Don Modarelli
Perkins described stuttering as a neuro-physiological speech disorder that involuntarily disrupts the smooth flow of spoken utterances. The three main speech abnormalities caused by stuttering are: repeating words or syllables, awkward pauses, and elongation of syllables. The frequency of stuttering may be affected by the audience and/or context, and the severity of stuttering may be influenced by unrelated situations in life that cause additional stress. Stuttering occurs in about 5% of children, of whom 70% recover naturally with or without intervention. This leaves about 1% of adults affected throughout their remaining lives. The cause of stuttering eludes the most intuitive research teams, so most therapy is directed towards reducing the symptoms of stuttering, and dealing with the emotional impact of such an obvious social deficiency.
Curious Aspects of Stuttering
One of the initial things discovered about stuttering is the seeming resistance to most forms of therapy. Most treatments are limited in their ability to reduce stuttering, with relapse at very high rates, so most programs focus more on the emotional and anxiety aspects to improve quality of life with the disability. On the other hand, it was found that stuttering has weaknesses that are begging to be exploited: the stutter disappears when the client sings, or speaks with external pacing assists, or cannot hear oneself speak, or when speaking to oneself, to an animal, or to a child. The causes of stuttering elude scientists as well. Several aspects of brain function or development have been suggested, but it cannot be determined if these dissimilarities to other brains are causes or results of the dysfunction.
Anxiety is also heralded as a possible culprit, but when anxiety is dealt with in therapy, it appears incidentally to be a result of the stuttering, and not the cause.
Parkinson’s disease shares some of the physical abnormalities of the basal ganglia. Scientists have speculated if Parkinson’s and stuttering are a subset of one or the other. That would provide helpful clues to the cause of stuttering. Other scientists have noticed similarities between stuttering and Tourette syndrome. Both diseases affect males much more so than females, the symptoms also disappear with singing and animals, and severe stutterers seem to express other involuntary, repeated physical gestures that resemble tics.
Chronic adult stuttering stands as an inviting mystery for those who enjoy a good, intellectual, neuropsychological challenge. When stuttering lasts into adulthood, the client is doomed to a lifetime of continual speech dysfunction with few therapeutic benefits which typically relapse sooner or later. It has received a significant amount of competent, and incompetent, research and therapeutic attempts to solve it. Finally, it was found that many mildly successful methods of treating stuttering were related to the sensation of hearing one’s own voice when speaking in a spontaneous, natural manner. In order to circumvent this situation, audio feedback devices have been created to delay or modulate the playback of one’s voice to eradicate stuttering. Programs designed to teach the client to modulate their voice have been tested to see if stuttering can be eliminated. None of them were 100% effective. In fact, the best numbers reported were a 12% improvement in reduction in stuttering incidents. There is plenty of room for a new and more effective solution to stuttering.
Impersonative Speech Modification
Very few past methods have worked, and they were awkward because they required headphones or some other device to modify the sound of the stutterer’s own speech. These methods take advantage of the “trick” that if a stutterer doesn’t hear his or her voice when they attempt to speak, the speaking will proceed without impairment. The problem of stuttering does not reside in the “speech composition” or the “speech delivery” portions of the brain and body! Stuttering seems to be most active when one is speaking freely to another individual at one’s own pace. Delayed auditory feedback simply plays back the sound of the speaker’s voice late enough so that don’t hear themselves speak until a designated pause later. Frequency altered feedback modulates the sound of the speaker’s voice up or down so that the speaker cannot determine that it is his or her own voice. Stuttered syllables are typically reduced 50-90% during these sessions.
Another assist for stutters is pharmacological agents, mostly dopamine-blocking drugs. This approach is a result of attempting to treat the similarities between stuttering and Tourette syndrome. The drugs are too extreme in order to make it a feasible permanent solution.
The one method that comes close to Impersonative Speech Modification (ISM) in the literature reviewed is speech restructuring. Using a method called prolonged speech, the clients were taught to speak at a slower rate than they naturally would. Reduced stuttering of 12% was reported a year after the initial training (11% if the training was coupled with CBT). This appears to be the most effective solution reported so far.
Clients were encouraged to imitate a clinician or to imitate a video model, but that was for the purpose of mastering speech prolongation. There have been many important aspects of stuttering discovered in the review of existing literature, but there seems to be a gap where ISM may be able to help stutterers. In conclusion, it appears that nothing like ISM had been tried or tested in a professional environment. This method has not been mentioned, nor has anything similar to it been attempted.
Discussion
The hypothesis being tested is Impersonative Speech Modification (ISM) which may be the best way to alter the feedback (trick the ears) and bypass the resultant involuntary disruption of smooth spontaneous speech. No form of psychotherapy is necessary because self-esteem is anticipated to naturally occur once fluid speech has been achieved. Clients are encouraged to modify their speech to mimic another person (impersonate a movie star, etc) when they speak for the full session of therapy. In the beginning, they are expected to “ham it up” so that the experience begins as repeating (and enjoying) written monologues. In time, it is expected that the accent will diminish slightly over time as the client gets more comfortable speaking their own words and holding conversations, in an adjusted or modified voice, without stuttering. With the natural voice “masked” without the use of bulky technology (headphones), this solution should prove portable.
People may, at first, mention the change in accent in positive or negative ways, but the client will be encouraged to continue obstinately. This solution has only been applied to one client with 100% success, and we are seeking more subjects to test this method for efficacy and scope.