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RE: [LidcombeUSA] What is a stutter?

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  • Alida Engel
    Dear Marty, Thank you so much for your answer. I guess there is no clear answered. What else is new?? It s interesting what you mentioned about Lidcombe. I
    Message 1 of 6 , Jun 1, 2004
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      Dear Marty, 
       
      Thank you so much for your answer.  I guess there is no clear answered.  What else is new??  It's interesting what you mentioned about Lidcombe.  I seems that I have to trust the mom's and my gut feeling.  We both felt that the child was skirting a block.  Catching them continues to be difficult, especially in running conversation, which is exactly when they happen. 
       
      Alida
       
      Alida Engel CCC-SLP
      374 Central Ave.
      New Haven, CT 06515
      (203) 397-3224
       
      Board Certified Fluency Specialist
       
       
      -----Original Message-----
      From: Martha Goebel [mailto:fluencylady@...]
      Sent: Saturday, May 29, 2004 4:54 PM
      To: LidcombeUSA@yahoogroups.com
      Subject: Re: [LidcombeUSA] What is a stutter?

      Alida,
       
      Sorry to answer so late. I don't check this box often as I should.
           After 28 years of counting dysfluencies, I grow less sure with each passing day. We know absolutely from the research that you can achieve reliability between clinicians in terms of count within the same clinic, but not across clinics. You can define until you are blue in the face (and I have taught many, many graduate students to count dysfluencies) but in the end, the count is forced, not by the definition, but by the teacher. I think to a large extent, you count what your theoretical substrate permits or encourages you to count.
           What I mean by that is, if I "believe" in a physiological genesis of stuttering, I am much more likely to count airflow blockages that another clinician, who "believes" in an attitudinal or operant genesis might not count.
           I "believe" that adults and children who stutter, are very capable of having all kinds of dysfluencies that I am unable to count externally by using any definition that can be produced. I am quite certain that this is so, because I myself was a "covert stutterer" and I have treated adults who had to self-identify their dysfluencies to "train" me to be able to identify them. But the bottom line is, stuttering is something that happens inside the person who stutters. The listener sees only the tip of the iceberg. William Perkins has written great stuff about this.
           As far as Lidcombe is concerned, I am absolutely "sure" that as kids are reinforced and their stuttering decreases, in some children the nature of the blocks changes.  I have a little boy (5 yr. old) who glanced at me furtively to see if I had "noticed" his dysfluency, since his mother did not. He did not talk as freely when I was counting. This went on for several weeks, and his behavior only changed when those blocks also disappeared. I asked myself at the time how those could disappear when Mom was always reinforcing "good speech" even when he and I both knew that he had suppressed a block.
           I think the clinician has to adjust her perspective on each child as the stuttering changes. I realize this is not the answer a lot of people like, but it's the only answer I trust.
       
      Martie Goebel

      Alida Engel <alidaengel@...> wrote:

      I have moved this sight out of AOL and into my high speed accurate so it
      will be easier to talk.  I would love to hear from some of you?  Does anyone
      else get confused about what to count and not to count when responding to
      stuttered speech.  I read the section in the book that talks about it and
      they note that only stutters that are obvious should be counted.  This is
      easy in the beginning but gets more vague as the stutters decrease.  Does
      anyone have any experience with this?  Alida
      -----Original Message-----
      From: Alida Engel [mailto:alidaengel@...]
      Sent: Friday, May 28, 2004 12:10 AM
      To: LidcombeUSA@yahoogroups.com
      Subject: [LidcombeUSA] TALK TO ME PLEASE


      I would really love to know how you all deal with deciding if something is a
      stutter or just normal dysfluent speech.  Doesn't anyone out there have some
      thoughts about this?  Alida





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    • mercedes cooper
      Martha, I think that your response to this issue was absolutely brilliant. To answer Alida s initial question: How to determine from normal disfluency vs.
      Message 2 of 6 , Jun 16, 2004
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        Martha, I think that your response to this issue was
        absolutely brilliant.

