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Article of Interest - Speech & Language

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Bridges4Kids LogoAvoiding Pepperoni
National Post reporter Joseph Brean, who stutters, writes about the latest treatment being pioneered by Toronto researchers, how he copes with the speech impediment and the perils of ordering pizza.
by Joseph Brean, Canadian National Post, August 12 ,2003
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A family legend has it that my mother made me stutter by suppressing my natural left-handedness. I was three, we were living in Nairobi, and my Kenyan pediatrician thought my tendency to grab for spoons and crayons with my left hand would doom me to a life of awkward scissor use and an inability to share golf clubs.

To save me, he said, my parents ought to put these utensils in my right hand and force the juvenile southpaw into the closet.

Today, I am all mixed up: I write with my right hand and throw right, but I kick left, shoot a hockey stick and swing a baseball bat left, and I golf very poorly with left-handed clubs. I am also told I eat strangely, cutting with my left hand and never switching my fork over.

This confused bi-dexterity, so the legend goes, also gave voice to something more sinister.

Scientists who studied stutterers in the 1920s claimed to have found that the disorder arises out of an incomplete dominance of one side of the brain when it comes to language production. In stutterers, they said, the hemispheres were competing and the result was choppy speech.

Messing with my burgeoning left-handedness, then, might have fostered this problem in me, and I might otherwise have been a fluent speaker.

In all fairness to my mother, this story is at least apocryphal and perhaps entirely false, but it reveals some persistent myths about the speech impediment.

With its vague ideas of neural restructuring and unconscious confusion, the story captures the modern intuition that stuttering cannot just be a nervous habit, such as talking too fast or saying "umm."

This early theory of skewed dominance, however, which held sway when I was a child, has not stood up to further experiments. But it did mark the beginning of a rich line of research into stuttering's origins in the brain.

"We find that people who stutter have a harder time doing two things at once," says researcher Sophie Lafaille, summing up her ongoing work at Toronto's University Health Network's Human Communication Laboratory.

Dr. Luc de Nil, who heads the lab, says that when you take an image of a stutterer's brain in mid-sentence, what you see is a flurry of activity in all speech-related brain regions. Compare this to the focused, localized brain activity of a fluent speaker and the inevitable conclusion is that stutterers are just trying too hard to get their words out. Something, somewhere, has to give.

This inability to multi-task -- on the most fundamental neurological level -- is the immediate cause of stuttering, Dr. de Nil says. Even when stutterers are reading words in their heads, their overactive brains show increased activity in a region responsible for preparing the body for such complex actions as speech.

But the ultimate cause, whether it be an inherited genetic trait, excessive pressure on a child learning language, or some combination of the two, remains a matter of debate.

Those who argue that stutterers are born rather than made are supported by the questions of heredity and genetics. Studies have shown more than half of stutterers know of a family member who also stutters (my grandfather, who stuttered most of his life, went on to become a popular Nova Scotia radio host), more than three-quarters of stutterers are boys, and if one twin stutters, it is nearly a sure thing that the other will, too.

Recent genetic studies have pinpointed one key gene with strong links to stuttering, and a project is underway at the University of Illinois at Urbana-Champaign to collect blood samples for a sweeping study of stuttering in families. But environmental factors complicate the tidy explanation of an inherited cerebral quirk.

In 1939, a misguided researcher (himself a stutterer) at the University of Iowa tried to make orphans stutter by teasing them mercilessly as they learned to speak, thereby proving the disorder had environmental causes. The victims, who are now suing the state, were given endless negative feedback to their vocal development, and in a twisted way, the experiment was a success; some of them stuttered.

Although the experiment has now been universally denounced, and was kept secret until a reporter unearthed the files in 2001, it is a reminder that stutterers can be made as well as born.

It is usually pressure on a child's growing language abilities that does it.

William Parry, a U.S. stutterer and independent researcher, theorizes that stuttering is a lingering neurological confusion from childhood attempts to speak more fluently than one is able. This stress of fearing dysfluency and trying to overcompensate underlies the speech impediment, which mimics the body's unconscious closing of the upper airway, he says.

An academic theory, the Demands-Capacity Model, proposed in 1990, similarly holds that stuttering arises out of an imbalance between a child's capacities for fluent speech and the demands placed on him or her by the environment, which usually means parents.

