Important Considerations for Stuttering Treatment Selection

The following information is provided by Hollins Communications Research Institute (HCRI) to help individuals who stutter effectively evaluate the array of stuttering treatments available and determine which program best meets their needs.

Stuttering results from faulty contractions of muscles that drive movements of the tongue, lip, jaw, soft palette, and vocal folds.  Since the disorder has a physical basis, it is possible to successfuly treat stuttering by teaching people how to adapt and control specific muscle behaviors to generate fluent speech.

Successful stuttering therapy outcomes require individuals to set speech goals; select a proven therapy program that matches their specific needs; and dedicate themselves to working hard and using the tools they are given to sustain fluency over time.

PROGRAM EVALUATION

When comparing stuttering treatment providers and approaches, consider the following:

Depth and Breadth of Experience

  • Does the provider exclusively work with issues related to stuttering?
  • How long has the provider been administering stuttering therapy to clients?
  • What are the credentials of the provider?
  • How many stuttering clients have been served?

Treatment Approach

  • Is the stuttering treatment methodology based on the provider’s own analysis of objective methods that produce fluent speech?
  • How much does the lenth and cost of the program?
  • What is the therapy drop out rate?

Stuttering Therapy Success Rate

  • What percentage of clients achieved fluency at the conclusion of the program?
  • What percentage of clients maintained fluency over five years?
  • What percentage of clients would recommend the provider’s treatment program to others?

For more information about successful therapy outcomes and to see before-and-after videos, visit HCRI’s website at www.stuttering.org .  To contact HCRI, send an email to  This email address is being protected from spambots. You need JavaScript enabled to view it.admin@stuttering.org  or call 540-265-5650.

HCRI: Proven Leader in the Research and Treatment of Stuttering

Hollins Communications Research Institute (HCRI) is a global leader in stuttering research and developing innovative stuttering treatment solutions that have helped thousands acquire fluency skills that have stayed with them for a lifetime.

The sophistication of HCRI’s stuttering therapy — and the individualized approach from which clients benefit — is unmatched by other treatment programs. HCRI’s venerable reputation for outstanding therapy outcomes results from the fact that 95% of clients learn how speak fluently in 12 days and return home with skills that enable them to maintain fluency for the rest of their lives.

HCRI’s stuttering therapy program is based on 35 years of intensive research by in-house scientists who have discovered and indentified specific muscle behaviors that are essential to producing fluent speech. HCRI clinicians are stuttering therapy experts who understand how to scientifically treat the physical and emotional aspects of the disorder, and skillfully teach clients muscle control skills that generate fluency.

As you take the important step of evaluating your stuttering therapy options, we invite you to review the information below to learn what makes HCRI’s stuttering treatment so extraordinary and effective. Then, get ready to enjoy a richness in communication never before possible by calling HCRI at 540-265-5650.

What You Should Know About Stuttering and Treatment

  • There is no cure for stuttering. Yet, you can learning to speak fluently by training the muscles that generate speech.
  • Stuttering is not an emotional problem. It is a physical problem that may cause emotional issues.
  • The outcomes of stuttering therapy programs vary significantly, as do the expertise of providers. Do your homework.

What Makes HCRI Stuttering Therapy Different?

Unlike other stuttering treatment programs, HCRI’s proprietary therapy has been developed by the Institute’s own research scientists who are internationally recognized experts in the field of stuttering. These Ph.D.-credentialed researchers have tested and honed HCRI’s 12-day therapy program with more than 5,000 people of varying age and stuttering severity.

No other therapy approach can replicate the sophistication of HCRI’s treatment delivery and success – or the individualized approach from which clients benefit.

Why HCRI Therapy Succeeds When Others Fail

HCRI’s proprietary therapy is scientifically derived and the most advanced available for helping people learn how to generate robust, fluent speech for a lifetime.

  • Successful outcomes are consistently achieved because clients are taught how to replace distorted muscle activities that cause stuttering with new muscle behaviors that generate fluent speech.
  • HCRI clients receive individualized attention from accomplished, HCRI-trained clinicians who treat more people who stutter in one year than most speech therapists treat in a lifetime.
  • A comprehensive package of post-therapy tools and clinician support services are provided to each client to help ensure long-term fluency results.

