JWCSC Montreal Day 1

Stammertime is in Montreal, for the Joint World Congress on Stuttering and Cluttering (JWCSC). This is a major stuttering event, organised every three years by the International Fluency Association. NEWSFLASH – the International Fluency Association are changing their name! No decision as yet on what the successor will be. However, it would appear that “fluency” is on the way out.

Joze Piranian, who stutters fluently in five languages, gave the opening keynote. Piranian is a hugely experienced speaker, incorporating stuttering into his delivery to great effect. There was a strong focus on wellness strategies and self-disclosure. These point towards a “mindset shift” which increases opportunity. The talk introduced discussion points such as the “Vienna Moment” and the “Inclusion Pool Paradox”, ending on the very apt note, “My obstacle has taken me around the world. Where will your obstacle take you?”

JWCSC runs parallel sessions so, sadly for Stammertime, it was impossible to attend all the talks. We were moreover at the conference in a professional capacity, giving a technical presentation about the vestibular system in stuttering following the keynote (similar content to this). We were delighted to join the PhD researcher session, in which senior researchers Nan Bernstein-Ratner and Soo Eun-Chang gave a workshop with some highly valuable tips about writing successful grant applications.

In perhaps the day 1 highlight. Marie-Christine Franken showed preliminary data from a follow-up to her group’s 2015 study comparing the Lidcombe and RESTART-DCM child therapies. Long-term watchers of stuttering research will recall her group’s finding of very little difference in effectiveness between Lidcombe and RESTART-DCM. This is despite the two therapies having dissimilar bases. In Lidcombe, parents actively change the way their child speaks. In RESTART-DCM, the parents ensure their child is never under pressure to speak. In 2015, Franken and colleagues found that between 71% and 77% of children who received therapy stopped stuttering, with no significant difference between therapy types. This range is strikingly similar to the approximately 75% rate at which children stop stuttering without any intervention. It might appear from these data that childhood stuttering therapies do not work at all! However, a better interpretation is that the therapies are important for the family. Whether or not stuttering stops, parent and child can bond over their experiences in working together. Ideally, a childhood therapist might even set the scene for teenage or adult therapy, if necessary and appropriate.

In today’s update from Franken, the children are followed up at age 11. Data are preliminary, and the conference audience was urged towards secrecy. However, it is possible to reveal that the lack of any statistical difference between Lidcombe and RESTART-DCM continues to hold at age 11. As well as expert assessments of stuttering, the follow-up evaluates child, parent and teacher attitudes. A variety of self-esteem and quality of life instruments were employed, including the well-known OASES. Children had high satisfaction with their speech and communication following therapy. There was a lot more to discuss within the presentation, but we will have to wait for the peer-reviewed article.

Naomi Rogers and Hope Gerlach-Houck talked about motivation. This is an often overlooked yet crucial precedent to successful change in attitudes to stuttering. For example, it is the first stage in the Van Riper stuttering modification programme. Yet, too often clients will begin therapy with only a vague idea of destination, or with the unrealistic belief that the therapist will remove stuttering as if it were a stone to be pulled from a hoof. Rogers and Gerlach-Houck suggested a framework for addressing motivational issues. This is based on stages of pre-contemplation, contemplation, preparation, action and maintenance. The intention is to develop the model into a scale. Their research is at an early stage, but has potential to improve delivery of stuttering therapy. For example, a difficulty with NHS therapy in the UK is that speech and language therapists cannot turn clients away, even in a situation where clients do not really want to do what is required for the change they say they want. Use of the scale being developed by Rogers and Gerlach-Houck could help to provide a principled basis for decision making with such clients. For example, it may be appropriate to refer clients to a course of psychological therapy, or for counselling, before the client reconsiders (“recycling”, in the phraseology of Rogers and Gerlach-Houck) what their appropriate next steps might be.

The prevalence rate for stuttering is well-established at 1%. Howells, Herring, Spray, Powell and Yaruss presented survey data from the political/marketing tool YouGov, showing a higher prevalence around 2.3%. The presentation comprised a detailed analysis of a data set of 150 respondents who indicated that they stutter. Only about a third of the respondents who indicated they stutter also indicated typical stuttering behaviours (e.g. repetition of word initial sounds, word substitution, prolongations, laryngeal block, repetition of syllables already spoken, insertion of syllables not required for the target sentence). If just these participants are identified as stuttering, the prevalence rate in the YouGov data becomes around 0.75%, which is in line with the adult prevalence rate established by Craig and colleagues in the 1990s using telephone survey and randomised, stratified sampling across 4,000 households. The interpretation of Howells and colleagues is that the additional 1.5% identified do indeed feel that they stutter, but are missed by definitions based on listener assessments. An alternative explanation is that the data are an example of the false positive paradox, a counterintuitive statistical phenomenon in which use of generalised survey instruments can give misleading results when testing very small populations. Follow-up work is planned, so perhaps the issue of false positive paradox can be resolved in future study designs. Based on the data in the JWCSC presentation, it would be misleading to report any stuttering prevalence statistic other than the well-established 1% figure.

There will be more JWCSC fun tomorrow – stay tuned for part 2!