Delayed Auditory Feedback Devices
Hello experts,
I am interested in your thoughts on delayed auditory feedback (DAF) devices. I know that DAF can help some individuals who stutter to become more fluent, and I have seen devices that look similar to a hearing aid that can provide DAF to the wearer during conversation. The one individual who I knew that had this device was not very happy with it’s performance. He said he did not think it helped to increase his fluency, partially because the microphone picked up too much background noise, and replayed it in his ear. Is this a typical response to these types of devices? Has there been much success in using DAF to increase fluency in conversational language outside of the clinic?
Thank you!
In practice, success has been varied with DAF devices (and electronic devices in general). Some experience success, others report none at all, and a third (and apparently largest) group falls somewhere in between. And yes, there are anecdotal reports suggesting that this variance can be partly explained by issues of background noise. Other possible factors include severity, waning effectiveness of the devices, and different levels of access to speech-language pathologists (who can offer guidance).
Thank you for the question. First of all, let’s go to the literature. O’Donnell, Armson & Kiefte (2008) have shown a decrease in stuttering outside of clinic settings (5 of the 7 participants).
Secondly, let’s go to the part of your question that asks about “success”. Does DAF (and FAF) reduce stuttering in most people???? Definitely! Does it carry-over into non-clinic settings????? In some cases. Is this what PWS consider success???? I think this is the million dollar (or 783797.35 Euro) question. For many people, reduction of stuttering is only part of the cure. Anxieties, feelings, fears, and in this case distractibility may be just as important as the elimination of stuttering. I have seen many PWS that can be stutter-free when using a control-technique (including DAF/FAF). However, some of these same PWS have chosen to sacrifice some stuttering in exchange for a more acceptable quality of life (less pressure to be perfectly fluent, etc.).
I think that SUCCESS needs to be defined, and I think the best definition comes from the actual PWS.
Thanks again,
John Tetnowski
The only clinical trial I know of showed an AAF device to not be efficacious in a nonrandomised Phase II trial:
Pollard, R., Ellis, J., Finan, D., & Ramig, P. (2009). Effects of the SpeechEasy on objective and perceived aspects of stuttering: A 6-month, Phase I clinical trial in naturalistic environments. Journal of Speech, Language, and Hearing Research, 52, 516–533.
In the interest of full disclosure, I offer apps, fluency devices and therapy options in my office and through a partnership with my client decide what path they want to pursue.
I have used DAF devices since about 1979, when I was a SLP graduate student at Northern Illinois University. I am afraid there are still misconceptions that persist from previous devices that were not technologically advanced and companies that did not put the needs of the clients first. Devices were sold without any support for the person who stuttered (PWS). Understandably, the device was thrown in a drawer and the client felt deceived and frustrated and told everyone that would listen, “those devices don’t work.” What would the outcome have been if the person was provided therapy with the device? I am sure the reputation of devices would be better if earlier trials were conducted by licensed therapists who were bound by our code of ethics. Unfortunately, rumors swirl and deter individuals from giving the devices and DAF a chance. I believe that Individuals who stutter are often dissuaded from trying DAF technology because of myths and rumors.
Why doesn’t one solution work for everyone? Because we are individuals; we are expected to use our critical thinking skills and a healthy dose of skepticism for any important decision. I use the analogy of buying a pair of size 7, brown shoes. We don’t expect that every pair of size 7, brown shoes we try on will fit us. I often find it surprising when individuals ask, do the fluency devices work for everyone? No, there isn’t one option that works for everyone. Back to the shoe analogy: how do you determine if the brown shoe will fit your needs? You try the shoe on and walk around to see if they fit. Do they pinch your feet or are they too big? Back to devices: how do you know if DAF will work for you? You try it on and you walk around with it. You use the device in quiet, in noise, talking on the phone, ordering in a restaurant and you see if it works. You obtain guidance from an SLP who is focused on your needs. You listen to the signal from the device and focus on it. You use techniques to assist your fluency. DAF devices are not a stand-alone treatment; they are a tool to be utilized with therapy techniques. Stuttering is complex and the solutions will be different for every individual. It’s like baking a cake; sometimes you need to add or subtract ingredients before you find the perfect blend for your tastes. You use DAF devices with therapy programs, not in place of them.
As a person who stutters, I would want to try DAF on a device or computer app. PWS have the right to determine their own communication pathway. As professionals, we can’t knock it if we haven’t tried it. Try the devices out, try the apps with some of your clients and ask their opinion. Visit a therapist who uses the devices, watch an evaluation session and see what goes into the decision to recommend a device. I have advised against devices for individuals for a variety of reasons. In the interest of full disclosure, I offer apps, fluency devices and therapy options in my office and through a partnership with my client decide what path they want to pursue. I believe the tide is shifting and hope individuals will reconsider their stance on altered feedback as a supplement to therapy techniques.