1. Alternative Treatments for Stuttering

2. “Alternative” approaches to stuttering treatment
Altered feedback devices
Pharmaceuticals

3. 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

4. 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

5. Commercial Devices Available
Speech Easy (Kalinowski et al.)
Most technologically advanced (~ $ )
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

6. Form of feedback alteration
Delayed auditory feedback
Delaying auditory feedback by 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

7. 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

8. 10 Dimensions to consider
Science vs. Pseudoscience (From Finn et al., (2005). AJSLP 41, )
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?

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

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

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

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

13. 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

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