"If there's too much demand placed on the system at an early age, that could certainly backfire," says Dr. Bob Kroll, a speech therapist.

Both Kroll and de Nil say the accepted wisdom is that stuttering is caused by the interaction of environmental and genetic factors. Whatever the cause, though, the scientist and the therapist seem to have figured out how to give a stutterer's brain a tune-up.

In a converted office building in northeastern Toronto, Kroll offers his patients, many of them children, a simple program of breath control that has made dozens of them fluent speakers. He calls it "fluency shaping" for the adults, "easy speech" for the teenagers, and "turtle talking" for the kids (because it starts out very slowly). It is all the same idea, though: easing into words to start them, then keeping the air flowing as you move to the next word. "You need air to talk on," he tells them.

And when Kroll's subjects go to de Nil for brain imaging, strapping themselves into the giant whirring doughnut of an MRI machine to stutter for science, the results are astounding.

In the early stages of treatment, the images look just as they would for a regular stutterer -- the brain lights up like Canada Day. As they learn the breathing techniques, though, de Nil points out how brain activity actually increases because the therapy adds another complication to producing speech.

But when the techniques have become second nature, and the stuttering is under control, the readouts look just like a fluent speaker's.

- - -

Casey Smith is a stutterer with a story that spans the explanations of heredity and environment.

He is a confused right-handed writer and left-handed golfer with a mother and two other relations who also stutter.

"I've always wondered where it starts," he says of his stutter, his words flowing without so much as a hesitation.

He is one of Kroll's success stories, a friendly 18-year-old who says his speech impediment has "majorly" affected his social life, but who has worked through the program and is now in the final, or "maintenance," stage.

Over Cokes in his living room, with his buddies waiting for him in the basement, he says he has always known that stuttering had something to do with breath control.

"I used to always think it was in my head, but after I started going to therapy and learned more about it, I realized the breathing part was more of a factor to me," he says. "I'll think too fast in my head of the words that I want to say, and then I won't have enough breath to say it. And when I get really excited, I'll just try to say too much and I'll stutter."

His mother, Debi Babiak-Smith, recalls the moment she heard her son, then a talkative seven-year-old, make that unmistakable pause in his speech, thus kicking off his speech impediment.

"My heart just jumped," she said. "I knew instinctively that it wasn't just a stumble. I knew it was a stutter."

She stutters, too, just like her grandfather and her uncle did. She attributes it to a traumatic experience with an elementary school teacher.

She did not have the benefit of speech therapy and says she avoids the telephone at work and has failed to pursue things in her life for fear of speaking in public. She fears her son will do the same.

It was Casey who came to her to ask for speech therapy about two years ago, just as the project to use brain scans to evaluate Kroll's classes was starting off. Casey had a typical teenage social life and was doing well enough in school, but wanted to overcome some of the embarrassment that kept him from speaking in class.

Looking over the diagrams of stuttering brains getting less and less cluttered over time as their owners learned Kroll's techniques, Casey nods in agreement.

"That's exactly what I went through," he says.

Like the guy on Seinfeld who converted to Judaism because he liked telling Jewish jokes, I feel no unease in publicly observing that, for all the anguish it causes, stuttering can be immensely funny.

It is an important point. For one thing, it helps to deflate some of the wailing despair that tends to dominate discussions of stuttering, which often focus on parental guilt and self-imposed loneliness.

A speaker at a stuttering conference this weekend in Toronto, for example, plans to argue the humourless point that forgiveness of others is the first step toward overcoming the disorder, as if stuttering were like losing a child to a drunk driver.

She goes so far as to claim stutterers need to forgive themselves for how they talk, which might be a useful exercise for some, but strikes me as a flighty piece of self-indulgence.

And it is humour, not penitence, that makes fluent speakers comfortable around a stutterer.

Take John Bray, for example, a Toronto cab driver and lifelong stutterer. Every now and again, when he stutters on a word but eventually gets it out, an impatient passenger will feign not understanding him (a common nervous reaction to stutterers, I have found) or insist on finishing his sentences.

