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The 7th World Congress On Fluency Disorders

Rachel Everard, Rosemarie Hayhow, Jan Logan | 01.09.2012

Three speech and language therapists (SLTs) share their experiences of the tri-annual event.

I, together with my colleagues Carolyn Cheasman and Jan Logan, was fortunate to attend this prestigious conference organised by the International Fluency Association (IFA) in July 2012.

L-R Jan Logan, Carolyn Cheasman and Rachel Everard, from City Lit in LondonThe IFA is an organisation devoted to the understanding and management of, and the improvement in the quality of life for people with, fluency disorders. This year's World Congress saw well over 200 people converging on Tours, France from all corners of the globe. For an intensive few days we were united in our passion for discussing all aspects of stammering and it was heartening to see amongst the attendees a fair number who stammered.

The breadth of the presentations or workshops was amazing. As an SLT specialising in adult stammering therapy, and as someone who stammers, I was naturally drawn to presentations focusing on research and therapy for adults who stammer. Here are my reflections on a few that I attended.

Often described as the Cinderella of fluency disorders, cluttering received due attention at the Congress thanks to Yvonne van Zaalen from the Netherlands, a powerful advocate for getting this misunderstood and misdiagnosed type of dysfluency firmly on the map. Yvonne estimates that out of everyone who stammers, 8-15% have a clutter, 33-55% have a combination of cluttering and stammering, and 30% have a stammer. In my own experience, many people referred to us at City Lit demonstrate cluttering characteristics, including a rapid rate of speech and reduced intelligibility, and it is important for me to take this into account when planning therapy. (For more information on cluttering, go to Cluttering.)

Another presentation which sparked my interest was by Claire Rowland of the Stammering Support Centre. Entitled 'Exploring individual client experience of speech-associated anxiety: a clinical tool', it described Claire's work with a client frustrated at his variability of stammering in different situations. Together they developed a detailed chart which provided a clear framework for aim-setting and recording subsequent progress. This great example of creative joint working illustrated the importance of putting the person who stammers at the heart of the therapy process (contact Claire at crowland@nhs.net for more details).

I was also fascinated by Shelly Jo Kraft's presentation on the identification of 10 possible genes associated with stammering. Shelly Jo has an ability to make even the most complicated topic accessible and within an hour I was much more knowledgeable about her genome-wide study. It's very exciting that we're closer to identifying which genes might be responsible for stammering.

It's very exciting that we're closer to identifying which genes might be responsible for stammering.

My one regret was that I wasn't able to attend Phil Schneider's presentation of his film 'Going with the flow: a guide to transcending stuttering', which follows the stories of two people who stammer on their therapy journey. Fortunately it's available to watch online at www.schneiderspeech.com/movies/ .

I would highly recommend attending the next World Congress, whether you're someone who stammers, an SLT or a researcher. You'll be made very welcome! 

Rachel Everard, City Lit

A children's therapy perspective

I was particularly interested in presentations about routine information-gathering or treatment evaluation. Without systematic assessment and an agreement on what should be measured, there won't be enough data to guide our knowledge and work with children and adults who stammer. It would be good if we could profile the children we see and then match them with the intervention that best fits that profile. Sadly we currently don't have the evidence for this. Only better clinical and research data will help therapists make these judgements.

The need for shared assessment procedures leads me to Sharon Millard's (Michael Palin Centre) report on a parental assessment of children's stammering (available from their website soon). This could provide pre/post treatment information that would help in comparisons between SLT departments and possibly between different profiles of stammering children and the therapy received.

Finding therapies that work is only part of the story, and comparison between the costs and benefits of different treatments is becoming necessary within our NHS. A Dutch team investigating the costs and benefits of the Lidcombe Programme (LP) vs. therapy based on the Demands Capacities Model (DCM) found that LP was slightly better than DCM in terms of recovery but had slightly higher costs. Maybe this illustrates the importance of finding the right therapy for the individual in order to maximise benefits while keeping costs down.