Ready to Change Your Life? Contact HCRI Today.  Click here or call 540-265-5650.

How to Help People Who Stutter

There are 66 million people globally who suffer from the debiliating effects of stuttering.  Yet there is help in the form of treatment that can transform their lives. That’s why Hollins Communications Research Institute (HCRI), a pioneer in stuttering research and treatment innovation, has launched a development initiative designed to extend treatment access and support vital research in the field of stuttering.  The fundraising effort is called the Inventing the Future campaign — and you can help.

Envision what it would be like to live each day having people…

  • Turn away when you try to talk with them;
  • Hang up the telephone when you call them; or
  • Laugh when you are desperately struggling to say something important.

This is what happens to people who stutter.  They have fluent thoughts, fluent writing abilities, and even fluent singing skills. Yet, it all breaks down when they try to talk.  Stuttering (also called stammering) affects three million people living in the United States and 66 million people worldwide.  Those who speak fluently take it for granted.

Sadly, stuttering has been ignored on the national health stage because it is deeply misunderstood by people who do not have it.  Many have the misconception that persons who stutter are less intelligent – or have emotional or mental problems. That couldn’t be further from the truth.

HCRI research scientists have demonstrated that stuttering has a physical basis and is not caused by mental dysfunction or anxiety.  The simple fact is that stutterers are normal people who have difficulty talking; and they deserve help and attention.

The good news is that HCRI, which was founded in 1972, has pioneered the development of scientifically based stuttering treatment methods that have helped thousands who stutter learn to speak fluently.

Researchers at the Institute are on the verge of key discoveries that may isolate the cause of stuttering, which could ultimately lead to a cure. In addition, HCRI is working on ways to use technology to extend treatment access to more people in more places than ever before possible.

The reality of operating a not-for-profit institute is that outside funding is needed to move forward with important work that will benefit society.  That’s what led HCRI to initiate the Inventing the Future campaign.   Interested persons can join the cause to help improve the lives of persons who stutter by making a gift at  www.stuttering.org or calling 540-265-5650.

Achieving Fluency through Persistence

The following is an excerpt of an article by Dorothy Carlson, a graduate of the stuttering therapy program at Hollins Communications Research Institue (HCRI) in Roanoke, Virginia. It is a candid account of her journey to fluency.

The word persistence reminds me of a conversation I had with a children’s author a few years ago. At dinner before speaking at my library, she revealed the key to success for a writer — persistence. Many would-be authors don’t get published, she told me, because they give up too easily. The pink slips discourage them from pursuing their dreams.

I already knew a little about persistence. At the age of 13, while helping in my junior high school library, I had decided to become a children’s librarian. The counselor at Drexel University warned me that I would never be given an opportunity. Why? Because I stuttered. Yet, I persevered and fulfilled my goal of becoming a librarian.

A few years into my position at Radnor Library in Wayne, Pennsylvania, I decided to get help for my stuttering and enrolled in the HCRI stuttering treatment program. I found the first three weeks difficult, yet hopeful. I learned new skills that were very hard, seemingly impossible to maintain with an 84% disfluency rate. Prone to depression, I wondered why I couldn’t speak fluently using the new target behaviors I had been taught.

Yet encouraged by the fluent reunion speeches of many HCRI stuttering program graduates, I kept working at it and even went back to Hollins for innumerable refresher courses. Each time I returned to the Insitute, my fluency improved. I have never regressed back to the initial disfluency rate.

The improvement in my speech has given me the confidence to accept several county children’s division positions, culminating in the chairmanship of the organization. In April 1996, I accepted the first Delaware County Outstanding Library Employee award. My acceptance speech, given before 150 people, was not perfect, but better than I could have ever imagined.

Maintenance of the fluency targets remains illusive. In 1984, I was diagnosed with cervical osteoarthritis and TOS (thoracic outlet syndrome). Both conditions create stiffness and nerve compressions in the vocal chord area. As a result, the ability to feel my speech targets continues to regress with age, making it even more difficult to monitor correct muscle movement patterns.

