The first in an occasional series of updates on the latest research into stammering, presented by members of the BSA research subcommittee who describe some highlights of recent research.

Velda Osborne
BSA chair

My most memorable research-related event of 2005 was the seminar given by Mark Onslow in June at the City University, London. The reasons for this are twofold. First, I was able to learn about the Lidcombe Program from its inventor. The program itself sounded amazingly simple and is based around acknowledgement of dysfluencies by parent and child in their everyday interactions. Professor Onslow's work has shown that the optimal age to start therapy is around 3.5 years of age and he recommends monitoring for six months post-onset before intervention. A thought that occurred to me later, was whether there are complications should a parent also stammer. Would this create confusion for the child?

Second, the event was organised by the BSA, and to me, epitomises just the sort of thing we should be doing. An added bonus was that Professor Onslow is a most engaging and persuasive presenter - not at all the dry academic.

Pete Howell
Professor of experimental psychology
University College London

1. The publication of an extended report of the seminal series of studies by Yairi, Ambrose and collaborators on early indicators of stuttering: 'Early Childhood Stuttering for Clinicians by Clinicians' by Ehud Yairi, Nicoline Grinager Ambrose.

2. The establishment of a state-of-the-art teaching and research facility for stuttering at VanderBilt University in the US that will serve as an international focus for research and clinical excellence. (www.vanderbilt.edu)

3. Growing awareness of the plight of people who stutter in less developed countries and attention to issues about how services can be delivered to remote communities (both in developed and less developed countries).

Robin Lickley
Research fellow
Queen Margaret's University College
Edinburgh

1. The publication of the Lidcombe Program's randomised control trial (RCT) is a very welcome addition to the literature. As others will no doubt point out, despite the respectable 'RCT' label, the study may not be entirely conclusive.

I think the best thing about its publication is the debate that it is provoking about evidence-based practice. Whether or not it is statistically sound (see Tom Weidig's responses), it raises many contentious issues. Some of these are nicely summarised by Bernstein Ratner [Journal of Fluency Disorders 30 (2005) 163-188]. One which strikes me about this and other interventions is: how justifiable is a therapy without a theory?

A possible negative outcome of the Lidcombe publication is the likelihood that this automatically leads to some therapists adopting the programme simply because it's there and because there's an efficacy study to support it. The Lidcombe team have done a fantastic job here and deserve congratulations: a study like this takes years and lots of money. But for those very reasons there's no similar (RCT) evidence that any other treatments are better or worse: will this ever happen? And will the Lidcombe team's effort ever be replicated?

A simple question that is left unanswered is whether removing the operant treatment element from the programme would make a difference: If parents spent 10 minutes a day 'quality time' with their child in calm conversation, would that have a similar effect? Well, a new study by Franken et al. [Journal of Fluency Disorders 30 (2005) 189-199] finding very similar outcomes for a comparison between a Lidcombe approach and a Demands and Capacities approach suggests there might be something in that idea.

2. On the theoretical side, my highlight of 2005 was meeting Per Alm and receiving a copy of his PhD thesis [Alm, P., 2005. On the Causal Mechanisms of Stuttering. PhD Thesis. University of Lund, Sweden] - an excellent piece of work. His article 'Stuttering and the Basal Ganglia' is a quite readable short account of his views on stammering and the brain.
www.stutteringhelp.org/Default.aspx?tabid=463

Rosemarie Hayhow
Research speech & language therapist
Bristol Stammering Research Centre

1. Per Alm from Sweden proposes a dual pre-motor systems model of stammering. The basal ganglia are thought to be important in providing the 'go-signals' for segments in motor sequences and his work explores how they might play a part in stammering.

2. Interviews with seven adults sought to understand more about how they successfully manage their stammering. The emerging themes of speech management, attitude, self-acceptance, taking on challenges and optimism support the case for a holistic approach to managing stammering. [Plexico, L, Manning, W. & DiLollo, A. (2005) A phenomenological understanding of successful stuttering management. Journal of Fluency Disorders 30, 1-22]

3. This paper [Bajaj, A., Hodson, B. & Westby, C. (2005) Communication ability conceptions among children who stutter and their fluent peers: A qualitative exploration. Journal of Fluency Disorders 30 41-6] provides evidence that primary age children who stammer are more likely to evaluate speaking according to the form of speech than their non-stammering peers who use more multidimensional criteria. They also have reservations about describing themselves as 'good talkers'.

Tom Weidig
Independent consultant
thestutteringbrain.blogspot.com

In 2005, brain imaging and genetics research have further confirmed and refined our understanding of stammering. First, brain imaging studies from more than 10 independent research groups have now found functional and structural abnormalities in people who stammer. Currently, several research groups are conducting experiments, especially on children and recovered stutterers, and these results could be very revealing.

Second, stammering often has a genetic component. Geneticists have already localised responsible genes, but there is no single stuttering gene. Further, a new large-scale drug trial started in Autumn 2005 in the US to test whether Pagaclone significantly reduces stammering. Results are expected in Autumn 2006, but in official reporting it is promising.

The highlight of my year was reading Per Alm's PhD thesis from the University of Lund. He has done some excellent research work, and his meta-analysis of past research was outstanding.
American Journal of Human Genetics, 2005 Apr; 76(4): 647-51.
Journal of Human Brain Mapping, 2005 May; 25(1): 105-17.

From the Spring 2006 edition of Speaking Out, pages 10-11