Shock! Horror! Excitement! A ten-year retrospective on stuttering research
By Mary Anne Strange, independent speech and language therapist

At the 2005 Oxford Dysfluency Conference, Mark Onslow identified some of the basic issues on how to develop therapies that have a good evidence base.

The excitement?

A glimpse of the future: the cause of stuttering is known, theories as to the cause of stuttering are no longer necessary.

In the meantime, Mark suggested that theories are critical but need careful scrutiny if they could have an impact on therapy. He referred to the history that Wendell Johnson's diagnosogenic theory conveniently covered a lack of knowledge; indeed "theories denote lack of knowledge and not one has been verified in a satisfactory way". Furthermore, "if the theory is wrong the resulting treatment must also be wrong," said Mark.

The shock?

No more than one theory, if any, can be correct and Mark argued that multi-factorial theories of early stuttering, such as the Demands and Capacities model, cannot be correct and in fact are impossible to disprove until the cause of stuttering is known. Further, it is vague because it provides no transparent means to measure outcomes and allows for many aetiologies of stuttering onset. Multi-factorial theories led to the CALMS model of early stuttering (cognitive, affective, linguistic, motor, social). Mark questioned whether more is better as more goals lead to more outcome measures.

The horror?

Mark suggested that multi-factorial theory denotes an absence of knowledge of stuttering and therefore a lack of knowledge of treatment: multiple and different causes for stuttering for each child can never be disproved and as such becomes a scientific circularity. As such, history is repeating itself. In fact, we have the same problem now as we had with the diagnosogenic theory: we are pretending to know the cause of stuttering when we do not, and hence delaying our quest for the scientific cure for stuttering.

The way forward?

Mark highlighted the importance of scientific rigour in research and the randomised control trial (RCT) as the epitome of scientific rigour.

He referred to the CONSORT guidelines (Consolidated Standards of Reporting Trials), which provide standards and quality of the reporting of RCTs. One of the fundamental CONSORT guidelines is that there should be a maximum of two primary outcome measures in any RCT.

Mark proposed the primary outcome measure for children to be stuttered speech: it is the only clear symptom and reflects the primary concern of children and parents. For adults, he argued, the second outcome measure should be speech-related anxiety. Research shows stuttering is significantly linked to social anxiety, and there is much current research exploring this dimension currently in progress.

From the Spring 2006 edition of Speaking Out, page 11

Mark Onslow and Scott Yaruss will open a debate on their work in the next issue of Speaking Out, Summer 2006.