Interview with Peter R. Ramig, Ph.D., Professor and Associate Chair, Department of Speech, Language and Hearing, University of Colorado, Boulder
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Beck:Good morning Peter. Thanks for joining me today.Ramig:Hi Doug. Thanks for the invitation.Beck:Peter, before we get to issues related to stuttering and your excellent book, "The Child and Adolescent Stuttering Treatment and Activity Resource Guide," by Thomson Delmar Learning, I was hoping you w
Beck:Good morning Peter. Thanks for joining me today.
Ramig:Hi Doug. Thanks for the invitation.
Beck:Peter, before we get to issues related to stuttering and your excellent book, "The Child and Adolescent Stuttering Treatment and Activity Resource Guide," by Thomson Delmar Learning, I was hoping you would review a little bit of your background? I know you had a severe stuttering problem as a young man and you were in the military during the Viet Nam era. Would you please tell me a little about your experiences?
Ramig:Sure, Doug. I entered the Marine Corps a year after graduating from high school, and I was in Viet Nam for a tour of duty from 1966 to 1967. I was in the Marines for two years and then started college at the age of 21. As an undergraduate, I went to the University of Wisconsin at Oshkosh, where I had a double major; psychology and social work, but my stuttering was significant at that time, and as a result I had difficulty getting a job in my area. I then went to the University of Wisconsin at Madison. There I was fortunate enough to meet and be treated by a wonderful and understanding speech-language pathologist, Dr. Lois Nelson -- she turned my life around.
I became much more in control of my speech, and in fact, that was the influence and basis for me deciding to become a speech-language clinician. So I earned my master's in Communicative Disorders in 1975 and then my doctorate at Purdue University, finishing up there in 1979. Since 1979, I have been Professor here at the University of Colorado in Boulder, specializing in stuttering treatment and research.
Beck:That's amazing Peter. I appreciate your sharing those rather personal notes with us, and thanks for your service to our country. OK, let me switch topics here, and let's talk about the book. Please tell me, when was it first published and who was the intended audience?
Ramig:February, 2005 was the original publication date, and the audience was intended to be professional speech-language clinicians, graduate students, and parents of children who stutter.
Beck: Peter, please tell me your preferred definition of "Stuttering"?
Ramig:Sure. I guess the simplest and widest definition is an interruption in the forward flow of speech. More technically, we might say stuttering is an abnormally high frequency (or duration) of stoppages in the forward flow of speech affecting continuity, rhythm, rate, and effort.
Beck:Peter, I know you see patients, and I was wondering what percentage of the patients you see are children?
Ramig:My caseload is a combination of preschool, school-age, teens and adults who stutter. In my private practice offices, I have several great associates who are very skilled at working with clients who stutter. 90 percent of all stuttering first manifests between ages 2 and 6 years, and we know the best long-term outcomes are in people for whom the diagnosis and treatment happen early. We feel early intervention does have the greatest potential for long-term success. We also evaluate and fit older teens and adults for/with the new SpeechEasy device. Although this is by no means a cure for stuttering, it is very helpful for some people who stutter. Some stutterers are helped by the SpeechEasy more than any other traditional form of treatment, so we keep it as one of our many treatment options.
Beck:I know before I even ask this next question, that the answer is vast, has incredible depth and tangents, and even if we had hours and hours, you probably could not answer it completely. So with all that as a given, I wonder if you could address the next question ....Why do people stutter?
Ramig:Well as you said, hours and hours would be required, but let's do this, I will answer your question in very general terms, as best I can, knowing there are exceptions and alternatives, and that in general, my response will include things that I know to be essentially true, for many people who stutter.
For example, we know from brain scans, such as fMRI studies during stuttering episodes, and others MRI and CT studies, that people who stutter have cerebral function that is different from those who do not stutter. In fact, some recent brain scan studies have shown actual structural differences in the Sylvian Fissure area within a sub group of adult stutterers. Many of us who specialize in stuttering believe there is also a pre-disposition to stutter, and so some people are born more likely to stutter and others are not. Of course, the embarrassment, frustration, and the overall experience of stuttering leaves little doubt that these feelings create increased muscular tension which fuels the stuttering.
Beck:And for the non-professional readers, let me point out that the Sylvian Fissure is the portion of the brain's temporal lobe which impacts speech and hearing, and can be directly involved with Broca's Aphasia and Wernicke's Aphasia, too.
