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Speak Easy
by J.D. Wilson

The U of M's School of Audiology and Speech-Language Pathology offers hope to those with a frustrating and sometimes embarrassing problem that can greatly hinder an individual's life.

Most of Walt Manning’s friends probably thought chocolate was his favorite flavor of ice cream. It was, after all, what he normally ordered as a kid. His taste buds actually craved a big scoop of vanilla, though.

“I’ll have v-v-v-chocolate,” Manning would say.

Manning was and is a person who stutters.

“Vanilla very quickly became a very powerful and feared word for me,” says Manning. “Something as simple as ordering ice cream became this huge, huge deal.”

So he’d always get chocolate. Not bad, but it also wasn’t what he wanted. Manning was trying to survive in a fluent world without humiliating himself. In grade school he would pretend to not know an answer or purposely answer questions wrong to keep from stuttering.

After spending his adolescent and undergraduate years hiding from his problem, Manning decided to face his stuttering head on. He learned of a therapy program for people who stutter at Penn State, 75 miles away from his hometown of Williamsport, Pa.

“I didn’t care what it took or cost,” says Manning, who was unable to qualify for the officer candidate programs in the Marines and Air Force during the Vietnam War because of his stuttering.

At Penn State, Manning met Dr. Eugene Cooper and underwent six months of intensive therapy. He learned to approach his stuttering instead of running from it. A routine assignment was to make, record and analyze 35 phone calls to learn how he stuttered. The therapy piqued his interest in the field of disfluency. He wanted to help people the same way he had been helped. With Cooper as a mentor, he enrolled in the master’s program at Penn State and a few years later received his PhD from Michigan State University. Today, Dr. Manning is associate dean and professor in the University of Memphis’ School of Audiology and Speech-Language Pathology, where the audiology program is ranked 8th and speech-language pathology is ranked 13th in the nation by U.S. News & World Report.

weekly adult therapy group
U of M clinical associate professor Julie Marshall leads a weekly adult therapy group at the Memphis Speech and Hearing Center-East on the Park Avenue campus. In each session, individuals state their weekly goals, and the group completes a speaking exercise. In some instances they play games like Catch Phrase, where there is time pressure to speak.

Stuck in a moment

Jack, a junior high student from Nebraska, quickly completed an in-class quiz. After everyone in the class finished, the teacher called out the answers and the students graded their own work. Jack made a 95 on the quiz. The teacher had each student stand up and say his or her name and grade. Jack stood and began to say 95 but got stuck. He quickly thought 85, but he knew he’d get stuck on that word, too. “Seventy-five,” came fluently out of his mouth, and the teacher recorded that score. He quietly sat back down at his desk. Jack just wanted to sound like everybody else. No one called it stuttering, but that’s exactly what it was.

Stuttering affects about 1 percent of the U.S. population – or 3 million people. The overwhelming majority of developmental stuttering begins in early childhood. Many children stutter for a period of six months or more, but almost three-quarters of those children will recover by late childhood.

“A lot of young kids are very nonfluent,” says Manning. “They’re having phrase repetitions, interjections, revisions and incomplete phrases. It sounds like stuttering in the sense that they’re repeating.”

When a child is evaluated, the speech pathologist looks for normal fluency breaks. The less typical disfluencies (single syllable word repetitions, part-word repetitions, prolongations and blocks) are called stuttering-like disfluencies. If the child does indeed stutter, the speech pathologist will determine if the child will recover without intervention.

Manning says that people who continue to stutter through adolescence and into adulthood have a much more difficult time becoming fluent and altering their coping responses. He went through his own horror stories as a teen. He had trouble saying Williamsport. When someone asked where he was from, he gave the person a roundabout answer.

Gil Stovall and family
Landrus Burress shared with the Memphis Speech and Hearing Center support group about having to give a presentation at work. Burress said he really had to concentrate on several words, but overall the presentation wasn’t that bad.
“I’d start off ‘ah-ah-ah’ to get my speech started,” says Manning. “Then I’d avoid having to say the name of my hometown by telling them it was a little town about 85 miles north of Harrisburg (Pa.). They’d ask, ‘Lock Haven?’ I’d say, ‘No, it’s actually west of Lock Haven,’ and this would go on until they guessed it.

“I’d come across like someone who didn’t know where he lived, or worse – someone who was rather strange. But I was just afraid to say Williamsport.”

And that fear causes a lot of people to avoid their problem.

“Most people are so desperate,” says Manning. “People will do some bizarre and maladaptive things.”

Manning has known people who wouldn’t buy a house because the street name started with an “H” or wouldn’t buy a Ford because they had trouble with “F.”

“That’s the way you function,” says Manning. “In many ways these are natural responses to a very scary situation that you desperately want to avoid. If you don’t believe me, try posing as a person who stutters for a day or two.”

