Response to article by Dr Miriam Stoppard

This is a response from BSA's Chief Executive to an article by Dr Miriam Stoppard in the Daily Mirror in February 2011.

Dear Dr Stoppard

I read your article in the Mirror on 7 February. While you're absolutely right to highlight The King's Speech I am writing on behalf of the British Stammering Association, the national association for all whose lives are affected by stammering, to express our dismay that the article, in large parts, runs counter to what we know about stammering through recent (and not so recent) research findings.

You say that many of Lionel Logue's techniques "still stand today". In fact, we don't really know what techniques Logue used - much of what we see in the film is dramatic license. Logue was an innovator, working without the benefit of any evidence base or research. Modern stammering therapy has its basis in work done at the University of Iowa from the late 1930s onwards - a modern therapist would certainly not do to a client what is depicted in the film.

You write that the King stopped stammering when he was distracted by loud music. The effect is not actually a distraction but is called 'masking'. It is a well-known effect but it is not used in modern therapy. You write that "all of these devices and tricks are used today to help stammerers" which is incorrect. Modern stammering therapy is based on clear evidence and research rather than using devices and tricks. Many of the phenomena you describe such as the masking effect, or apparent fluency when reciting poetry or singing, may be of value in telling us something about how the brain processes language but they have no current impact on modern therapy.

You write that "stammering can occur because the muscles of the jaw, face, tongue.... get very tense". This is analogous of saying that a person with cerebral palsy has problems with movement because their muscles are tense, and confuses cause and effect. These muscles can be tense because of stammering, not the other way round. However, there are many people who stammer without undue tension in the muscles of face, jaw, etc and they still stammer. It is also not a question of 'relaxing' these muscles to enable clear speech, in some people who stammer there may be a problem of co-ordination.

Speech therapists do not "loosen the jaw, tongue and back of the head" (one wonders how they would go about loosening the back of the head?). They may, for some people for whom physical tension is a problem, teach physical relaxation methods, but this is certainly not true for all people who stammer.

After almost 20 years of working with the BSA I have yet to hear of a speech therapist referring a client for surgery despite what it says in the article about tongue-tiedness. Speech therapists may go back to basics in terms of reducing secondary behaviour and reducing stammering to its core behaviour, but an adult who stammers can speak fluently in certain situations and certainly does not require "building speech in the way a child would acquire it".

Stammering is acquired - but we do know from recent genetics research that people who stammer are born with the predisposition and that it is highly unlikely that without this predisposition a child would begin to stammer. While hesitancies are a normal part of speech development, stammering is not and parents are usually very good at spotting the difference. As you said in your rather excellent article on stammering in children in 2010, early intervention is the key for successful prevention.

You state that stammering can be precipitated by psychological trauma. While this is certainly what the film seems to suggest, there is no evidence for this. Stammering is a symptom that at some point in the child's speech and language development, neurological pathways in their brain aren't being wired normally. The root cause of developmental stammering is neurological - this much we know. Why at a certain point in time it happens to one child and not another is still unclear - but a lot of research has been done into family dynamics, psychological trauma and other factors and there is no evidence that stammering is caused by external influences such as these.

You then go on to say that a person who stammers may then be referred to a psychotherapist to 'exorcise' the deep trauma. Again, this is incorrect. Naturally, stammering as a communication disorder may well have some adverse psychological and emotional impact on the person who stammers - just as any other physical condition would have. For example, if a child grows up with cerebral palsy you would expect the CP to have some emotional and psychological impact but, unlike in stammering, no-one would suggest that the emotional problems are the cause of CP. A specialist in stammering therapy will be able to address the emotional and psychological aspects of stammering without recourse to psychotherapy.

Rowan Atkinson still stammers. As you rightly say earlier in the article, many people who stammer find that the controlled environment of acting helps them to be temporarily fluent. Gareth Gates is using a technique which helps him to maintain control over his fluency - but to say that he shows barely a trace of his stammer would be rather overstating it.

While we were delighted about the publicity around The King's Speech, we were concerned that it would perpetuate some of the myths around stammering such as stammering being caused by emotional trauma, or by being forced to become right-handed (for which there is no evidence, either). The film is set in the 1920 and 1930s and naturally shows the prevailing views of stammering in those days. Our knowledge has advanced somewhat since then and we have tried very hard in the past months to ensure this message is getting across so that these outdated notions about why people stammer, and what can be done to help, are finally overcome. I was, therefore, shocked, to read this article - especially given your rather excellent article on stammering in young children I mentioned earlier. Please remember that we work with the leading UK experts in stammering and that we are always happy to advise on content if called upon, in advance of publication.

Yours sincerely

Norbert Lieckfeldt
Chief Executive, British Stammering Association.