Is it true that just about everyone stutters at one time or another during their early speech and language development? And if that's true, is the influence of peers, parents and the other people around you significant in determining your long-term fluency?
Ramig:Yes, well, the direct influence of parents on stuttering was a theory made famous by Wendell Johnson Ph.D. many decades ago...and although it still appears to be a component of the whole puzzle, there are other issues, too. In fact, I think all these things inter-relate...the child is born with or without a predisposition to stutter, and that's probably a neurologic reality. But then once it starts, stutterers have an emotional or psychological by-product they deal with, too, and the management of those issues, likely impacts the long-term result for the individual. I think some parents are supportive and others are not, and that impacts the child, too. So there are many ingredients that influence stuttering, but the emotional and psychological issues are enormous, and they can elicit the fight or flight response...and the impact and weighting of all these factors adds to the outcome. But I think it is important to emphasize that contrary to what some people may think, I know of no credible research that supports parents as the cause of stuttering. Once stuttering is evident in a child, the parent can certainly influence it one way or another, but to point a finger at them as the culprit causing the problem, is short sighted and not supported by the facts.
Beck:And so I believe you're arguing essentially for a multi-factor etiology, and I would have to agree, that makes the most sense to me. Can individuals stop themselves from stuttering without professional help?
Ramig:Yes, it's certainly possible. But it can be very difficult, and perhaps the exact same effort and determination that will lead to success in one person, may not in another. We know that when some people try to not stutter, the more they hold it back, the worse it can become for the individual. So the variation is enormous.
Beck:Let's spend a few moments on management and intervention.
Ramig:Sure. Like with so many disorders, the first issue is gathering an excellent history, so we want to obtain all the information we can from the parents through one-on-one interviewing, and from the person themselves through language samples and other testing. We're also interested in their environmental issues, situations and stresses, and getting a really good understanding of their stuttering and it's impact -- before we suggest treatment options. We try to look at how advanced the stuttering is, and other factors. For example, is there tension in his/her speech? Are there pitch-rises, prolongations, is there a family history of stuttering, are there concomitant non-stuttering speech or language concerns? And another very important issue is educating the parents to understand what's happening with their child and what we can accomplish as we work together.
Beck:And that's an important point, too, which we sort of mentioned earlier, to effectively manage it, one has to first understand the unique dynamics of the particular situation. What percentage of pre-school children who stutter, will resolve successfully without intervention?
Ramig:Depending on whose research you quote, anywhere between 40 to 70 percent of all stuttering in the pre-school years will resolve without intervention. But I must emphasize these percentages refer to very young children who are stuttering. We would not say that these percentages pertain to persons who have more persistent stuttering that has existed for 2-3 years and more.
Beck:So the question is...how to identify which children need intervention?
Ramig:Right. Although we are aware of some indicators or danger signs that may increase the child's chance of a persistent stuttering problem, we cannot definitively tell who will and who will not go on to resolve, or who will go on to stutter. If we knew, it would be great because then we could prioritize our treatment focus on those children who are less likely to self-resolve.
Beck:And since we cannot "withhold" treatment, such as would be required to conduct a scientific experiment using a control and an experimental group on diagnosed children, we cannot get a grip on the success or failure rates of the treatment, as we cannot tell if the child would've become fluent or not without treatment?
Ramig:That's the problem in a nutshell. We certainly know that all children who stutter are not referred to us. Many are probably handled by the pediatrician, and we don't have definitive criteria and guidelines which can identify particular children who require intervention to obtain fluency. So the only thing to do is approach each child carefully, with knowledge, with the parents, and with an understanding that each child is unique, and there's no "cookie cutter" management approach, but there are many excellent therapies that can really impact stuttering and the long-term outcome.
Beck:Peter, it's delightful speaking with you. Before I let you run, I just want to mention for SLPs and moms and dads, that your book offers many hundreds of treatment and therapy room activities for treating all ages of children who stutter, IEP models, handouts for parents and teachers written in English and in Spanish, assessment protocols, and other very pragmatic tools. Thanks so much for your time and expertise.
Ramig:My pleasure, Doug. It's been fun for me, too.
For more information about
The Child and Adolescent Stuttering
Treatment and Activity Resource Guide
Thomson Delmar Learning
ISBN 1-4018-9719-3
Please visit:www.delmarlearning.com
www.delmarhealthcare.com
www.thomson.com/learning
Ramig:Hi Doug. Thanks for the invitation.
