History Trails

Toward Fluent Speech: A Beginning

Abruptly the phospher dots end their confused dance and an image appears on the video screen: a young man, seated. just a perfectly normal-looking young man.

Then; from somewhere outside the camera's ken, someone asks the young man his name, and he is no longer normal.

He struggles to speak. And as he struggles the video monitor is forgotten: you are there with him, sharing his naked misery. It is not pleasant.

One minute later the image dissolves. Presently the young main reappears. But now he is not the same person. Now he talks fluently. He smiles:

And as the tape runs the miracle is repeated over and over again. With Chris, with Bob, with Jim ; with David. (Mates outnumber females as stutterers by a ratio of 5:1, says Dr. Boberg.) Each has struggled to speak, and the struggle has been severe. There have been bizarre contortions and bizarre sounds.

And then each has had his burden lifted. Each has spoken easily and smiled,

"That's enough to give you some idea of what we are dealing with," says Dr. Boberg as he punches the stop button of the video recorder.

The tape, which contains before and after speech samples from participants in his stuttering clinics, is only a fraction of its way through, but it has already spoken volumes: unbelievable though it may seem, in each instance only three weeks have separated 'before' and 'after'.

It is not by any miracle but by their own hard work that the people who take part in the clinics for stutterers held each summer at the University of Alberta gain fluency. Hard work given focus by one of the world's most successful stuttering remediation programs.

The now-renowned Alberta program had its genesis in a small clinic organized by Professor Einer Boberg in 1972. Impressed with the success demonstrated by the Australian therapists Ingham and Andrews of Sydney, he closely modelled his original clinic on their work. Since then, however, the clinic has become more eclectic, drawing from the work of various other researchers and a great deal from Dr. Boberg's own experiences and observations.

Einer Boberg was born in Drumheller, Alberta and grew up on the rolling prairie nearby, on a farm south of the Valley in the Dalum district. His childhood would not have differed greatly from those of thousands of other Prairie boys, except for his stuttering. From the time he had learned to speak, he had stuttered.

"I was like Jim," says the speech pathology professor, referring to a former patient whose speech difficulties had been recorded on videotape. For the entire minute that the tape had played Jim had struggled without success to say his first name.

"Typically it would take me three to four minutes to say my name," says Dr. Boberg, now a professor of speech pathology and audiology at the University.

At the time that he was growing up there were no speech therapists in Alberta. His journey to fluent speech did not begin until the last year of his teens when he boarded a bus for Minneapolis. There he underwent weeks of therapy. When it ended he could speak fluently - but his journey was not over. It was to last another 10 years.

After repeated relapses and therapy, at age 30 Dr. Boberg was finally free from the prison his speech difficulty had contrived. "I still stutter slightly from time to time," he says, "but I've learned to live with it."

Sparked by his own experience, Dr. Boberg gave up a career as a violinist to pursue the studies which have enabled him to help others free themselves from their personal prisons, the prisons of fear and humiliation their stuttering has created. At the University of Iowa he earned bachelor of arts and master of arts degrees, and then he returned to the University of Minnesota, where his own remediation therapy had begun, to earn a doctoral degree. In 1971 he returned to Alberta to assume the chairmanship of the fledgling speech pathology and audiology program at the University of Alberta.

According to Dr. Boberg, the search for a cause and a cure for stuttering has been long, curious and frustrating. Through the ages, stutterers have had their tongues burned, blistered and severed. They have participated in weird rituals, chanted in monotone, and stuffed their mouths with strange appliances. Some have given up speech entirely, choosing to live in silent misery.

Modern medicine has experimented with surgery, breathing exercises and medication. The cause of stuttering has also been sought in the features of a deviant or neurotic personality, with remediation in the form of psychoanalysis. The success of this latter approach is perhaps best demonstrated by the joke it has given rise to: upon completion of his psychoanalysis the longtime stutterer is heard to admit that he still stutters but adds "But n-n-n-now I know wh ... y!" The only consistent findings which have emerged from the extensive psychological testing which has compared stutterers to the normal population are that adult stutterers tend to lack self-confidence and withdraw from social situations — characteristics which are more reasonably seen as resulting from the stuttering than causing its development.