Though, I continue to work on my fluency targets and attend HCRI refresher courses, which always bring new insights. A few years ago, I learned that target precision resulted in fluency. Within a limited range, without unusually strong vibrations, I could do the required muscle movements that produced fluent speech. What a revelation!

Like so many would-be authors deluged by pink slips, I’ve faced the dilemma of giving up or going on, doing the best I can. My client file grows thicker with each new attempt. But my persistence may give people who stutter hope, whether they have a special medical problem or not. Fluency is worth the effort. It is attainable if you don’t give up trying. I know I never will.

For more information about HCRI and the Institute’s research-based treatment program, click here or call the Institute at 540-265-5650

Stuttering Research Commentary #4 by HCRI

Genetic Studies: Possibilities and Limitations Related to Stuttering

Commentary by Ronald L. Webster, Ph.D., Founder and President of Hollins Communications Research Institute (HCRI), a nonprofit center dedicated to the investigation and treatment of stuttering.

The issue of genetics in stuttering is important and it deserves to be understood in terms of what genetic analyses can and cannot do in improving our understanding of stuttering. The scientific and popular enthusiasm for modern DNA analyses is generating a possibly problematic situation with the seemingly magical expectation that the human condition can be understood almost solely through genetic analyses.

It is clear, however, that the information resulting from genetic analyses must be integrated with other forms of knowledge about how organisms are organized and how they function.

The coherent formulation of knowledge about fundamental properties of organisms will lead to better understanding of the specific mechanisms that are embodied within them and the activities accomplished by these mechanisms. This will be true for the disorder identified as stuttering.

A few recent studies illustrate the nature of research being conducted on genetics and stuttering.  Following are links to abstracts.

ABSTRACTS

These reports show scattered and inconsistent results when different types of genetic linkage studies are conducted. The main point is that there is still relatively little evidence for specific genetic factors in the broad population of stutterers. Evidence improves slightly when more closely related samples are examined.

There is the long-standing general observation that stuttering tends to run in families. Approximately half of the people who stutter can identify someone in their family background who stuttered. That finding implicates the notion that genetic factors are relevant in some way to the problem of stuttering.

There is preliminary evidence that aspects of stuttering within family members can be accounted for by advanced genetic models. However, when geneticists have conducted genetic linkage studies in which they searched for genetic markers that differentiated family groups with stuttering represented with family groups without stuttering represented, only weak relationships were found.

One of the conclusions that can be drawn about the probable role of genetics in stuttering is that slightly more that 50 percent of the cases will have a genetic component present. That means there will be a considerable proportion of stuttering cases where a genetic component will not be present. There is considerable importance to this interpretation when it comes to searching for the cause or causes of stuttering.

It seems likely that there is a mechanism or mechanisms that can produce stuttering in a individual even when there is no specific genetic element present. If this is indeed the case, then, in those instances of stuttering where a genetic component is identified, it would be expected that the physical manifestations of the genetic material are acting upon components of an existing body system that is primarily responsible for the disfluent speech events.

The implication that I draw from the genetics research is that we should intensify the search for physical mechanisms within the body that govern speech motor output. A good place to begin the search is to examine the broad array of physical variables that enhance fluency in stutterers and degrade fluency in normal speakers. Nature is presenting us with sets of clues that are almost certainly pointing to the arena where the causal factors in stuttering will be found.

For information about HCRI’s 39 years of research and therapy delivery, visit www.stuttering.org.

HCRI Research Study Commentary – An Introduction

Stuttering: Generating Fluent Speech as a Tool for Discovering the Cause(s) of Stuttering

By Ronald L. Webster, Ph.D., Founder and President
Hollins Communications Research Institute (HCRI)

There are a number of observations regarding stuttering and manipulations of physical conditions that reliably generate fluent speech. It would seem reasonable to state that, with these observations on conditions that generate fluent speech, nature is pointing clearly and strongly to a way to advance our understanding of stuttering as a physically based disorder.

This type of information also has special significance for understanding stuttering because it is based specifically upon the direct manipulation of physical variables and not upon studies that merely seek relationships between and among nonmanipulated variables.