Hewat obtained promising results from helping children learn to self-correct during intensive group therapy. She explained the approach isn't about stopping the stammer but more like catching a ball, being a good goalkeeper, then changing the stammering into a slower start. This seems a positive image for increasing skills in managing stammering and helping children feel more in control of their speech.

There was interest in how people who stammer can suffer from social anxiety disorders (SAD). A University of Sydney study found that SAD can develop in children around 10-16 and is usually associated with negative social experiences, e.g. bullying. These children may be less resilient to the rough and tumble of growing up. Cognitive Behaviour Therapy (CBT) can be helpful, but facing the fear without support can end up making things worse. Gun and colleagues have been working on an online-based CBT program for adolescents, which could prove a good way of reaching those who don't wish to attend clinic appointments.

There are mixed views about online treatment. Many countries have dispersed populations and web-based therapy is the only way to make help and support possible. Busy parents and adults who stammer can find regular clinic visits difficult, so webcam sessions may help. Bridgeman reported on webcam LP that was helpful but raised some unexpected issues, e.g. is it okay for parents and children to have web therapy in their nightwear? Is it harder for parents to remember they have a session when it takes place online rather than in a clinic? Dealing with unco-operative children is more of a problem with webcams too. Bridgeman talked about the importance of clarifying the 'rules' for online therapy, a good reminder that when we try new things we mustn't assume that old ways will fit the new situation.

Finally, Joseph Agius discussed his use of creativity and humour with school-age children who stammer. His study of changes in attitudes and feelings led to the development of the Smart Intervention Strategy (SIS). He uses some of DeBono's thinking tools and said encouraging more creative and flexible thinking helps children change their perceptions. Laughter is often an indication that we're seeing something differently and it is good for us on many levels. Any approach that makes therapy fun for children must be worth serious consideration!

Rosemarie Hayhow, Bristol Speech & Language Therapy Research Unit

Narrative therapy

Narrative therapy is a non-blaming approach to counselling which sees people as experts on themselves and views problems as separate from people. As a therapist interested in narrative therapy I was struck by the emphasis many speakers at the conference placed on the value of hearing the client's experience of stammering. Talking about self-help, David Shapiro spoke of stories of people who stammer (PWS) as 'beacons of hope' and 'portraits of success'. Scott Yaruss gave a vibrant keynote speech in which he talked about the importance for SLTs to find ways to gain as much understanding as possible about what stammering means for PWS.

The therapy team from 'Free to Stutter, Free to Speak' (Ireland) ran a workshop entitled 'Changing stories of stuttering using narrative therapy and art', pointing out the 'problem' story so often associated with stammering tends not to be the whole story. A narrative approach helps people find alternative storylines and can assist PWS in re-authoring their story, leading them to an identity they are more comfortable with and reducing the impact of stammering in their lives.

'Therapeutic documents' are a key aspect of narrative therapy. My presentation focused on how the process of writing can be used to support change in adult stammering therapy. Sharing client experiences allowed me to illustrate how therapeutic writing helped some PWS find a new way forward and to maintain the changes they had made in therapy. For anyone interested in the chance to re-author their story of stammering, we have a new course: 'Telling your story - finding a new way forward with stammering', (12th Nov-10th Dec 2012). 

Jan Logan, City Lit

Clinician of distinction awards

Willie Botterill and Carolyn Cheasman who received The Clinician of Distinction award.

Willie Botterill (Michael Palin Centre) and Carolyn Cheasman (City Lit) were honoured by the IFA, receiving The Clinician of Distinction award at the conference. In their acceptance speeches they both talked about the important role of mentors in their professional lives. Willie paid tribute to Lena Rustin, whose indomitable spirit was responsible for putting stammering on the map in the UK and setting up the MPC. Carolyn acknowledged the late Renée Byrne, the highly influential and respected fluency specialist. Colin Firth and David Seidler were awarded the Contributor award for The King's Speech, which has done so much to raise awareness of stammering. Carolyn and Willie were a little disappointed that Colin was not there in person to receive his award!

From Speaking Out Autumn 2012