While much has been learned about stuttering in the last 20 years, much about its cause and development still remains unexplained, says Dr. Boberg. There is, however, a clearer picture emerging.

Close observation of pre-school-aged children has shown that most children of this age have frequent dysfluencies, pauses, and even signs of tension associated with their speech. That this should be so is not surprising: as Dr. Boberg points out, speech requires considerable co-ordination of fine motor movement. If all goes well — and it normally does — the children soon overcome their difficulties and develop normal fluency.

Some children, however, have an unusual amount of difficulty during this developmental phase, repeating or prolonging an unusual number of syllables. Often this is associated with tension. Most leading speech researchers now share the view that these children fall on the low end of a continuum in respect to the ability to co-ordinate the speech musculature and that this may be related to some, as yet, undetermined neurophysiological condition. These children may also display more than the usual number of articulation errors during early development.

The child's environment may also become a factor as the child who is experiencing dysfluencies interacts with those around him. If for some reason the child becomes wary or is made to become wary of making mistakes in his speech and begins to worry about the speech process, he may begin to struggle to avoid dysfluencies. In his struggling he may find that some type of behavior - excessive blinking, nodding, or lip smacking, for instance — provides a distraction which somehow eases his speech.

From this point, it is thought, the stuttering develops, through a form of avoidance or escape learning which is not yet well understood. Essentially, it is believed that when these accessory or distracting behaviors are repeated they are reinforced and eventually become a part of that child's speech repertoire. The distracting effect, however, soon declines and the child may add new or more vigorous struggle behaviors in an attempt to break through the temporary blockage.

Because these behaviors, whatever their initial usefulness might have been, are not only irrelevant to the production of speech but actually inhibit it, the child becomes confirmed in his view that speech is a difficult undertaking and reacts with fear and tension. He struggles harder, and the anticipated difficulty becomes real difficulty — and lasting difficulty. He is now caught in a vicious cycle.

Dr. Boberg explains the theory in this way: "In other words a person stutters because he or she believes in the difficulty of speech, anticipates failure and struggles to avoid it. The efforts to avoid difficulty are the stutterings or lead directly to them. Having stuttered, the person is vindicated in the expectation of speech difficulty, and so the cycle continues."

While this theory of the development of stuttering has received wide acceptance among speech pathologists, Dr. Boberg stresses that it is by no means complete and requires further research.

"If a final satisfactory theory is ever developed it will likely be multicausal," he says. Indeed, he has recently begun some interesting research which seems to point to differences in the cerebral processing of speech and language by stutterers and non-stutterers. Preliminary work shows an unusual amount of right brain hemisphere activity associated with the speech of stutterers — and remediation, it seems, alters that, increasing the left hemisphere involvement.

Dr. Boberg refuses to speculate as to the possible importance of these findings. "It's too early to tell."

Despite his continuing interest in the causes of stuttering, Dr. Boberg has devoted most of his attention to developing an effective remediation program. And he has done so with considerable success. The summer clinics which he conducts through the University of Alberta Hospitals have attracted international attention, and he and a former co-ordinator of the clinics, Deborah Kully, have recently collaborated in the writing of a detailed description of their treatment program. It is being published by C.C. Publications of Oregon and will be distributed internationally under the title "The Boberg-Kully Comprehensive Stuttering Program."

The program as it is instituted at the University of Alberta Hospitals demands a great deal from the participants. "It's a lot of hard, hard work," says Dr. Boberg. But the hard work brings results.

With very few exceptions, those stutterers who participate in the intensive three-week clinics will leave with normal-sounding speech. Statistics taken from a typical clinic involving 12 stutterers show that prior to the clinic the participants stuttered on nearly 20 per cent of the syllables they spoke (based on an average calculation); after the clinic the comparable rate was less than one per cent.

