Tuesday, January 11, 2011
There have been advances made in speech therapy since the 1930s when Britain's King George IV worked to overcome his stammer, as well as new insights into what causes stuttering.
The movie The King's Speech follows the efforts of King George IV of Britain to overcome his stutter. At a time when England needed a confident voice to guide the nation through World War Two, King George was ready to do just about anything to get rid of his speech impediment.
There have been advances in speech therapy since the 1930s as well as new insights into what causes stuttering in children and adults.
Guest: Carole Roth, Division Head of Speech Pathology, Naval Medical Center, San Diego.
What'll I call you?
Your royal highness.
And after that?
How about Ferdy?
Only my family uses that.
Well, in here it's better if we're equals.
If we were equals, I wouldn't be here. I'd be -- at home with my wife, and no one would give a damn.
Well, please don't do that.
I believe sucking smoke into your lungs will kill you.
My physician said it relaxes the -- the throat.
They've all been knighted.
It makes it official then.
CAVANAUGH: That was a clip from the movie, The King's Speech, featuring actors Geoffrey Rush and Colin Firth. I'm Maureen Cavanaugh, you're listening to These Days on KPBS. The movie, The King's Speech, following the efforts of British king George VI to overcome his stutter. At a time when England needed a confident voice to guide the nation through World War II, King George was ready to do just about anything to get rid of his speech impediment. There have be great advances made in speech therapy since that time, but there are also new types of injuries that cause stuttering. Veterans of Iraq and Afghanistan who have suffered traumatic brain injuries, often have to over come the stuttering such injuries may cause. This morning we'll be talking about the treatments for stuttering in children and adults. With my guest, Carole Roth, division head of speech pathology at the Naval Medical Center here in San Diego. Carole, good morning.
ROTH: Good morning. Thank you very much.
MAUREEN CAVANAUGH: Now, we're inviting our listeners to join the conversation. Have you had a problem with stuttering? How did it affect your life? If you've gotten over a stuttering problem, tell us how you did it. Give us a call with your questions and your comments of hour number here is 1-888-895-5727. That's 1-888-895-KPBS. Carole, first off, did you see the movie, The King's Speech?
ROTH: I did. Just about a week ago.
MAUREEN CAVANAUGH: And what did you think of it.
ROTH: Oh, I enjoyed it very much because it gave an opportunity for the issue of stuttering to come to the public eye for further discussion. And it's become quite a hot topic in the last few years.
MAUREEN CAVANAUGH: Certainly has. Now, how did the actor portraying king George the sixth, Colin Firth, how did he portray the king's sputtering?
ROTH: You know, that has been a topic of discussion among us professionals. And that was one of those strengths of the movie, we felt, that it was -- it went beyond focusing on the actual symptoms of stuttering and really highlighted the psychological component. The disempowerment that a person feels when they do not have control over their speech.
MAUREEN CAVANAUGH: I'm wording, if you could, Carole, tell us what is stuttering actually? I mean, what physically happening to people to keep them from speaking fluently?
ROTH: Well, we refer to stuttering as a disruption in the forward flow of speech. And so when you look at the whole physiology of speech production, it requires continual air flow that creates vibration in the vocal fold, then we valve and articulate that energy to produce our speech. A person who is stuttering has disruption in that flow of area, and as a result they experience either repetitions, prolongations, blocking that can occur at any level of the speech mechanism. So in the throat, back of the tongue, in the lips.
MAUREEN CAVANAUGH: Is there really something physical that causes that disruption in the flow of air or is it totally psychological in.
ROTH: That's an excellent question. It gets at the issue of what is the cause of stuttering.
MAUREEN CAVANAUGH: Uh-huh.
ROTH: And over the many, many years that individuals have been interested in studying and examining people who stutter, there have been a lot of theories. And we now know and appreciate that there's no one cause for stuttering. It's what we refer to as multifactorial or it has lots of different contributors. We know that there are three primary factors that contribute to the on set of stuttering. One is a genetic predisposition, another is neurological defenses of and these aren't significant in terms of pathology, but the individual is simply wired differently. And third, there is an environmental component, and extending on the environmental influences, the actual expression of that genetic predisposition occurs or may not occur.
