Stuttering therapy

Treatment of stuttering in children younger than six years of age focuses on the prevention or elimination of stuttering. Families play an important role in the management of stuttering in children: therapy is usually characterized providing an environment that encourages slow speech, affording the child time to talk, and modeling slowed and relaxed speech.

Lidcombe therapy has involves a parent or some significant person in the child's life being trained and delivering treatment in the child's everyday environment.[4] In the program, family members are to provide an environment in which the child receives praise for fluent speech in the child's daily speaking and negative correction of stuttering. Some of the most effective preschool intervention programs call for direct acknowledgment of stuttering in the form of contingencies such as "that was bumpy" or "that was smooth".

Fluency shaping therapy focuses on changing all of the speech of the person who stutters. This type of therapy involves teaching the stutterer to use a speaking style that requires careful and prominent self-monitoring; examples of such therapy include one in which the stutterer slows his speech down or speaks in a controlled tone. This type of approach can reduce stuttering, although in children its effectiveness decreases if stuttering persists after eight years of age.

The Modifying Phonation Intervals (MPI) Stuttering Treatment Program is designed to be a computer-aided, bio-feedback program that requires appropriate software (MPI smartphone app) and hardware (a throat microphone headset) which records the phonation intervals, or PIs, from the surface of the speaker's throat.

The app records all PIs as well as speaker-rated speech performance measures.

The MPI Stuttering Treatment Program is based on a series of experimental studies by Roger Ingham and colleagues (Gow & Ingham, 1992;[5] Ingham, Kilgo, Ingham, Moglia, Belknap, & Sanchez, 2001;[6] Ingham, Montgomery, & Ulliana, 1983[7]).

The MPI Stuttering Treatment Schedule is divided into four phases: Pre-Treatment, Establishment, Transfer, and Maintenance. Each phase is designed to be managed jointly by the speaker (person who stutters) and the clinician. The Pre-Treatment phase is directed by the clinician, but the other phases are largely self-managed while also requiring regular validation by a clinician.

Stuttering modification therapy, also known as traditional stuttering therapy,[2] was developed by Charles Van Riper between 1936 and 1958.[8] It focuses on reducing the severity of stuttering by changing only the portions of speech in which a person stutters, to make them smoother, shorter, less tense and hard, and less penalizing. This approach attempts to reduce the severity and fear of stuttering, and strives to teach stutterers to stutter with control, and not to make the stutterer fluent. Therapy using this approach tends to recognize the fear and avoidance of stuttering.

Contemporary devices used to reduce stuttering alters the frequency of the speaker's voice to mimic the "choral effect", a phenomenon in which person's stutter decreases or ceases completely when she is speaking with a group of others, or slows the rate of speech through delayed auditory feedback.

Delayed auditory feedback devices, such as Speech Easy encourage the slowing down of speech by replaying the speaker's words into their ears. The stutterer is then forced to slow her rate of speech to prevent distortions in the speech that is heard through the device. This is not effective for all people who stutter, and is shown to wear off over time.[9]

Several treatment initiatives use diaphragmatic breathing (or costal breathing) as a means by which stuttering can be controlled.[10]

Stuttering support/community groups have gained prominence and visibility and can be an important part of the process for stutterers,[11][12] A growing number of speech–language pathologists encourage their clients to participate in support groups.[11]

Research shows that participating in support groups and self-help sessions with others who stutter may reduce the negative attitudes associated with stuttering.[13] Becoming part of stuttering groups may help reduce the feelings of loneliness, fear, shame and embarrassment that comes with years of stuttering.[14] Participants of group sessions show lower internalization of stigma regarding stuttering. They have lower levels of negative feelings about themselves. Moreover, the goal of helping others who stutter in the group has been linked to better psychological well-being.[15]

Studies in the United States involving members of support groups of the National Stuttering Association have found that 57.1% of survey respondents said that the support group had affected their self-image "very positively", with no respondents indicating that it had a negative impact.[11]

Cognitive behavioral therapy (CBT) may be used to help people who stutter. CBT may be partially effective in helping clients reduce their secondary behaviors, anxiety, and cognitive distortion.[16][17] Cognitive behavioral therapy is a collaborative process that requires the client and the therapist working together to explore the buried feelings of frustration, avoidance, anger, and self-doubt. Younger children who stutter are more benefited by CBT as compared to adults who stutter. Research at the Michael Palin Center has shown that CBT is a powerful tool for children who stutter.[18]

Several pharmacologic, i.e. drug-based, methods to control or alleviate stuttering events have been studied, but each has either proved ineffective or have had adverse effects. A comprehensive review of pharmacologic interventions for stuttering showed that no agent leads to valid improvement in stuttering or in secondary social and emotional consequences.