The people taking part in the clinics meet for six hours a day, five days a week, for three weeks. During the first two weeks they live in a University residence. Explains Dr. Boberg: "We believe it is easier to modify behavior in a novel environment, particularly when surrounded by other people who are trying to make similar changes." Then, too, the participants are able to use each other as an audience a: they relearn their speech.

During the final week, however, those who care are encouraged to return home as part of the process by which they transfer their new-found fluency into the outside environment.

The therapy groups range in size from four to six participants. At the outset of the program they learn to discover and describe the behavior they are trying to change. That accomplished, they begin their effort at altering their manner of speaking.

They learn to stretch vowels, keep consonants very soft and brief, and the airflow continuous. Fluency is acquired through the use of prolonged speech. After years of being told to "hurry up," they are told to "slow down." They learn to speak at a rate of 60 syllables per minute and then move through a series of carefully constructed steps until they can speak fluently at the normal rate of about 200 syllables per minute.

In the final phase of the program, the participants take the smooth, easy speech acquired in the clinic into the outside world. They begin by conversing with secretaries in the clinic building and then move on to other assignments, recording their accomplishments on a tape recorder. They speak with students on campus, telephone commercial establishments, go shopping, and even arrange and conduct a job interview.

When they leave the clinic, the participants have truly gained a new lease on life. For Dr. Boberg, whose personal experience gives him a profound appreciation of the transformation these people have accomplished, it is "tremendously exciting and satisfying."

Unfortunately, however, two factors prevent Dr. Boberg's satisfaction from being complete: the very real possibility of relapse and the long list of people waiting for therapy.

As he himself did, some of Dr. Boberg's "graduates" will return to old ways. Not only is it hard work achieving fluency, it is no easy matter retaining it. In the same way that the successful weight watcher may return to undesirable eating habits or the reformed smoker to the weed, the "cured" stutterer may relapse. The old behavior is so well learned that under conditions of fatigue or stress it may well reassert itself. In recognition of this a maintenance program has been established — an aspect of stuttering therapy not given much attention until the last decade. The maintenance program includes refresher visits to campus and daily speech exercises. But still some will falter.

And there are those many who must wait. Since 1972 approximately 300 persons have found help through the summer clinics, but almost half that many names remain on the waiting list. And even that does not give a true indication of the number who could benefit. It is estimated that in North America the incidence of stuttering is seven per 1,000 population — an estimated 10,000-plus stutterers in Alberta alone.

Dr. Boberg would dearly love to see a permanent clinic established at the University of Alberta, but the resources necessary to support such a clinic are not easily found, and fund-raising isn't something to which he can devote a great deal of time. "I'm a speech pathologist, not a fund-raiser," he once told a newspaper reporter, quickly adding, "but I would welcome with open arms anyone who would like to do that kind of work."

A permanent clinic would be able to devote attention to young children who are just beginning to show signs of stuttering, providing therapy before their speech habits become ingrained by the passing years, he says.

"What we are doing here now is really just a beginning."

While stuttering usually develops in children between the ages of three and six, repetitions, prolongations, revisions; interjections, and pauses are common in the speech of preschool children, says Dr. Boberg. The professor of speech pathology recommends that parents "simply view these dysfluencies as part of the normal process of speech development."

However, if your child seems to be having increased difficulty with speech, Dr. Boberg recommends that you ensure that the child doesn't have to compete for attention when he is speaking: "Come down to his level. Put an arm around him. Look at him, smile at him. Show him that he has as much time as he needs to finish what he wants to say . . . that you love him. Don't interrupt."

But there may come a time when the difficulties can no longer be regarded as part of normal development. "If the child begins to accompany the dysfluencies with tension and struggle, if he looks worried and avoids speaking or withdraws from social contact, then he needs help." says Dr. Boberg: At that point, he says, the parent should contact a speech pathologist to have the child assessed.

Local health units, hospitals, or schools can be of assistance in providing contact with a professional speech pathologist.

Published Winter 1984.

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