MAUREEN CAVANAUGH: I'm speaking with Carole Roth. She is division head of speech pathology 59 the naval medical center here in San Diego. And we're talking about stuttering, and inviting you to join the conversation. Do you have a child with a stuttering problem ownership perhaps you've gotten over a stuttering problem yourself. Give us a call with your questions and comments. The number is 1-888-895-5727. 1-888-895-KPBS. Are there different types of stuttering in that does it manifest itself in different ways?
ROTH: Well, definitely each individual presents their stuttering uniquely, as each of us speaks uniquely. Speech is very much a part of each of us. And for that reason, the stuttering looks different in each person. Or it has similarities but it has unique features as well. Thought as we each have our own characteristics. It also makes our speech very personal to us, which adds that psychological component to having difficulty speaking, creates stress.
MAUREEN CAVANAUGH: Do you mean that some people might get stuck on certain letters or some people might repeat letters or other people with a stuttering might just be silent as they try to get out a certain combination of letters.
ROTH: Definitely those different examples are good ones. For example, when we see that children first start speaking and having difficulty, their stuttering, which we often refer to as normal degree of disfluency, basically it's not quite stuttering, is easy repetitions. When they become multiple where you have large numbers of repetitions, 3, 4, 5 repetitions as they're trying to say muh-muh-muh-mom. Or as they're perhaps rushing to get their idea out faster than their speech mechanisms can produce. Then there's easy repetitions, and there's that tension. As that child continues to stutter, more tension increases. As a person continues to stutter over a period of time into their elementary school years, high school, there's an increase in negativity attached to their stuttering, more tension is attached to it. Then we have blocking and prolongations as that person is struggling to fight through their stuttering moments.
MAUREEN CAVANAUGH: I see. So in other words, it could make a trouble as much situation even worse as time goes on.
MAUREEN CAVANAUGH: In the movie, The King's Speech, the therapist played by Geoffrey Rush tried to identify a child trauma that may have cause the king to start stuttering. Is that the approach that's taken today? Some sort of deep seated emotional trauma that may have started bringing on some sort of speech impediment like stuttering?
ROTH: I think that what was emphasized by the movie and through the speech teacher was that there's more to stuttering than just the motor speech aspects, the technique. And as you may recall in the movie, the king said you're not to get into my past, you're not to ask me personal questions, you're only to teach me technique. Work on technique. And so in the process of trying to get at other how this individual had disempowered himself, given up his self esteem, given up his confidence and how his speech had really impacted his centeredness in terms of what he was, and what he was about, and had over taken his whole personality, he was trying to develop rapport, and in that process getting at that's other aspects and getting more perform. It's not that we hook for a trigger that's emotional. Typically there might be a trigger this, but it is not the cause of the stuttering. You know, I love the line that you played at the beginning. If we were equals, we wouldn't be here. You know, the first response is to think, well, he's king. But really what he was saying is, if I didn't stutter, I wouldn't be here, and by stuttering, I'm less than you are.
MAUREEN CAVANAUGH: Uh-huh.
ROTH: And that was the crux of this movie, was to really get at showing that there's more to stuttering than what we refer to as the tip of the iceberg, and that is just the speech behaviors.
CAVANAUGH: We're taking your calls about stuttering and treatments for it and causes for it, the number is 1-888-895-5727. My guest is Carole Roth. Lorena is calling right now from Chula Vista. Good morning, Lorena, welcome to These Days.
NEW SPEAKER: Good morning, thank you for taking my call. My question is, first of all, I am bilingual, I speak fluent English and Spanish. And I used to stutter as a child, but only in Spanish. And I'm wondering why that might have been.
ROTH: Which language was your first language? Were you learning Spanish and English simultaneously in the home?
NEW SPEAKER: I would have to say Spanish. I was learning Spanish from my mother 50.
ROTH: So probably that stuttering started, it usually starts in children when the speech skills and language skills are developing between 2 and 4 years of age, so I would suspect that's when your stuttering started. By the time you had become bilingual and were in the stage of developing the English skills, your motor skills were already developed so you were less likely to have as much difficulty with having the motor skill ability to produce the speech and language expressions as you did when you first started speaking Spanish.
MAUREEN CAVANAUGH: Thank you for the call, Lorena. Thank you very much.
NEW SPEAKER: Thank you.
MAUREEN CAVANAUGH: And so basically she just got stuck in stuttering in Spanish and she didn't get stuck that way in English?
ROTH: Exactly, and one of the explanations for stuttering in children is that the language abilities exceed the child's motor development. And when the brain and the vocabulary and the grammar is developed faster, this child is trying to produce these utterances or sentences, statements, as fast as their mind is going, but they can't get it out like that.
