close to your mouth or contacting your throat. It should be noise-canceling and not pick up background noise.

Use better earphones. Adult male vocal folds vibrate around 125 Hz. FAF lowers that below 100 Hz. SpeechEasy devices have a frequency range of 200-8,000 Hz, with a peak response around 3,000 Hz. DAF doesn’t work if you can’t hear your voice.

Combine fluency shaping therapy with DAF. Slow down by stretching your vowels.

 

 

I tried thiamin but it didn’t work for me. What should I do?2021-03-14T18:46:45-06:00

Check the dosage. Adults usually take around 300mg of thiamin.

Take magnesium with thiamin. 300mg is usually what adults take.

Get a nutrition test such as the Spectracell Micronutrient Panel.

Stop consuming vegetable oil (canola, corn, soy, safflower, sunflower), caffeine, and chocolate.

Employment questions

Where should a stutterer look for a job?2021-03-14T12:08:56-06:00

Sign up with your state’s vocational rehab agency. They’ll pay for speech therapy or a device, look through their database of job openings with employers who want to hire people with disabilities, and coach you with interviewing.

How should a stutterer handle a job interview?2021-03-14T12:24:47-06:00

Say that you stutter, show what you’re doing to improve your speech, and then do it.

Ask the interviewer to help you. If you need to slow your speech, ask the interviewer to raise a hand when you talk too fast. Ask the interviewer to slow their speech and you raise your hand when they talk too fast.

How should a stutterer ask for a promotion at work?2021-03-14T12:25:35-06:00

Talk to your employer about your speech. The Americans with Disabilities Act (ADA) prohibits employers from asking employees about disabilities. You have to start the conversation.

Ask your employer to help you improve your speech. That could mean time off to go to speech therapy or help paying for an electronic device.

If speech therapy is going well ask to change to a job that requires talking to more people. Talking many hours a day is essential to make therapy stick.

We’ve heard many stories from stutterers who talked to their employers about their speech and their employer said, “You’re our best employee and we want to promote you. We’ll do whatever you want to help you improve your speech.”

Dating

How can a stutterer find a girlfriend/boyfriend?2021-03-14T12:09:12-06:00

I got a girlfriend by saying, “My speech therapist wants me to introduce myself to more people. Can I talk to you?” That was at one-second stretch.

Etiology

Is stuttering genetic?2021-03-14T18:58:54-06:00

No. For more information see our blog post Genetics of Stuttering.

What is the neurology of stuttering?2021-03-14T19:06:39-06:00

The two most prominent neurological abnormalities associated with stuttering:

  • Overactive speech motor control, resulting in too much speech muscle movement, such as hard blocks, prolongations, and repetitions. DAF helps stutterers to slow down speech muscle movements. Fluency shaping therapy trains stutterers to speak with relaxed speech muscle movements.
  • Underactive auditory processing, resulting in poor integration between how we hear our voices and how we feel our muscles moving. DAF, FAF, and MAF appear to increase auditory processing activity.

Stuttering is also a dopaminergic disorder, along with Tourette’s syndrome and obsessive-compulsive disorder (OCD). Dopaminergic disorders manifest in relation to stress. Stereotypical behaviors increase if the person tries not to do the behavior.

For more information see our free e-book Neurology of Stuttering.

 

What causes stuttering?2021-03-14T18:50:10-06:00

Books

What are some recommended books about stuttering?2021-03-14T12:08:28-06:00

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