Why Stuttering Therapy Fails 1: Not Talking Enough

My biggest speech breakthrough was in 1995. I’d built an electromyographic (EMG) biofeedback device that measured my respiration, vocal folds, lips, jaw, and tongue muscle activity. As I tensed my speech-production muscles, a row of 16 lights went from green to yellow to red. The yellow lights switched on delayed auditory feedback (DAF) and frequency-shifted auditory feedback (FAF). The red lights increased the delay and shifted the FAF pitch lower.

In other words, when I started to overtense my speech-production muscles, before I stuttered, I received a visual and auditory warning. If I tensed my speech-production muscles more, the device forced me to slow down and relax my breathing and vocal folds. When I regained control and relaxed my speech-production muscles, the green lights returned and the altered auditory feedback (AAF) switched itself off.

I demonstrated the device at the American Speech-Language Hearing Association (ASHA) convention. For three and a half days I showed speech-language pathologists (SLPs) how I could make the lights go from green to yellow to red by tensing my speech-production muscles. I showed how my speech was fluent and relaxed when the lights stayed in the green.

I talked ten hours a day. These weren’t conversations where sometimes I talked and sometimes I listened. I did almost all the talking. At the end of each day I was too tired to socialize so I didn’t talk to anyone.

After the convention I couldn’t stutter for a week. Eventually my stuttering returned, but mildly and I knew what to do to regain my fluency.

My prior experiences of stuttering therapy was that I’d go to a speech clinic twice a week for an hour, talk fluently with the SLP, and then go right back to stuttering when I left the speech clinic. This went on for years.

A 1996 Australian study [1] found results similar to my experiences. The researchers divided 96 school-age stutterers into four groups. One group received “smooth speech” (fluency shaping) speech therapy in a speech clinic. A second group went to the speech clinic for the same therapy, but their parents came along and participated in the therapy. A third group went to the speech clinic and used EMG biofeedback computers, similar to the device I’d built, with minimal interaction with the SLPs.

The children who used the computers were the most fluent at the end of the study. The children whose parents participated in their therapy were a close second. The children who’d done therapy with the SLPs at the speech clinic were far behind. (The fourth group were the controls, who received no therapy and had no improvement in their speech.)

Two lessons can be drawn here. First, EMG devices increase the effectiveness of stuttering therapy. (Several other studies have also found this.)

Second, parents are better therapy-providers than SLPs. These children did therapy at home every day, with their parents reminding them to slow down and relax their speech-production muscles.

Training your brain’s speech motor control area for fluent speech requires a lot of talking. I needed more than thirty hours of on-target talking. This might mean sixty to one hundred hours of conversations (in which the other person talks).

I also needed to not talk off-target (i.e., stutter). Speech is no different from other motor (muscle movement) activities, such as golf or tennis. If your coach straightens your elbow during practice, you need to keep that elbow straight even when your coach isn’t watching. Getting sloppy will erase what your coach trained you to do. (Coaches often say they’d rather work with a novice than try to correct an experienced athlete’s well-learned bad habits.)

Most stutterers don’t talk enough to benefit from speech therapy. Most of us have found jobs, hobbies, and relationships that don’t require much talking. Young people now prefer to text instead of talk. If you want to develop fluent speech, change your life to talk more. You could:

• Ask your supervisor to let you talk to customers.
• Volunteer at a hospital’s information desk directing patients where to go.
• Eat lunch at a restaurant that has a community table (e.g., Whole Foods) and chat with strangers.
• Take an acting class.
• Volunteer to represent the National Stuttering Association at your state’s speech-language hearing association convention and talk to SLPs all day.
• Talk to people! Say that your speech therapist wants you to introduce yourself to strangers, and ask if you can talk to the person. No one will say no. Ask where they’re from, complement their appearance, etc.

And you must stay on-target, i.e., slow down and relax your speech-production muscles. I can’t pay attention to this while also paying attention to the conversation. Brain imaging studies show that stutterers have underactive auditory processing, i.e., there’s something wrong with how we hear our voices. I’ve often asked conversational partners to signal when my speech is too fast or I start to stutter, but people either can’t or won’t do this. Luckily we now live in an era of miniaturized electronics so devices such as MPIstutter can help you stay on-target.

What do you think? Do you talk a lot, or do you avoid talking? Share your experiences in the comment bos (below)!