        To answer Alida's initial question: How to determine
        from normal disfluency vs. stuttering... well (and
        I've recieved criticism for this before, so if you
        don't agree then...) I try to not get hung up on
        whether a break or pause in fluency is "normal" or
        not. Children frequently present with a range of
        disfluent behavours, just as adults do. Some of these
        will be "normal" (I think we call "normal" that which
        we see in the typical population, not really
        considering what is going on at the physiological
        level) and we label the rest "stuttering" (because
        that's what we consider to be outside the norms of the
        typical population). The whole "normal" vs.
        "stuttering" issue is really quite ugly if we think
        about it. In my practice, I know that I'm counting
        more than most clinicians are (hesitations, fillers-
        when used in excess, fixed postures and of course, the
        repeated movements) because I base my %s on the
        recognition that most people in the population
        probably around a .02% SS. However, I'm not counting
        moments of linguistic revision, whole word repetitions
        when tension isn't present, or phrase repetitions
        (unless tenstion or struggle is present). I'm also
        considering that, when a child is at a .5% on my
        charts, with only extremely mild behaviours such as
        hesitations, they are probably well on their way to
        sounding very much like a typical child.

        Another simpler way to think about this problem is to
        examine: tension. If it is present, it is probably
        stuttering. If tension isn't there, then maybe the
        disruption in fluency is related to other factors.

        Mercedes


        --- Martha Goebel <fluencylady@...> wrote:
        > Alida,
        >
        > Sorry to answer so late. I don't check this box
        > often as I should.
        > After 28 years of counting dysfluencies, I grow
        > less sure with each passing day. We know absolutely
        > from the research that you can achieve reliability
        > between clinicians in terms of count within the same
        > clinic, but not across clinics. You can define until
        > you are blue in the face (and I have taught many,
        > many graduate students to count dysfluencies) but in
        > the end, the count is forced, not by the definition,
        > but by the teacher. I think to a large extent, you
        > count what your theoretical substrate permits or
        > encourages you to count.
        > What I mean by that is, if I "believe" in a
        > physiological genesis of stuttering, I am much more
        > likely to count airflow blockages that another
        > clinician, who "believes" in an attitudinal or
        > operant genesis might not count.
        > I "believe" that adults and children who
        > stutter, are very capable of having all kinds of
        > dysfluencies that I am unable to count externally by
        > using any definition that can be produced. I am
        > quite certain that this is so, because I myself was
        > a "covert stutterer" and I have treated adults who
        > had to self-identify their dysfluencies to "train"
        > me to be able to identify them. But the bottom line
        > is, stuttering is something that happens inside the
        > person who stutters. The listener sees only the tip
        > of the iceberg. William Perkins has written great
        > stuff about this.
        > As far as Lidcombe is concerned, I am
        > absolutely "sure" that as kids are reinforced and
        > their stuttering decreases, in some children the
        > nature of the blocks changes. I have a little boy
        > (5 yr. old) who glanced at me furtively to see if I
        > had "noticed" his dysfluency, since his mother did
        > not. He did not talk as freely when I was counting.
        > This went on for several weeks, and his behavior
        > only changed when those blocks also disappeared. I
        > asked myself at the time how those could disappear
        > when Mom was always reinforcing "good speech" even
        > when he and I both knew that he had suppressed a
        > block.
        > I think the clinician has to adjust her
        > perspective on each child as the stuttering changes.
        > I realize this is not the answer a lot of people
        > like, but it's the only answer I trust.
        >
        > Martie Goebel
        >
        > Alida Engel <alidaengel@...> wrote:
        >
        > I have moved this sight out of AOL and into my high
        > speed accurate so it
        > will be easier to talk. I would love to hear from
        > some of you? Does anyone
        > else get confused about what to count and not to
        > count when responding to
        > stuttered speech. I read the section in the book
        > that talks about it and
        > they note that only stutters that are obvious should
        > be counted. This is
        > easy in the beginning but gets more vague as the
        > stutters decrease. Does
        > anyone have any experience with this? Alida
        > -----Original Message-----
        > From: Alida Engel [mailto:alidaengel@...]
        > Sent: Friday, May 28, 2004 12:10 AM
        > To: LidcombeUSA@yahoogroups.com
        > Subject: [LidcombeUSA] TALK TO ME PLEASE
        >
        >
        > I would really love to know how you all deal with
        > deciding if something is a
        > stutter or just normal dysfluent speech. Doesn't
        > anyone out there have some
        > thoughts about this? Alida
        >
        >
        >
        >
        >
        > Yahoo! Groups Links
        >
        >
        >
        >
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      • Alida Engel
        Mercedes, That is a lot to think about. Here is what Joe Attanasio, Chair of the communcations dept. at Montclair Ste University responded. He teaches
        Message 3 of 6 , Jun 16, 2004
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          Mercedes, That is a lot to think about. Here is what Joe Attanasio, Chair
          of the communcations dept. at Montclair Ste University responded. He
          teaches Lidcombe and has written some stuff with Mark. Alida

