Alternative Treatments for Stuttering

“Alternative” approaches to stuttering treatment Altered feedback devices Pharmaceuticals

Altered Feedback Devices: Background Altering auditory feedback can often enhance fluency Delayed feedback (DAF) Frequency altered feedback (FAF) Masking noise Altering feedback has a long history in stuttering treatment to Establish changes in behavior (slow speech) As a direct means to reduce fluency

Recent History Revival of interest largely initiated by Kalinowski and colleagues at East Carolina University According to research group, behaviorally oriented treatment fails, in part because it relies too heavily on voluntary modification of a largely involuntary process Use of a device that does not require voluntary behavioral change may result in more enduring reductions in disfluency

Commercial Devices Available Speech Easy (Kalinowski et al.) Most technologically advanced (~ $4000-5000) Fluency Master Small devices placed in or behind the ear like a hearing aid. Contains circuits that will delay signal and shift frequency of signal Requires training to perform fittings http://www.youtube.com/watch?v=b9mvqN1BrMs

Form of feedback alteration Delayed auditory feedback Delaying auditory feedback by 50-300 msec Frequency shifted feedback Shifting spectral components of speech up or down (typically about ½ octave) FAF + DAF Purported to provide a choral effect Settings appear to be highly individualistic

Is it helpful? Recent reports of 40-80% reductions in stuttering However, Heavy reliance on personal testimonials Weaker research designs Nature of outcomes not well established Persistence of reduced stuttering Utility in natural environments (appears to work best for reading) Appears to be responders and nonresponders and results appear to individualistic

10 Dimensions to consider Science vs. Pseudoscience (From Finn et al., (2005). AJSLP 41, 172-186.) 10 Dimensions to consider Untestable: Is the Treatment Unable to Be Tested or Disproved? Unchanged: Does the treatment approach remain unchanged even in the face of contradictory evidence? Confirming Evidence: Is the rationale for the treatment approach based only on confirming evidence, with disconfirming evidence ignored or minimized? Anecdotal Evidence: Does the evidence in support of the treatment rely on personal experience and anecdotal accounts? Inadequate Evidence: Are the treatment claims incommensurate with the level of evidence needed to support those claims? Avoiding Peer Review: Are treatment claims unsupported by evidence that has undergone critical scrutiny? Disconnected: Is the treatment approach disconnected from well-established scientific models or paradigms? New Terms: Is the treatment described by terms that appear to be scientific but upon further examination are found not to be scientific at all? Grandiose Outcomes: Is the treatment approach based on grandiose claims or poorly specified outcomes? Holistic: Is the treatment claimed to make sense only within a vaguely described holistic framework?

From Finn et al. (2005). AJSLP, 14, 172-186

Pharmacologic Interventions Dopamine (D2) blockers Termed neuroleptics or antipsychotics Many side effects; i.e. tardive dyskinesia Newer ‘atypical’ neuroleptics have fewer side effects

Pharmacologic Interventions Serotonin-specific reuptake inhibitors (SSRI) Used for OCD and depression Mixed results Side effects a problem

Pharmacologic Interventions Beta Blockers Used to control blood pressure Slows heart rate Can also diminish anxiety No controlled studies

Pagoclone Anxiolytic (anti-anxiety) Was in Phase II clinical trials with persons who stutter Study was halted in late 2011 Early evidence of reduced stuttering and social anxiety associated with stuttering

Pharmacologic Interventions BOTOX Rationale: reduce severity of blocks No clear benefit to its use