MAUREEN CAVANAUGH: As you said, Carole, some minor stuttering, you know, among children is pretty typical. I'm wondering if there's anything that parents do or say that can typically make things worse, I mean, sort of aggravate a problem that might just resolve itself by itself and sort of make it into a problem.
ROTH: I'm so happy you asked that question. Because it's really important to recognize and acknowledge that when a child is learning to speak, it's fun. It's meant to be play. You know, they play with sound, they babble, and babbling becomes reinforcing because they get all this attention from their parents, and they develop words, parents respond for positively. So this is positive reenforcement constantly going on, and when the child starts having difficulties just because they can't talk as efficiently as they can think and express ideas, they start perceiving sometimes some negative feedback about what they're saying. And that tends to create anxiety about speech, when in fact we want to get back to focussing on rewarding the child for communicating and getting their message across. And recognize that there's going to be some bumps in the road that are normal.
MAUREEN CAVANAUGH: I'm speaking with Carole Roth, and we're taking your calls about stuttering. The number is 1-888-895-5727. Jacob's on the line from San Diego. Good morning, Jacob, welcome to These Days.
NEW SPEAKER: Hi, yes, I just wanted to share my experience as being someone that over came a stuttering problem. Just to also, just to kind of give some -- what can you call it? Some -- some hope to people or some parents that have children that stutter themselves.
MAUREEN CAVANAUGH: Sure.
NEW SPEAKER: I was a middle child, and everyone thought that my older siblings spoke for me, and so that's what the neighbors said, but then when I didn't develop speech very well, I went to the speech pathologist, all the way through about third grade, and it was through the local public school, so, you know, as far as those additional services that people get in the public school, that's one that is very beneficial. I tried to or I eventually over came stuttering through -- I found that through singing, that helped me find a voice. And then I did -- I took some acting classes when I was in college, and I've since gone on, I have my pH D in psychology. I was a four-year letterman in college football and now I'm a naval officer.
MAUREEN CAVANAUGH: Are, Jacob thank you.
NEW SPEAKER: And so those are all things that require a lot of public speaking, but there is hope if someone stutters.
MAUREEN CAVANAUGH: Jacob, thanks very much for the call, and that story that Jacob Gave us about, speech therapy, and singing and acting classes, you were nodding your head there. All good ideas huh?
ROTH: Oh, Jacob, I really appreciate your calling in and sharing your story because it does give a lot of hope for people. And it shows people that it [CHECK AUDIO] finding your voice, you actually experienced more consistent ability to speak fluently, and that led to your recovery. And I also appreciate your recognizing the value of school based services.
MAUREEN CAVANAUGH: Now, what's the prognosis for a child who stutters? Do most kids grow out of it.
ROTH: Excellent question. That statistics have shown that as high as 80 percent of children who sometimes have some stuttering, recover from stuttering. We also think there is a genetic predisposition for recovering from stuttering as well, and this is based on some research that went on for 20 years out of the University of Illinois. So there's T definitely there's much -- a very positive prognosis, it's important to get children in, to get services early on, if their problems are persistent.
MAUREEN CAVANAUGH: Now, Carole, you are division head of speech pathology at Naval Medical Center here in San Diego. And there are some veterans who have developed a stuttering or other speech pathologies as a result of that a traumatic brain injury, and other traumatic injuries 678 tell us about that. How does that happen?
ROTH: Well, wee definitely seen many more people than in the past coming back from combat with stuttering or stuttering like speech. We know that there is adult on set stuttering as well as childhood on set of stuttering, and we see it can occur because of neurological events such as a stroke or even Parkinson's disease. And as you mentioned, traumatic brain injury. There's also another form, and it's what we occur to be more psychologically based. And as you know, more of our service members returning from combat have a combination of traumatic brain injury, as well as post-traumatic stress. So what we're being challenged with in our profession as well as in an are is tremendous research interest is this issue of determining what type of stuttering these individuals are presented with, and treating them most effectively.
MAUREEN CAVANAUGH: And give us an idea again about how that affects someone's recovery, someone's reintegration into, you know, trying to get a job, trying to just live a normal kind of a life.