Inferences drawn from experiments have the potential for being stronger and more useful than inferences drawn from simple associations. That is, they have to power to permit the correct inference of causal relationships.

We here at HCRI understand that physical facts and the patterns among them represent the foundation information upon which the eventually discovery of the cause or causes of stuttering will emerge. Identification of cause in stuttering will, in turn, generate work that will have potential for curing the disorder.

We note, for purposes of clarity, that we shall be focusing only on developmental stuttering. We will not be addressing stuttering associated with physical damage to the central nervous system induced by insult, disease or drugs.

On this site, we have provided and will continue to add representative studies, along with commentary, that have demonstrated reliable links between specific physically manipulated conditions and the propagation of fluent speech in persons who stutter.

After all, one of the major tasks of the scientific analysis of events in nature is to discover patterns of lawfulness among those events. Another major task is to develop a parsimonious network of constructs that organizes this information and suggests next steps in research. We shall indicate the properties of the patterns we see and will also discuss the scientific implications that can be drawn from this work. Click on the links below for specific studies and commentary by HCRI:

If you would like information about HCRI’s scientifically based stuttering treatment program, visit www.stuttering.org or call 540-265-5650.

Stuttering Research Commentary #3 by HCRI

As research scientists focus on determining the cause of stuttering, it is important to examine how the brain is involved in stuttering. Yet, it is premature to rush to the simple conclusion that the brain is “causing” stuttering.

The brain operates as a complex set of physiological systems that are, in turn, provided with an array of inputs and outputs. The research task is to develop an understanding of the complex context within which the brain functions.

The following research abstract is the third in a series es provided as a service by Hollins Communications Research Institute (HCRI).  HCRI is a nonprofit Institute based in Roanoke, Virginia that has been at the forefront of stuttering research and treatment innovation since 1972.

The commentary provided following the abstract is provided Ronald L. Webster, Ph.D., HCRI’s Founder and Director.

ABSTRACT:

Structural and functional abnormalities of the motor system in developmental stuttering.

Brain. 2008 Jan;131(Pt 1):50-9. Epub 2007 Oct 10. Watkins KE, Smith SM, Davis S, Howell P. Department of Experimental Psychology, University of Oxford, Oxford, UK. kate.watkins@psy.ox.ac.uk

Summary:

Though stuttering is manifest in its motor characteristics, the cause of stuttering may not relate purely to impairments in the motor system as stuttering frequency is increased by linguistic factors, such as syntactic complexity and length of utterance, and decreased by changes in perception, such as masking or altering auditory feedback.

Using functional and diffusion imaging, we examined brain structure and function in the motor and language areas in a group of young people who stutter. During speech production, irrespective of fluency or auditory feedback, the people who stuttered showed overactivity relative to controls in the anterior insula, cerebellum and midbrain bilaterally and underactivity in the ventral premotor, Rolandic opercular and sensorimotor cortex bilaterally and Heschl’s gyrus on the left.

These results are consistent with a recent meta-analysis of functional imaging studies in developmental stuttering. Two additional findings emerged from our study. First, we found overactivity in the midbrain, which was at the level of the substantia nigra and extended to the pedunculopontine nucleus, red nucleus and subthalamic nucleus.

This overactivity is consistent with suggestions in previous studies of abnormal function of the basal ganglia or excessive dopamine in people who stutter. Second, we found underactivity of the cortical motor and premotor areas associated with articulation and speech production. Analysis of the diffusion data revealed that the integrity of the white matter underlying the underactive areas in ventral premotor cortex was reduced in people who stutter.

The white matter tracts in this area via connections with posterior superior temporal and inferior parietal cortex provide a substrate for the integration of articulatory planning and sensory feedback, and via connections with primary motor cortex, a substrate for execution of articulatory movements.

Our data support the conclusion that stuttering is a disorder related primarily to disruption in the cortical and subcortical neural systems supporting the selection, initiation and execution of motor sequences necessary for fluent speech production.

