Subgroups of persons who stutter
I am a speech and language pathologist with a big interest for stuttering. I have some questions about subgrouping of persons who stutter. I’m thinking very broadly of genetics, early brain damage/prematurity, brain studies, developmental paths, stuttering patterns in persons who do/do not show later remission, response to therapy… Please feel free to answer very freely (and not covering everything) with what you find most exciting in this very broad topic, both from a research perspective and from clinical experience.
What is your opinion of the current knowledge of possible subgrouping of persons who stutter?
(= What do we know?)
What information regarding subgrouping would you find most interesting to find out in upcoming research?
(= What would we want to know?)
What would you see as the benefits of knowing more about subgroups of persons who stutter?
(= How would this help us in clinical decision making etc.?)
Thank you very much for this wonderful opportunity to ask questions.
Karin, as an SLP who has worked with more than a few thousand people who stutter, I feel that until we have reliable knowledge that there are subgroups of known etiology, it is best to look at each individual and design our therapy to meet their needs. If one day we KNOW that some people stutter due to a specific gene marker, a lack of a vitamin, or some from some other factor, we would be able to treat the underlying problem. Since today we don’t have that information, I think we are wasting our clinical hours trying to place a client into a subgroup. I am happy to hear that you have an interest in stuttering. It is a very fascinating field that has given me a lot self fulfillment. I am happy to hear of others who enjoy treating and researching stuttering.
There is an article on subtyping stuttering by Yairi in Journal of Fluency Disorders (2007) that may be of interest to you if you haven’t read it.
Karin,
For more than a century, people have worked on subgrouping stutterers (and clutterers) according to symptoms, etiology, associated problems, etc. Of course, each approach has its pluses and minuses, but in my view, the only taxonomy that has stood the test of time very well is Van Riper’s four “tracks” of stuttering. He highlighted “typical” child-onset stuttering (Track I), cluttering associated with stuttering (Track II), later onset, traumatic event onset stuttering (Track III), and stuttering secondary to psychopathology (Track IV). Some stutterers could not be fitted into any of the tracks.
Ultimately, the value of subtyping must come from consistent differences across studies that have explored different aspects of stuttering. In my view, this is something that typically has not happened with most subgrouping. The value must also come from differential response to the same treatments from clients in different subgroups in a consistent way…and later from predictable response to different treatments. Otherwise, subgrouping seems to have worked well only or primarily for whatever dimension the researcher chose to make the subgroup. Personally, I used to think subgrouping was our biggest priority, but I am no longer sure. Having seen subgrouping lead nowhere so often, perhaps it is premature for us to subgroup much more than Van Riper’s tracks until we know a great deal more about the disorder. For example, we need to better understand genetics and stuttering, language and stuttering, motoric abilities and stuttering, sensory processes and stuttering, what happens physiologically and linguistically between the onset of stuttering in childhood and school-age or adolescence, etc.
This is a start at addressing your questions.
Ken St. Louis
I concur with an earlier post. Fitting people into subtypes is probably not more useful than simply observing what they need, therapeutically. We are not dealing with the difference between type I and II diabetes, where underlying metabolic/pharmaceutical treatment is informative. I’d want my therapist to understand where I am, in terms of behavioral strengths and needs, rather than try to peg me to a profile (but then, I have always had a paradoxical response to many medications). I believe we can fit people to subtypes, in the eventual long run, but… I am not sure this is the best answer to more effective treatment.
Nan BR
You post some very interesting and intriguing questions. I will respond to your query regarding what I find to be most interesting in upcoming research. I was fortunate to see Dr. Dennis Drayna present this summer at the NSA conference. He was discussing his research into genetics. Rather than attempt to regurgitate his talk, here is a link to a very similar presentation of his done at the NIH in September. How this research affects future therapies remains to be seen.
Charlie O
http://videocast.nih.gov/summary.asp?Live=14774&bhcp=1
Thank you very much for your answers. I found it very inspiring to read about your clinical experience, thoughts about the history/future and ideas of where I could learn more about the topic.