European Symposium
on Fluency Disorders

A rationale for three levels of therapeutic goals for individuals who stutter is presented. The advantages and disadvantages of medical and common factors models for informing clinicians about therapeutic change are described. The common treatment factors that have been shown to account for a successful therapeutic outcome in a variety of fields - regardless of specific therapeutic protocols - are presented. Following a discussion about clinical-decision making based on rules and principles the rational for four underlying principles of therapeutic change are presented, each with examples of activities for promoting successful change.

Numerous twin and family studies have demonstrated a significant genetic contribution to stuttering.  Identification of the specific genetic variants that underlie this contribution would be an important advance in our understanding of the causes of this disorder.  The traditional first step in this process is a genome-wide linkage study to identify the chromosomal location of the causative gene(s).  We identified a group of large families in Cameroon, West Africa in which persistent stuttering shows linkage to markers on chromosome 15.  We've also studied a group of highly consanguineous families in Pakistan, where we demonstrated linkage to a region on chromosome 12.  Detailed studies of the genes within this region have revealed mutations that commonly occur in individuals who stutter, but do not occur in normally fluent individuals.  These mutations indicate stuttering is the result of an inherited metabolic disorder in these individuals, and suggest the possibility of new therapies for this disorder.

In the past decade, numerous pilot studies have been carried out with the purpose of developing a reliable, valid, user-friendly survey instrument to measure public attitudes toward stuttering and other conditions worldwide, the Public Opinion Survey of Human Attributes (POSHA). The final prototype was recently completed together with a format for presenting summary information graphically and numerically to characterize attitudes of particular populations samples. The growing archive of comparative data on the POSHA permits users to compare their sample results with corresponding results from similar and dissimilar samples using a common instrument. Importantly, the POSHA has shown sensitivity to efforts to improve attitudes toward stuttering. Future challenges are numerous. These include: assuring accurate translations, developing cost-effective probability sampling strategies, identifying maximally effective strategies for changing attitudes, explaining differences in attitudes that exist, and broadening measurement to other conditions besides stuttering.

One of the firm facts about stuttering is that a lot of children start to stutter (about 1 in 20), but most get better by teenage (about 1 in 100 continue stuttering through to adulthood). The issues surrounding these facts that will be examined are:1. How is stuttering defined and diagnosed? There are alternative ways of doing this that affect estimates of onset of stuttering in childhood and recovery rates.2. Epidemiology. Do all members of society have an equal chance of starting and continuing to stutteror do particular groups have higher chances of stuttering?3. Symptomatology. There are disputes about what symptoms should be considered stuttering (these affect onset and recovery estimates). Different stuttering symptoms may have different roles in the process of recovery.4. Prognosis. Recent studies that report on risk for stuttering onset and for recovery will be examined.

My purpose is to discuss new insights in the research of the basal ganglia and limbic system in stuttering, related to the possible dysfunction of neurotransmitters through the amygdalae and the striatum and to develop a hypothesis which could account for the dynamics of stuttering and other movement disorders. We must return to some fundamental statements: 1) Stuttering is an irregular speech and language disorder, irregular in its manifestations and in its forms, its duration and the context in which it appears. 2) Neurogenic Stuttering does not differ from Developmental Stuttering in its symptoms: it does not display a static, permanent character either. 3) What we call “psychological”, emotional aspects and stress are expressed through physiological manifestations. 4) Stuttering develops during language learning; it should therefore be interesting to study the interactions of the different systems, active in language processes and learning

Recent work in childhood stuttering, converging with contemporary theories of stuttering development, has shown that within the general population of children who stutter exist subtypes in both etiology and behavior. The purpose of this presentation is to discuss the application of theory and research to the differential diagnosis of stuttering subtypes in young children. Specific focus will be placed on the evidence for risk factors in the development of stuttering with regard to unassisted recovery or persistence. In addition, the implications for using risk factors in clinical decision-making will be described.

At the First World Conference on Cluttering in 2007 in Razlog, Bulgaria, I proposed an agenda for the next decade related to seven statements—serving as guidelines—that could produce fruitful results to significantly advance the science and clinical management of cluttering. They are: (a) “Rate is central.” (b) “Definition matters.” (c) “Start with pure clutterers.” (d) “Epidemiology is critical.” (e) “Improve assessment.” (f) “Systematize therapy.” (g) “Advocacy must grow.” Since 2007, progress has been made in several of these areas, e.g., recognizing the importance of rate, growing consensus that an operational definition is basic to progress, improved measurement and assessment procedures, and increased professional and consumer knowledge. Work is still needed, for example, to understand how and why clutterers speak too fast, to generate solid data on the prevalence of cluttering, to understand brain mechanisms contributing to cluttering, and to better treat cluttering in all its manifestations.