HCRI Comment:

This study found evidence for anomalous cortical and subcortical activation in stutterers. While the authors  refer to these systems in terms of motor activation and control, the door remains open to the question of sensory involvement in motor execution. That is, a flaw in sensory return associated with speech initiation would have significant implications for motor functions.

For more information about HCRI’s work in the field of stuttering and treatment programs, visit www.stuttering.org .

Stuttering Research Commentary #2 by HCRI

All human behavior is associated with brain functioning of one type or another — including stuttering.

As research scientists focus on determining the cause of stuttering, it is important to examine how the brain is involved in stuttering. Yet, it is premature to rush to the simple conclusion that the brain is “causing” stuttering.

The brain operates as a complex set of physiological systems that are, in turn, provided with an array of inputs and outputs. The research task is to develop an understanding of the complex context within which the brain functions.

The following research abstract is the second in a series provided as a service by Hollins Communications Research Institute (HCRI).  HCRI is a nonprofit Institute based in Roanoke, Virginia that has been at the forefront of stuttering research and treatment innovation since 1972.

HCRI commentary follows the abstract and is provided Ronald L. Webster, Ph.D., HCRI’s Founder and Director.

ABSTRACT

Common features of fluency-evoking conditions studied in stuttering subjects and controls: an H(2)15O PET study.

J Fluency Disord. 2003 Winter;28(4):319-35; quiz 336.  Stager SV, Jeffries KJ, Braun AR.  Language Section, Voice Speech and Language Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA.

Educational Objectives:

1. Compare brain activation patterns under fluency- and dysfluency-evoking conditions in stuttering and control subjects;

2. Appraise the common features, both central and peripheral, of fluency-evoking conditions; and

3. Discuss ways in which neuroimaging methods can be used to understand the pathophysiology of stuttering.

Summary:

We used H(2)15O PET to characterize the common features of two successful but markedly different fluency-evoking conditions — paced speech and singing — in order to identify brain mechanisms that enable fluent speech in people who stutter. To do so, we compared responses under fluency-evoking conditions with responses elicited by tasks that typically elicit dysfluent speech (quantifying the degree of stuttering and using this measure as a confounding covariate in our analyses).

We evaluated task-related activations in both stuttering subjects and age- and gender-matched controls. Areas that were either uniquely activated during fluency-evoking conditions, or in which the magnitude of activation was significantly greater during fluency-evoking than dysfluency-evoking tasks included auditory association areas that process speech and voice and motor regions related to control of the larynx and oral articulators.

This suggests that a common fluency-evoking mechanism might relate to more effective coupling of auditory and motor systems — that is, more efficient self-monitoring, allowing motor areas to more effectively modify speech. These effects were seen in both PWS and controls, suggesting that they are due to the sensorimotor or cognitive demands of the fluency-evoking tasks themselves.

While responses seen in both groups were bilateral, however, the fluency-evoking tasks elicited more robust activation of auditory and motor regions within the left hemisphere of stuttering subjects, suggesting a role for the left hemisphere in compensatory processes that enable fluency.

HCRI Comment

This article hints at problems in auditory sensory and motor activation relationships. These results are consistent with the idea that there is a flaw in sensory/motor feedback relationships.

For more information about HCRI’s work in the field of stuttering and treatment programs, visit www.stuttering.org.

Stuttering Research Commentary #1 by HCRI

There is no doubt that stuttering is associated with specific forms of brain activity. In fact, all human behavior is mediated by brain functioning of one type or another. When we learn something new — a fact, a poem, a song or a motor skill — we do so because we have experienced reorganization of brain function.

As research scientists focus on determining the cause of stuttering, it is important to examine how the brain is involved in stuttering. Yet, it is premature to rush to the simple conclusion that the brain is “causing” stuttering.

The brain operates as a complex set of physiological systems that are, in turn, provided with an array of inputs and outputs. The research task is to develop an understanding of the complex context within which the brain functions.

The following research abstract is the first of a series provided as a service by Hollins Communications Research Institute (HCRI).  HCRI is a nonprofit Institute based in Roanoke, Virginia that has been at the forefront of stuttering research and treatment innovation since 1972.

HCRI commentary follows the abstract and is provided Ronald L. Webster, Ph.D., HCRI’s Founder and Director.

