Oxford Hosts Conference

Oxford Hosts Conference

Event Draws Experts from Around the World

By Lisa Scott, Ph.D., The Florida State University, and Willie Botterill, MSc, Michael Palin Centre for Stammering Children

St. Catherine's College, Oxford University, was the location for the eighth Oxford Dysfluency Conference held July 3-6, 2008. The conference is organized every three years and brings together approximately 150 researchers, clinicians, and people who stutter from around the world who have a specialized interest in stuttering. The Stuttering Foundation has a history of co-sponsoring this conference. This year's event was co-sponsored by the Stuttering Foundation and the Michael Palin Centre for Stammering Children.

Keynote speakers represented several diverse backgrounds regarding their interests and experiences with stuttering. Their presentations reflected this diversity and provided new perspectives for attendees.

Frances Cook, of the Michael Palin Centre for Stammering Children in London and Stuttering Foundation Board member, opened the conference Friday morning and introduced Professor Marc Shell, the Irving Babbitt Professor of Comparative Literature at Harvard University whose address was entitled, Talking the Walk & Walking the Talk. A person who stutters, Dr. Shell recently published a book called Stutter, which provides an interdisciplinary perspective of how stuttering has been described throughout time in art, literature, and film. His fascinating address highlighted these references and provided a unique and alternative viewpoint for attendees.

Next, Dr. Per Alm, professor of neuropsychology at Uppsala University in Sweden and an affiliate of the Danish Information Centre for Stuttering, presented 'Fluency Disorders: A Discussion of Possible Causes and Mechanisms From a Neuro science Perspective.' Highlighting key findings regarding the role of the brain in stuttering, Dr. Alm summarized for the audience what is currently known regarding the underlying neurological aspects of stuttering. For example, research seems to indicate that stuttering is related to an impairment in left hemispheric regions of the brain responsible for controlling the speech system, and that the brain partially compensates by recruiting regions of the right hemisphere. Dr. Alm then described the associations between traits of basal ganglia disorders and stuttering, and further proposed that stuttering, at its core, may be a neurological difficulty in speech motor initiation.

On Saturday, Professor Paul Dolan, Chair in Economics at Imperial College London, discussed the relationship between stuttering and well-being in his talk, 'Stuttering Into Happiness.' Approaching therapy outcomes from an economist's perspective, Professor Dolan emphasized looking at therapy in terms of costs and benefits, resource allocation, and quality of life. Conceptualizing quality of life as the degree of attention one gives to a problem (i.e., past, present, and future) and the problem's impact on the individual's thoughts and feelings, Professor Dolan proposed that stuttering is 'an attention grabber.'

Therefore, an important aspect of measuring therapy outcomes is to assess how much attention the client or the family is giving to stuttering at any one point in time, and developing measures that are able to capture the impact of stuttering on the client's quality of life rather than looking simply at frequency of stuttering.

Dr. Anne Smith followed Professor Dolan with a presentation on her current research program, 'New Win dows on the Onset of Stuttering in Young Children.' It is known that adults who stutter exhibit differences from normally fluent adults in motor control, understanding and processing language, and in anatomical and functional components of the central nervous system. What is unknown, however, is when these differences emerge. Are they present in children? At what age could we expect to observe such differences?

To attempt to answer these questions, Dr. Smith and her research team are recruiting 72 children who stutter between the ages of 4 and 5, who will be seen once a year for 5 years. Age and gender-matched peers are also being recruited. Early findings suggest that children who stutter may exhibit some evidence of motor differences from their typically fluent peers, as exhibited by motor deficits on a simple clapping task.

Additionally, on a grammatically simple sentence repetition task, children who stutter demonstrate increased motor variability from their nonstuttering peers in repeating the sentences. They are also less accurate at repeating nonwords (e.g., mab). Finally, working memory in the group of children who stutter seems to be less robust than in the typically fluent group. Dr. Smith suggested that these preliminary findings may be evidence for atypical brain development in children who stutter.

On the last day of the conference, the audience heard 'Why Stuttering Therapy Works: The 'Common Factors',' by Dr. Patricia Zebrowski of the University of Iowa. Dr. Zebrowski discussed research from the psychotherapy literature on four common factors that are present in any type of intervention: the specific type of intervention used; the therapeutic alliance between the clinician and client; the extra-therapeutic factors that clients 'bring to the table,' such as temperament, resilience, and external support; and, the client's hope or expectancy for change.

For the field of psychotherapy, treatment research has yielded findings that individuals who get treatment do better than clients who don't go to treatment. Furthermore, on average, treatment is effective regardless of the particular intervention approach used. Finally, statistical differences in effectiveness of various treatments are likely to be due to client variability and clinician expertise rather than the specific treatment approach itself.

Dr. Zebrowski challenged the clinicians and the researchers in the audience to begin thinking of ways to measure these common factors within the context of stuttering therapy. In such a framework, building evidence for specific treatment approaches would receive less emphasis than building evidence for the kinds of factors that contribute to a client's improvement in fluency and in communication.