          About your question: I
          assume you are referring to the parent's judgment of
          stutters. My view is that if a parent is not
          certain that a stutter has occurred, then it hasn't.
          That is, if the parent has been accurate in
          identifying stutters and non stutters throughout the
          course of the program, then I have to think that the
          parent continues to be accurate towards the end.
          That said, if the parent begins to question whether
          or not a stutter has occurred, it probably hasn't.
          Just recently, the mother of one of the children I
          see expressed the very issue you raise. During our
          discussion, she said that her son's speech now
          sounded like the speech of all his friends (same
          age) and she questioned if what she was hearing in
          her son's speech were actually stutters. You can
          anticipate my response to her: if her son speaks
          the way his non stuttering age mates speak, then
          mother's question reflects an understanding of age
          appropriate fluency. She simply needed my
          confirmation. By the way, her SRs continue to match
          mine and her general assessment of stuttering/non
          stuttering occurrences during the clinic visit match
          mine. If necessary, parents can observe the speech
          behaviors of normally speaking children to get a
          benchmark -- especially helpful when the treated
          child has successfully reached the end of the
          program and is no longer stuttering. I hope that
          this helps. Hope to see you at another conference
          some day.

          Regards,

          Joe


          -----Original Message-----
          From: mercedes cooper [mailto:mercedeskc@...]
          Sent: Wednesday, June 16, 2004 7:35 PM
          To: LidcombeUSA@yahoogroups.com
          Subject: Re: [LidcombeUSA] What is a stutter?


          Martha, I think that your response to this issue was
          absolutely brilliant.

          To answer Alida's initial question: How to determine
          from normal disfluency vs. stuttering... well (and
          I've recieved criticism for this before, so if you
          don't agree then...) I try to not get hung up on
          whether a break or pause in fluency is "normal" or
          not. Children frequently present with a range of
          disfluent behavours, just as adults do. Some of these
          will be "normal" (I think we call "normal" that which
          we see in the typical population, not really
          considering what is going on at the physiological
          level) and we label the rest "stuttering" (because
          that's what we consider to be outside the norms of the
          typical population). The whole "normal" vs.
          "stuttering" issue is really quite ugly if we think
          about it. In my practice, I know that I'm counting
          more than most clinicians are (hesitations, fillers-
          when used in excess, fixed postures and of course, the
          repeated movements) because I base my %s on the
          recognition that most people in the population
          probably around a .02% SS. However, I'm not counting
          moments of linguistic revision, whole word repetitions
          when tension isn't present, or phrase repetitions
          (unless tenstion or struggle is present). I'm also
          considering that, when a child is at a .5% on my
          charts, with only extremely mild behaviours such as
          hesitations, they are probably well on their way to
          sounding very much like a typical child.

          Another simpler way to think about this problem is to
          examine: tension. If it is present, it is probably
          stuttering. If tension isn't there, then maybe the
          disruption in fluency is related to other factors.