He has a secret weapon for these reactions, a phrase that, by some quirk of confidence, he always says clearly. "Do I stutter, or what?" he deadpans, and the ice always breaks. "Folks laugh at that because they know I do," he says.

Humour can also reveal some of the silly lengths to which stutterers often go to avoid embarrassment.

Consider the man who came to Kroll for treatment, and after a few sessions confessed he had never eaten a Big Mac because he could only say "cheeseburger."

Pathetic though it may be, that is funny, and speaking as someone who has developed a taste for Hawaiian pizza after deciding several times not to take my chances with "pepperoni," I do not doubt this anecdote.

I have changed many sentences in mid-stutter ("That's r-r-ridicu .. ridicu-cu-cu ... r-r-r ... crazy," for example), and spoiled many a joke by stuttering on the punchline. The occupational demands of daily newspaper journalism carry their own peculiar risks, too. (It is hard to imagine a situation more rife with untapped humour than my interview last year with Peter Kelly, the stuttering Mayor of Halifax.)

Print journalism offers an empowering shield for the stuttering writer that is breached only in interviews, and with the name of a national daily as a calling card, it is easy to be self-assured. Radio, however, is the acid test of confidence.

Why bother with radio if you stutter? It is a good question, and worth asking the broadcaster in Gabon who was fired last year by state censors after he stuttered on air through the name of President Denis Sassou-Nguesso of neighbouring Republic of Congo. And kudos to the stuttering man who, just a few weeks ago in the United States, was denied his request to dedicate a song to his wife on air, prompting a rash of angry responses that ultimately got the show cancelled.

This same question troubled me once in university, when I agreed to go on a campus radio talk show, but I knew the audience would be so small it would hardly matter. A few days ago, though, I recklessly agreed to go on the air, live, all across Manitoba.

The Vatican had denounced gay marriages. I wrote a story in this paper about the history of papal intervention in politics, and a Winnipeg radio station decided I would make an interesting guest. Against my better judgment (and over e-mail) I agreed, and got through my first sentence quite well. Then I fell headlong over the name of Mary, Queen of Scots, much to the surprise of the host, who had introduced himself not 60 seconds earlier and had not yet heard my voice.

When I had finished the late queen's name (though I had not yet got to my central point about the Vatican) I was summarily disconnected with a nervous "thank you," after which the host urged his listeners to turn to the Post for a somewhat clearer explanation.

And this, which might have been a mortifying experience, highlights what I think is a useful coping mechanism for stutterers: unabashed self-confidence and a pig-headed refusal to be embarrassed.

As coping mechanisms for people who have not yet attained fluency go, it is one of the better ones, and is a hands-down winner over not talking.

The others range from the quirky to the elaborate: I sometimes say "like" to get the air going if I am stuttering, employing a Valley Girl-ism that should be cause for more embarrassment than stuttering. I also avoid eye contact in mid-stutter; Casey blinks, and his mother used to record herself asking for her friends on the phone so she would not have to talk. All stutterers struggle to find synonyms for the words we know are hard to say, as if we are tip-toeing through a thesaurus.

Treatments are equally varied. Just last week, it was announced a device is available that plays one's own speech into the ear, slightly delayed, to create the feeling of speaking along with someone else, which, according to the makers of the US$1,500 device, is easier for stutterers. Indeed, de Nil says auditory feedback for stutterers is one of the next things he intends to study.

Other treatments have involved meditation, repetitive practise, and one that I briefly toyed with had me listening to special beeping noises in earphones to somehow reorganize how my brain deals with speech. I don't think it did.

But for stutterers looking to make their lives easier, nothing is more common than avoidance, and that is the real crime.

Take Wilfrid from Sudbury, who went to Kroll to say he would no longer be attending classes because he did not believe he would ever speak clearly. He had been offered a promotion at work that would require speaking more, but he did not want the added pressure or the attention he knew he would attract if he started speaking fluently.

"I felt like strangling him," Kroll says, so he asked him to demonstrate on the phone what was so hard about the fluency techniques. Wilfrid did, spoke without a stumble, and turned to Kroll to explain. "You just wait until next time," he said. "That was just lucky."

Email with questions or comments about this article.


Phone 1-888-STUTTER or 416-252-8255 in Toronto for more information about stuttering.

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