Many stutterers do not seek help until the problem becomes so big that they “hit a wall.” Manning’s story of waiting until early adulthood is typical. At this point, the responsibilities of life begin to pile on, and the grip stuttering holds becomes too tight.

“A lot of people realize that it isn’t going away,” says Manning. “They can’t get the job they want, or they can’t go on a date. There are a million things, but once they start to approach and deal with their stuttering their quality of life improves drastically.”

But many people don’t even know that treatment is available.

“There are a lot of great programs and clinicians out there,” says Manning. “A lot of people are not aware though, so they don’t seek help.”

Humor in hamburgers

Jill sat in a circle of fellow stutterers. The therapy group was sharing the past week’s homework assignment. They were supposed to put themselves in a situation they typically avoided because of their stuttering. Jill went through a fast-food drive-thru. Every time the voice came from the box she would freeze, but this time she stuck with it. “I finally got up enough courage and just did it,” says Jill. “I went, ‘I’ll have a hamburg-hamb-hambur-hambur-hamburg-hamburger, an order of fries and a cola.’” The group congratulated her, and the moderator asked, “So what did you think?” Jill says, “It was good. The only problem was I had a soda, some fries and six hamburgers.” Everyone laughed, including Jill.

Julie Marshall, clinical associate professor of speech-language pathology at the U of M, helps people who stutter every day at the University’s Memphis Speech and Hearing Center (MSHC). She sees stutterers in all shapes, sizes and colors.

When a person comes to the MSHC, the patient must be evaluated. This involves a case history form, speech analysis and an interview.

“We talk to them about their life,” says Marshall. “We try to find out how much their stuttering impacts their daily activities. From there we make recommendations.”

Those recommendations vary from person to person. Some involve very intensive individual therapy or group therapy.

The MSHC uses a combination approach of Fluency Shaping and Stuttering Modification therapies. Fluency Shaping helps the patient speak more fluently by changing and controlling the physical behaviors behind the stuttering.

“It’s almost like physical therapy for the mouth,” says Manning. “It’s really like reprogramming how you talk, and research is beginning to show that cortical and subcortical changes do take place as a result of treatment.”

Stuttering Modification does not immediately eliminate the stutter. Instead, this technique modifies the stutter into an easier, more fluent-sounding stutter. Stuttering Modification also addresses anxiety issues associated with stuttering.

“This looks at stuttering with a more whole-person approach,” says Marshall. “It does change the way someone stutters, but it also looks at the life impact of stuttering along with the social ramifications like shame and avoidance.”

Avoidance is a major hurdle in treating stuttering. Approaching the problem is the key to any type of therapy, according to Manning and Marshall, and a patient simply disclosing to others that he or she stutters is an enormous first step.

“They’re just trying to survive,” says Manning. “Avoidance is not the best coping response, but it’s a natural coping response. Understanding that is very important for clinicians.”

Marshall adds, “It usually takes a period of rapport building before someone opens up. Once they do, though, I would say that almost everyone who is committed makes some degree of positive change.”

Winning the race

Manning spends most of his time conducting research and presenting workshops along with writing and editing for journals. He does still teach several classes at the U of M, and every so often he will stutter. “When I’m in front of a class and get stuck, I have to keeping from smiling,” says Manning. “This used to be a horrible thing. Now I get a big kick out of it.” He has given himself permission to stutter. “I’m not going to avoid it. I’ll stick with it and modify it. I’ll ‘g-g-gggo like that’ and stutter and turn it into a good, easy stutter.”

Relapse can almost be guaranteed with stuttering. Along with his doctoral students, Manning is currently doing research to understand how people cope with their stuttering as they go through therapy. The research looks at several data sets, but Manning says the most interesting part of the research is the analysis of the patients’ personal narratives.

Each patient is asked to write a short essay about himself or herself. Manning and his team then analyze each narrative and extract pawn statements and origin statements.

“Pawn statements are negative. ‘I can’t do this, or I’m helpless,’” says Manning. “Origin statements are more active and positive. ‘I’m going to take action and do this.’”

Manning hopes to develop a procedure that will help clinicians predict long-term success for their patients. He believes this procedure will be a better indicator of success because it is individualized to each patient. Other tools are more generic and do not apply to the individual, according to Manning.

“We think this might be a more sensitive indicator because it’s driven by their individual story,” says Manning.

Ultimately, though, it’s up to each person to make a change in his or her own life.

“I’m really a coach, and they’re running the race,” says Manning. “Not much is going to change in a one-hour session, so they have to work on their own in their daily lives.

“It’s their race and their story, and they can take the action to change. That’s the heart of the story,” concludes Manning.

Do you or someone you know want help with a stuttering problem? Contact the Memphis Speech and Hearing Center at 901/678-5858.

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