Treatment Programs for Adults Who Stutter
What is a Stuttering Disorder?
The speech disorder we call stuttering has varied symptoms. Most people think of stuttering as sound repetitions and repetitions of words, but only some adults (and children) who stutter fit that stereotype. Many people repeat neither sounds nor words. Their stuttering blocks look and sound quite different.
Sometimes people think they have a voice or breathing disorder, because they may gasp or break off words, or "choke" when they try to speak. In fact, there are people so adept at covering their stuttering, that others do not identify them as stutterers at all. They may avoid or substitute words, distract their listeners with "tricks," or avoid certain situations entirely. These people are "covert stutterers," and may experience even greater fear and anxiety than the person who stutters openly.
Most people who stutter began to stutter in childhood, some as early as two years, as they began to speak. The majority begin between the ages of four and six, but some don't begin until puberty. In exceptional cases, stuttering can begin later in life, but usually there is some indication that the person stuttered as a child and apparently remitted for a period of years.
What causes Stuttering?
Stuttering is a neuromuscular disorder, not an emotional disorder. Of course, in time, the effects of stuttering may lead to anxiety and a poor self-concept.
Research has shown that stutterers may differ in central nervous system characteristics. Most people process language in the left half of the brain, whereas stutterers appear to process language in both halves. Stutterers tend to perform no less accurately, but slower on fine motor coordination activities. Most recently, researchers have identified areas of lesion in the brains of adults who stutter.
People who stutter have delays in getting the voice started, and even their fluent speech contains tiny pauses in speech flow. Finally, breathing patterns of adults who stutter are also different from those of non-stutterers. The combination of this respiratory and laryngeal disturbance causes disruption of the speech mechanism as the stutterer tries to begin voicing. Each pause in speech can result in a repetition of this difficulty. The struggle against these blockages in the speech flow results in what we see as stuttering.
Is Stuttering Hereditary?
Research strongly suggests that genetics may play an important role in the development of stuttering. Up to 80% of all stutters report a familial history of stuttering. Nearly four times as many males as females stutter, but this is also true for language disorders and learning disabilities. Although males appear to be more susceptible biologically to stuttering, women who stutter have a 36% likelihood of having family members who stutter, men who stutter have an 18% likelihood.
What is "CAFET"?
CAFET is the acronym for "Computer-Aided Fluency Establishment Training." It is a tool which was developed to help the speech clinician treat the stuttering client comprehensively, from identification of the problem through retention of the fluency skills following therapy. CAFET was developed by the Annandale Fluency Clinic starting in 1983, with help from a research grant through the National Institutes of Health. The Director of College Park Speech and Language Clinic formerly practiced with the Annandale Fluency Clinic and has extensive experience with CAFET. It is used in speech clinics, hospitals and school systems throughout the United States and Canada.
The client wears a respiratory sensor and a tiny microphone which feed into a computer system. CAFET presents the patient's voice and breathing as visual biofeedback on the computer screen. Rather than trying to change only the surface behaviors of stuttering, the underlying physiological behaviors are addressed through muscle retraining.
This tried and proven computer program teaches the patient to coordinate the breathing with the onset of speech, to breathe without breath holding, and to maintain the speech flow throughout the phrase. Some people have called the process "physical therapy for the vocal cords." These aspects of coordination are practiced so thoroughly, that they maintain and become part of the everyday speech of the patient.
The Treatment Program
Before treatment can begin, a complete evaluation is necessary. Using the CAFET diagnostic procedure, the client's speech-flow characteristics are profiled, so that an individualized treatment program can be planned. In addition, an attitudinal assessment is performed, which will determine not only the best format for the therapy, but also help in planning the transfer stage of treatment.
Two types of programs are offered to adults to accommodate individual needs. The first is an individual program of "semi-intensive" therapy: at least four hours per week during the first four to five weeks in two-hour sessions. During the session, the "targets" of monitored speech are practiced with the computer program and molded with the help of the clinician in a "normalization" procedure. Nearly all patients are able to establish normal-sounding fluent speech by the end of the establishment program.
This is followed by transfer therapy (moving the new speech skills to the real-life environment and desensitizing "difficult" speech situations). During transfer, the sessions occur at a rate of one to two hours weekly for ten to twelve weeks until the client and clinician feel that fluency is "solid".
Another important component of the program is group therapy. Once weekly throughbout both the initial and transfer stages, clients spend two hours (one evening) in group. This provides the client the opportunity to practice speech skills as they are being learned in a "safe" environment. It also provides the support the client needs in changing long-held negative attitudes toward himself and his speech.
The clinic also offers the option of attending one of our small-group, intensive programs. These may be four weeks, half day or three weeks, full day, combining individual and group therapy.
How Effective is this Program?
CAFET has been in use since 1983. Thousands of adults and teens have completed the program. An early clinical study measured the success of therapy with pre-therapy videotapes, audiotapes, computer speech analysis, home baseline tapes and a series of taped phone calls to strangers. The data collection process was performed pre-treatment, at six months, one year, and two years post therapy, and included an interview and attitude assessment.
At six months post-therapy 82% of the patients interviewed met the criteria for fluent, natural-sounding speech. At 12 months post-therapy that figure rose to 89%, and at two years post-therapy, 92% of the former patients had retained their speech control. In addition, many of them responded that they seldom, if ever, thought about stuttering any more.
The goal of the College Park Speech and Language Clinic is to provide a treatment program which produces the best results, and at the same time is the most cost-effective for the client. A comparison with other forms of therapy suggests that this therapy not only produces excellent results, but does so very efficiently.
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