The King’s Speech: What stuttering treatment works?

Many people loved the movie The King’s Speech. But few were more riveted to the screen than current or former stutterers – like myself. At some point in early childhood, I began to stutter when I said certain words. Unlike the King, I was pretty fortunate. For some reason, my playmates were generally supportive rather than tormenting and I don’t recall being teased about my fluency problems.

And I will be forever grateful to Dr. Wolfe, the speech therapist in the college town in which I grew up. I remember Dr. Wolfe as jolly fellow, who reassured us kids that we’d be fine, we’d probably outgrow it, but would we mind just trying this or that technique? He spiced up the lessons with trips into real-world settings, such as ordering in our local candy shop. The best part: I got out of school for the therapy sessions. Dr. Wolfe would have to be well into his 80s by now, so if you’re still around: Thanks!

Like many children who stutter, my speech became more fluent as I got older (possibly because of therapy, but a large proportion of children who stutter get better on their own). But having had an inspirational speech therapist myself, my Evidence-Based Living antennae began to hum, leading to the question:

What is the research evidence on the effectiveness of speech therapy?

In particular, what’s the evidence on behavioral therapy such as that practied by Lionel Logue, who actually was King George VI’s speech therapist? Of course, at EBL we know where to turn: To systematic reviews of the literature. Fortunately, a great review of stuttering treatment research exists – in fact, I suggest you look at it just because it is such a terrific example of systematic review.

Dr. Anne Bothe and colleagues looked at all published studies from 1970 – 2005. Articles had to be original research, they had to have measurable outcomes, and they had to meet a set of critera for good science (described in the article).

One interesting finding right from the start: Only 31 articles met the criteria for sound methods. So even in an area with so much interest as stuttering, very few studies exist that use randomized-controlled designs, have adequate controls for reliability and validity, and look at both short-term and long-term outcomes.  Another review by Nan Bernstein Ratner looks at various forms of treatment from a clinical perspective (2010).

There is so much that’s interesting in these reviews, I suggest you take a look. Scientists are continually finding out new things about why stuttering occurs, from the genetic component to the influence of brain structure and function. But in honor of The King’s Speech, what do the reviews say seems to work best for adults?

For adults, Rhode’s systematic review most strongly endorses what’s called fluency shaping. This treatment works to replace stuttering with more fluent speech (hence the name). And the extensive review Bothe et al. conducted shows that one particular type of fluency shaping really seems to work: prolonged speech. This therapy involves such techniques as managing the stream of breath, creating a more deliberate flow between words, and generally slowing the speech down. One problem with these programs is that speech sometimes doesn’t seem totally natural; the most effective programs use prolonged speech therapy combined with other techniques.

Now, that seems does seem somewhat like what King George VI got from Lionel Logue, after all.

If you have some time to kill, the Stuttering Foundation has some very reassuring information for the approximately 1% of adults who stutter: Lists of famous people who struggled with the problem. Did you know that stutterers include: James Earl Jones, Nicole Kidman, Marilyn Monroe, baseball player Johnny Damon, and writer John Updike?

(And here’s a disclaimer to prevent riled-up comments from the speech therapy world: I know there is a huge debate over what kind of therapy works best for stuttering. For those of you who are interested, the two reviews are a good place to start. Some places to go for descriptions of therapies are the National Institute on Deafness and other Communication Disorders (NIDCD) and the Stuttering Foundation.

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