ABSTRACT: A positron emission tomography study of short- and long-term treatment effects on functional brain activation in adults who stutter.

J Fluency Disord. 2003 Winter;28(4):357-79; quiz 379-80., e Nil LF, Kroll RM, Lafaille SJ, Houle S., Graduate Department of Speech-Language Pathology, University of Toronto, Ont., Canada M5G 1V7. luc.denil@utoronto.ca

Educational Objectives:

1. Use of functional neuroimaging PET in the study of stuttering;
2. Differences in neural activation between stuttering and non-stuttering adults; and
3. Effects of behavioral fluency treatment on cortical and subcortical activations in stuttering speakers.

Summary:

Previous studies have shown that fluency-inducing techniques, such as choral speech, result in changes in neural activation as measured by functional neuroimaging.

In the present study, positron emission tomography was used to investigate the effects of intensive behavioral treatment, followed by a 1-year maintenance program, on the pattern of cortical and subcortical activation in stuttering adults during silent and oral reading of single words.

The results indicate changes in activation lateralisation, as well as a general reduction in over-activation, especially in the motor cortex, following treatment. The results are discussed in light of previous functional imaging studies with stuttering adults.

HCRI Comment:

This article illustrates clearly that differential brain function is seen in stutterers before and after participation in a therapy derived from one of our earlier therapy systems. The essential point is that post-treatment, brain activity in stutterers was closely similar to the brain activity of fluent speakers.

For more information about HCRI’s work in the field of stuttering and treatment programs, visit www.stuttering.org .

How to Evaluate the Cost of Stuttering Therapy >>

When individuals decide to make a life-changing decision and seek stuttering therapy, they may be surprised by the cost of treatment that can reach into the thousands. Yet, thinking about cost alone is a deceptive proposition. Rather, learning and retaining fluent can have a dramatic impact on an individual’s personal and professional life.  For this reason, the cost needs to be considered in tandem with the value and outcomes of being able to speak fluently.

Cost of Stuttering

One important idea that should register firmly in the minds of persons who stutter is that stuttering has costs. These costs include lost opportunities for employment or advancement on the job lost possibilities for potentially important social contacts overwhelming discomfort, frustration and anxiety that can be engendered every day by stuttering.

The personal costs for stuttering, like it or not, are extraordinarily high. When one considers the human potential that is bottled up within a person who stutters, and the fact that this set of extraordinary capabilities is not realized at an appropriate level, the costs of stuttering are enormous.

There is yet another cost of stuttering. It involves the cost that comes from missing the simple joy of speaking freely and fluently at will.

Cost of Stuttering Treatment at HCRI

In day-to-day living, most of the objects and services that are worthwhile and necessary have a dollar cost to them. The mechanic at a car dealership is billed at $75 per hour. The cost to have a root canal and crown for an aching tooth can exceed $3,000. Braces on a child’s teeth cost about $5,000. And, the list goes on and on.

At HCRI, the cost for stuttering therapy is well below the national average. For comparison purposes, a “clinical service hour” at HCRI is 60 minutes and priced at $48 for the full hour.  However, the cost for stuttering therapy at other facilities in the U.S. can easily exceed $75 and the clinical service hour is only 45 minutes in length.

While there are stuttering therapy providers who are less costly than HCRI, it is useful to think about the purchase of other important goods and services. Wise choices are usually based on value – what you get in return for the price you pay. Rarely does the cheapest choice provide the same level of satisfaction and results that a value-based choice offers.  HCRI costs and stuttering therapy results yield high value — quite possibly the best value available anywhere.

HCRI program graduates have made a critical investment in their future through their stuttering therapy program participation.  And they are enjoying the benefits of fluent speech in their everyday lives, year over year. A single investment yielded hundreds of thousands of fluent words.

HCRI’s Flexible Payment Options

HCRI offers several options to help you meet the cost of therapy. We have payment plans, scholarships and advice on agencies that might assist in meeting your costs.

Our staff will be glad to help make HCRI’s effective stuttering therapy program available to you. Call 540-265-5650 or click here to send an email for more information.