Brain, Temperament, and Behavior: New Approaches to Understanding Fluency Disorders

It is a pleasure to introduce this issue, one of a continuing series of updates that Seminars in Speech and Language offers its readers on recently released research findings relevant to the clinical assessment, treatment and counseling of individuals who stutter and their families. With one exception, the papers in this issue are based on research presented at a Research Symposium hosted by the National Stuttering Association in conjunction with its annual meeting in July 2013 in Scottsdale, Arizona. The Symposium was organized and headed by Vivian Sisskin, who serves as Guest Editor for the issue. This Symposium, which offered additional presentations not reflected in this issue, was designed to provide both clinicians and individuals who stutter with the most up-to-date information available on the management of this highly complex, poorly understood, and frequently handicapping chronic communication disorder.

This issue starts with what is arguably one of the “hottest” issues in most areas of communication disorders – how advances in neuroimaging have changed our understanding of the anatomical and physiological systems that appear to be involved in the etiology and in the persistence of stuttering. Soo-Eun Chang and her colleagues have made what will surely be seen as some of the most important discoveries in elucidating the physical and functional differences that appear to distinguish both those who stutter from fluent speakers, as well as children who do and do not appear to recover from stuttering in early childhood. These findings have immediate application to counseling individuals who stutter, and their families, who often (despite advances we have made in understanding the genetic and physiological contributors to stuttering) hypothesize wrongly that experiences or parenting are primary contributing causes to the onset of stuttering and its persistence. Although we do now understand that experience can impact the human genome, whatever is causing the symptoms of stuttering to emerge and continue is at least reflected by very real differences in brain anatomy. In my experience, when recent research findings such as these are discussed with clients and families, we may see considerable reduction in blame/guilt, freeing the client and family to focus on positive discussion of appropriate treatment choices and options.

Shelly Jo Kraft introduces readers to a topic not well-covered in the stuttering literature, the concept of effortful control, and the role it may play in mediating severity of stuttering symptoms.

Jayanthi Sasisekaran reminds us of another, increasingly well-documented feature of stuttering that impacts its clinical management: that it is frequently accompanied by observable or subtle impairment in other aspects of communicative function, such as phonology and/or language. She provides a thorough survey and critique of what we know about the co-morbidity of stuttering and phonological disorder, an examination of how fluency and phonological abilities may interact, both overtly, and “under the surface,” and suggestions for how to utilize this knowledge in clinical practice.

As Kraft and Robin Jones note, temperament is playing an increasingly larger role in research examining contributors to stuttering onset and persistence. Understanding how individual temperamental characteristics may interact to predict symptom severity and inform treatment planning and implementation is an evolving area of interest. We have come a long way since early hypotheses about the role of personality factors in the etiology of stuttering, to a more reasoned understanding that reflects how basic human traits (such as how the child responds to novelty, change or challenge) may predict how clients respond both to their communication difficulties as well as to family and therapist efforts to assist in helping the client manage speaking and stuttering more effectively.

Janet Beilby documents the broad and specific impacts that stuttering has on the quality of life experienced by individuals who stutter, from childhood through the life span. She contrasts the impacts experienced by the persons who stutter, with those in their family circle, from siblings, to parents, to life partners. Her studies illustrate, perhaps more clearly than ever before, the startling differences in how the affected individual views the challenges of stuttering in daily life as well as how others in the family perceive them. She concludes by suggesting that progress made in clinical psychology in working with disorders that impact the family or a relationship (as most chronic or significant life conditions do) may be of tremendous utility to us in our work with clients who stutter. This contribution continues a recent trend emphasizing how we can profit from evidence garnered from allied fields to move improvements in treatment along at a more rapid rate.

The issue concludes with a research report from Sisskin's own treatment outcome research program, in which she tackles an increasingly documented and frustrating profile of fluency impairment that has received little attention in the literature; moreover, she reports a successful treatment outcome. Treatment outcomes reports are the most valuable kinds of reports for our readers, as they provide tangible guidance that can be applied immediately to clients who have not responded to more traditional therapy approaches. In this case, successful treatment of a client with a baffling and conspicuous profile of word and phrase repetition that impaired both his communication as well as social function involved, perhaps surprisingly, approaches that were somewhat simple, and in many ways different from traditional fluency treatment options. The field needs more of such case study publications; all large scale treatment research starts from observation of individual cases.

I believe that most readers will find the contributions in this issue to be of substantial help in their work with fluency-disordered clients. It remains the single most often identified area of clinical practice of which readers request more coverage in our journal pages.