ROTH: Well, the exciting part about treating an adult on set is that their prognosis is quite good. The exception is someone who's had a very severe brain injury with permanent damage. But most of our individuals are recovering very nicely from mild traumatic brain injury as well as their post-traumatic stress is being addressed through an intensive, multi-therapeutic, lots of different disciplines, helping them with the combination of neurologic symptoms, physical symptoms, their pain issues as well as their post traumatic stress. And with this team approach at Naval Medical Center as well as other military treatment facilities, VAs and other community based services around the country, we're actually seeing tremendous prognosis and outcome. I have had many successful cases here at naval medical center where these individuals have recovered from their stuttering along with their recovery and ability to return to active duty.
MAUREEN CAVANAUGH: We have a caller on the line, mickey is calling us from San Diego. Good morning, mickey, welcoming to These Days.
NEW SPEAKER: Hi there. I have just a rather simple question. Is there a difference between stuttering and stammering?
ROTH: Great question. No, there is not. Years ago, I think the initial term was stammering. But now we typically refer to it as stuttering. I would say the professionals probably most commonly refer to it as stuttering, and lay people think of it as stammering.
MAUREEN CAVANAUGH: Now, there's an idea -- I remember hearing this from people that, you know, kids don't need any treatment about this. It's just going to go away naturally. Do you find that that -- do you have any confidence about that? Or if a child is actually developing a pronounced stutter that that should be attended to?
ROTH: There are certain flags or indicators that would tell a parent that they should bring the child in, at least to be screened by a speech pathologist. Because we know 80 percent of children between 2 and 4 recover from stuttering, we really recommend that parents -- we have recommendations if are parents and I would encourage them to look at the stuttering foundation of America website, so there is a WWW.stutteringhomepage, H-O-M-E, PAGE.COM. And in there, you can print out a list of recommendations on how to interact with your child if he here she begins to show signs of stuttering. If those signs persist or get worse over a period of six months other then we say bring your child in to be evaluated.
MAUREEN CAVANAUGH: In the movie, The King's Speech, you have the therapist having poor king George the sixth having to roll around on the floor and jump around, and do all this sort of physical activity. I wonder -- I would imagine that that is not necessarily the type of thing you do anymore. But do you incorporate any kind of physical exercise along with any therapy that you might have for those speech impediments.
ROTH: It's interesting you bring that point up. As you may recall, the speech teacher was not actually a certified speech clinician. And his background was in performance and in public speaking. And so he was applying those techniques based on his experience working, interestingly, with studying in adults related to post-traumatic stress. When the Australian wounded came back from World War I.
MAUREEN CAVANAUGH: Oh.
ROTH: That's where he had gained his experience. So it shows how long ago we were recognizing that there is adult on set stuttering related to post-traumatic stress. So getting back to the techniques that he used. So he was applying these techniques working on air flow and breathing. Which we know is effective for performers and public speakers, and obviously is important if we want continuous air flow for eliminating stuttering. So those techniques aren't actually used quite to the extreme that he was using them, but definitely we work on air flow techniques, and I believe we have become more sophisticated in how we work with our patients now.
MAUREEN CAVANAUGH: Yes, yes.
ROTH: So we do much more on strategy training, how to have easy on set, how to prolong their sounds, beginning a little bit. And so everything is easier and the air is flowing more smoothly. And this is also really emphasizing the anxiety and the fear, and helping the individual feel in power again and take back their speech.
MAUREEN CAVANAUGH: Is there -- and my last question to you, Carole, is there anything on the horizon that is going -- that you see might be used as a new technique to help people who have really persistent stuttering problems?
ROTH: Well, again, the move kind of alluded to this. People may recall, if they saw it, that before king George sixth became king George, when he first saw his speech instructor, the instructor put ear phones on him, and played music in his ears quite loudly, which distorted his ability to hear himself speak but resulted in speech being fluent. And so interestingly, nowadays we have a device that people are working on, there's one out there in the public market maybe more than one. And people continue to work -- look at using a device that can go in the ear and actually produce fluent speech. So there's -- I think it's called the speech easy. And the other thing is that techniques are getting better. So I think we will actually learn to be more fluent.
MAUREEN CAVANAUGH: Thank you so much. I appreciate it. I want to thank everyone who called in. If we did not get to your cull, please go on-line and tell us your story. KPBS.org/These Days. Carole Roth, division head of speech pathology at the naval medical center, thanks again.
ROTH: Thank you. Thank you very much.
MAUREEN CAVANAUGH: Thank you for listening to These Days. Stay with us for hour two, coming up, just a few minutes here on KPBS.