PSYCHOGENIC STUTTERING: TREATMENT By: Ally Bryan and Melanie Asbury Ally

PSYCHOGENIC STUTTERING Stuttering that is the result of pronounced emotional disturbances with no prior history of stuttering. Psychogenic stuttering (PS) was previously referred to as hysterical stuttering in the literature (Mahr & Leith, 1992). Currently, psychogenic stuttering is classified as a subtype of acquired stuttering, which emcompasses neurogenic and psychogenic stuttering. Ally

DIFFERENTIAL DIAGNOSIS According to Manning (2010), differentiating between neurological and psychological etiologies is one of the most difficult components of the assessment and treatment process since this type of acquired stuttering cannot be determined based solely on the fluency presentation. The author recommends obtaining a thorough case history and client interview to determine: If life events relate to onset of symptoms Evidence of an impairment of the CNS Sources of emotional distress A ubiquitous theme with all of our articles was the importance of obtaining a differential diagnosis in order to effectively treat this population

DIFFERENTIAL DX CONTINUED Other symptoms that help clinicians distinguish between neurogenic and psychogenic stuttering include: Symptom resolution (i.e. stuttering that disappears) Immediate change in speech fluency Symptoms that worsen during less difficult speaking tasks Unusual movements (e.g. head bobbing) unrelated to speech production and speech fluency

CHARACTERISTICS OF PSYCHOGENIC STUTTERING Defining characteristics of psychogenic stuttering include: Sudden onset of stuttering with no prior history of a fluency disorder Strong correlation between psychological factors and the onset of stuttering (e.g. onset relates to traumatic life event) An absence of organic or neurologic etiology Associated symptoms of psychogenic stuttering include: History of emotional problems Atypical fluency patterns, which include: Repetition of initial and stressed syllables of words Fluency is not affected by singing, choral reading, and delayed auditory feedback Disfluencies present during rote tasks (e.g. counting to ten) No negative reactions or avoidance behaviors associated with stuttering Situation-specific, episodic stuttering Ally Roth, Aronson, & Davis, 1989

TREATMENT OF PSYCHOGENIC STUTTERING Traditional fluency treatment Speech modification techniques (e.g. easy onsets and light contacts) Counseling Maintaining a confident, positive attitude is imperative to the client’s success in therapy Research indicates that fluency can improve during the first session Making appropriate referrals to a psychologist or other medical professionals if symptoms do not change Many with PS seek other types of therapy (e.g. bereavement counseling) in conjunction with fluency treatment. Counseling → creating an open, safe environment since there is an psychological, emotional basis to their fluency disorder Roth, Aronson, & Davis, 1989 Ward, 2010

Psychogenic Stuttering: A Case Study Currently, the research is very limited on psychogenic stuttering. Moreover, the majority of studies are anecdotal for this population. As such, we decided to present a case study by Byrd, Braxley, and Shapiro to further explore how a client might present as well as how we would assess and treat this population.

CASE STUDY Harry P. Age: 24 yrs. Reported sudden onset of stuttering following a neurology appointment in which he interpreted being told by the neurologist that his seizure disorder would cause progressive brain damage. Harry also reported no situations in which fluency improved and a high level of anxiety and frustration related to his stutter. Harry’s neurologist reported that Harry demonstrated “no difficulty speaking” and had “clear and appropriate” speech during the appointment. The neurologist also reported that Harry’s previous emergency room evaluation for seizure activity was negative and the seizures “represent psychogenic events”. He stated that Harry had a positive history of mental illness (i.e. anxiety, conversion disorder, depression, and insomnia). Ally Byrd, Baxley, & Shapiro, n.d.

CASE STUDY: ASSESSMENT Conversational speech sample was collected in initial meeting. Harry demonstrated disfluency on 100% of words spoken. All disfluencies were part-word repetitions (specifically word-initial sounds, vowel and consonant) No secondary characteristics were observed. Observed disfluencies during choral reading, singing, gentle onset, rhythmic speech, and tapping with reduced rate. Harry’s disfluency demonstrated no change in response to fluency facilitating contexts. Adaptation Effect Harry demonstrated no adaptation effect during reading tasks. ME Byrd, Baxley, & Shapiro, n.d.

CASE STUDY: TREATMENT Harry was seen for therapy 2 times. 1st session Fluency shaping Stuttering modification (e.g. easy onset and light contacts) Slow, rhythmic speech No improvement noted throughout session. No identified phonemic pattern of disfluency was observed, while consistent disfluency on all word-initial sounds (vowel or consonant) was noted throughout the session. 2nd session Discussed neurologist’s report 3rd session Prior to 3rd session, Harry called and reported that his disfluency resolved completely in all speaking situations, citing that a lack of consistency in taking medication was to blame. He terminated treatment. Clinician completed two follow-up calls, in which Harry displayed fluent speech. Ally Byrd, Baxley, & Shapiro, n.d.

Summary of Psychogenic Stuttering Obtain a differential diagnosis, which includes: Recognizing the defining characteristics of PS Counsel clients Utilize a contextual model of therapy for this rare fluency disorder

REFERENCES Byrd, T., Baxley, B., & Shapiro, D.A. (n.d.). A case of psychogenic acquired stuttering: “A solution in search of an explanation”. International Stuttering Awareness. Retrieved from http://isad.isastutter.org/isad-2015/papers-presented-by-2015/research-therapy-and-support/a-case-of-psychogenic-acquired-stuttering/ Mahr, G., & Leith, W. (1992). Pyschogenic stuttering of adult onset. Journal of Speech and Hearing Research, 35, 283-286. Manning, W. (2010). Clinical decision making in fluency disorders (3rd ed.). Clifton Park, NY: Delmar, Cengage Learning. Roth, C. R., Aronson, A. E., & Davis, L. J. (1989). Clinical studies in psychogenic stuttering of adult onset. Journal of Speech and Hearing Disorders, 54, 634-646. Ward, D. (2010). Sudden onset stuttering in an adult: Neurogenic and psychogenic perspectives. Journal of Neurolinguistics, 23, 511-517.