          Mercedes


          --- Martha Goebel <fluencylady@...> wrote:
          > Alida,
          >
          > Sorry to answer so late. I don't check this box
          > often as I should.
          > After 28 years of counting dysfluencies, I grow
          > less sure with each passing day. We know absolutely
          > from the research that you can achieve reliability
          > between clinicians in terms of count within the same
          > clinic, but not across clinics. You can define until
          > you are blue in the face (and I have taught many,
          > many graduate students to count dysfluencies) but in
          > the end, the count is forced, not by the definition,
          > but by the teacher. I think to a large extent, you
          > count what your theoretical substrate permits or
          > encourages you to count.
          > What I mean by that is, if I "believe" in a
          > physiological genesis of stuttering, I am much more
          > likely to count airflow blockages that another
          > clinician, who "believes" in an attitudinal or
          > operant genesis might not count.
          > I "believe" that adults and children who
          > stutter, are very capable of having all kinds of
          > dysfluencies that I am unable to count externally by
          > using any definition that can be produced. I am
          > quite certain that this is so, because I myself was
          > a "covert stutterer" and I have treated adults who
          > had to self-identify their dysfluencies to "train"
          > me to be able to identify them. But the bottom line
          > is, stuttering is something that happens inside the
          > person who stutters. The listener sees only the tip
          > of the iceberg. William Perkins has written great
          > stuff about this.
          > As far as Lidcombe is concerned, I am
          > absolutely "sure" that as kids are reinforced and
          > their stuttering decreases, in some children the
          > nature of the blocks changes. I have a little boy
          > (5 yr. old) who glanced at me furtively to see if I
          > had "noticed" his dysfluency, since his mother did
          > not. He did not talk as freely when I was counting.
          > This went on for several weeks, and his behavior
          > only changed when those blocks also disappeared. I
          > asked myself at the time how those could disappear
          > when Mom was always reinforcing "good speech" even
          > when he and I both knew that he had suppressed a
          > block.
          > I think the clinician has to adjust her
          > perspective on each child as the stuttering changes.
          > I realize this is not the answer a lot of people
          > like, but it's the only answer I trust.
          >
          > Martie Goebel
          >
          > Alida Engel <alidaengel@...> wrote:
          >
          > I have moved this sight out of AOL and into my high
          > speed accurate so it
          > will be easier to talk. I would love to hear from
          > some of you? Does anyone
          > else get confused about what to count and not to
          > count when responding to
          > stuttered speech. I read the section in the book
          > that talks about it and
          > they note that only stutters that are obvious should
          > be counted. This is
          > easy in the beginning but gets more vague as the
          > stutters decrease. Does
          > anyone have any experience with this? Alida
          > -----Original Message-----
          > From: Alida Engel [mailto:alidaengel@...]
          > Sent: Friday, May 28, 2004 12:10 AM
          > To: LidcombeUSA@yahoogroups.com
          > Subject: [LidcombeUSA] TALK TO ME PLEASE
          >
          >
          > I would really love to know how you all deal with
          > deciding if something is a
          > stutter or just normal dysfluent speech. Doesn't
          > anyone out there have some
          > thoughts about this? Alida
          >
          >
          >
          >
          >
          > Yahoo! Groups Links
          >
          >
          >
          >
          >
          >
          >
          > Yahoo! Groups SponsorADVERTISEMENT
          >
          >
          > ---------------------------------
          > Yahoo! Groups Links
          >
          > To visit your group on the web, go to:
          > http://groups.yahoo.com/group/LidcombeUSA/
          >
          > To unsubscribe from this group, send an email to:
          > LidcombeUSA-unsubscribe@yahoogroups.com
          >
          > Your use of Yahoo! Groups is subject to the
          > Yahoo! Terms of Service.
          >
          >
          >
          > ---------------------------------
          > Do you Yahoo!?
          > Friends. Fun. Try the all-new Yahoo! Messenger




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