Relapse rates for adult stuttering treatments are too high. Even for best-in-class, evidence-based speech restructuring and prolonged speech programs like the Camperdown Program, roughly a third of people treated relapse after treatment.
Like many things with stuttering, we don’t know for sure. But there are some likely culprits.
For some, social anxiety and other mental health disorders get in the way. Although they don’t cause stuttering, social anxiety and other mental illnesses can make it worse and increase the risk of relapse in adults treated with speech restructuring.
For others, the cognitive and emotional demands of everyday living may be partly to blame. Using a new speech pattern to reduce stuttering requires constant attention. The pattern is usually easy enough to learn and use when you are sitting in a clinic with a trusted speech pathologist. But it’s much harder to use the pattern out in the real world – especially when your attention is split between two or more priorities. For example, in the workplace, we are often required to dual task, e.g. to read emails while talking on the phone; or to participate in a meeting while taking notes. It can be hard to maintain a new speech pattern when you’re thinking about something else.
Doing two things at once is called “dual tasking”. The effect of dual tasking on stuttering – speaking while doing something else at the same time – has interesting implications for stuttering treatments, which are starting to be explored in earnest:
- some studies show that stuttering stays the same or decreases when the secondary task does not involve language; and
- other studies (including the one cited below) have shown that stuttering increases when the second task is language-related and/or is cognitively demanding. In other words, stuttering increases when under cognitive stress, which makes intuitive sense to people who stutter.
In a recent study, three adults who stutter practised their new Camperdown Program speech pattern under dual task conditions. One aim of the study was to raise each participant’s awareness of how he allocated brainpower while doing two things at once. The participants performed category word games using a device while conversing with their speech pathologist using their new speech pattern. They also met together as a group to dual task in conversation with each other.
The participants all reported that they found dual task practice helpful – particularly for understanding how other tasks might interfere with their ability to maintain their new speech pattern. This knowledge in turn, enhanced their sense of control over their stuttering.
To find out if dual tasking stuttering therapy has real potential to reduce the risk of relapse, we need much more research. Specifically, we need to see a randomised controlled trial with a large sample of participants split into a standalone Camperdown Program vs Camperdown Program + Dual tasking groups, with adequate follow up – at least 12 months after effective speech restructuring treatment.
Adults who stutter should be informed about this promising research and encouraged to think about how their fluency is affected by dual tasking. In some situations, where fluency is essential, an adult may choose to dedicate all of his or her attention and brainpower to speaking fluently. In other situations, where fluent speech is not a priority, an adult may accept some stuttering and instead focus on the more important task at hand. Either way, for relapse rates to come down, adults who stutter must be encouraged to make their own informed decisions about how best to manage their fluency out in the real world. This is an essential part of good therapy for stuttering.
Source: Metten, C., Bosshardt, H-G., Jones, M., Eisenhuth, J. Block, S., Carey, B., O’Brian, S. Packman, A., Onslow, M, & Menzies, R. (2011). Dual tasking and stuttering: from the laboratory to the clinic. Disability and Rehabilitation, 33(11): 933-944.
- Camperdown Program
- Does anxiety cause stuttering?
- Controlling stutering: what it feels like in the read world
- Research Review: Stuttering Relapse – Video Self-Modelling versus Cognitive Behaviour Therapy