Beck:Peter, before we get to issues related to stuttering and your excellent book, "The Child and Adolescent Stuttering Treatment and Activity Resource Guide," by Thomson Delmar Learning, I was hoping you would review a little bit of your background? I know you had a severe stuttering problem as a young man and you were in the military during the Viet Nam era. Would you please tell me a little about your experiences?
Ramig:Sure, Doug. I entered the Marine Corps a year after graduating from high school, and I was in Viet Nam for a tour of duty from 1966 to 1967. I was in the Marines for two years and then started college at the age of 21. As an undergraduate, I went to the University of Wisconsin at Oshkosh, where I had a double major; psychology and social work, but my stuttering was significant at that time, and as a result I had difficulty getting a job in my area. I then went to the University of Wisconsin at Madison. There I was fortunate enough to meet and be treated by a wonderful and understanding speech-language pathologist, Dr. Lois Nelson -- she turned my life around. I became much more in control of my speech, and in fact, that was the influence and basis for me deciding to become a speech-language clinician. So I earned my master's in Communicative Disorders in 1975 and then my doctorate at Purdue University, finishing up there in 1979. Since 1979, I have been Professor here at the University of Colorado in Boulder, specializing in stuttering treatment and research.
Beck:That's amazing Peter. I appreciate your sharing those rather personal notes with us, and thanks for your service to our country. OK, let me switch topics here, and let's talk about the book. Please tell me, when was it first published and who was the intended audience?
Ramig:February, 2005 was the original publication date, and the audience was intended to be professional speech-language clinicians, graduate students, and parents of children who stutter.
Beck: Peter, please tell me your preferred definition of "Stuttering"?
Ramig:Sure. I guess the simplest and widest definition is an interruption in the forward flow of speech. More technically, we might say stuttering is an abnormally high frequency (or duration) of stoppages in the forward flow of speech affecting continuity, rhythm, rate, and effort.
Beck:Peter, I know you see patients, and I was wondering what percentage of the patients you see are children?
Ramig:My caseload is a combination of preschool, school-age, teens and adults who stutter. In my private practice offices, I have several great associates who are very skilled at working with clients who stutter. 90 percent of all stuttering first manifests between ages 2 and 6 years, and we know the best long-term outcomes are in people for whom the diagnosis and treatment happen early. We feel early intervention does have the greatest potential for long-term success. We also evaluate and fit older teens and adults for/with the new SpeechEasy device. Although this is by no means a cure for stuttering, it is very helpful for some people who stutter. Some stutterers are helped by the SpeechEasy more than any other traditional form of treatment, so we keep it as one of our many treatment options.
Beck:I know before I even ask this next question, that the answer is vast, has incredible depth and tangents, and even if we had hours and hours, you probably could not answer it completely. So with all that as a given, I wonder if you could address the next question ....Why do people stutter?
Ramig:Well as you said, hours and hours would be required, but let's do this, I will answer your question in very general terms, as best I can, knowing there are exceptions and alternatives, and that in general, my response will include things that I know to be essentially true, for many people who stutter.
For example, we know from brain scans, such as fMRI studies during stuttering episodes, and others MRI and CT studies, that people who stutter have cerebral function that is different from those who do not stutter. In fact, some recent brain scan studies have shown actual structural differences in the Sylvian Fissure area within a sub group of adult stutterers. Many of us who specialize in stuttering believe there is also a pre-disposition to stutter, and so some people are born more likely to stutter and others are not. Of course, the embarrassment, frustration, and the overall experience of stuttering leaves little doubt that these feelings create increased muscular tension which fuels the stuttering.
Beck:And for the non-professional readers, let me point out that the Sylvian Fissure is the portion of the brain's temporal lobe which impacts speech and hearing, and can be directly involved with Broca's Aphasia and Wernicke's Aphasia, too.
Is it true that just about everyone stutters at one time or another during their early speech and language development? And if that's true, is the influence of peers, parents and the other people around you significant in determining your long-term fluency?
Ramig:Yes, well, the direct influence of parents on stuttering was a theory made famous by Wendell Johnson Ph.D. many decades ago...and although it still appears to be a component of the whole puzzle, there are other issues, too. In fact, I think all these things inter-relate...the child is born with or without a predisposition to stutter, and that's probably a neurologic reality. But then once it starts, stutterers have an emotional or psychological by-product they deal with, too, and the management of those issues, likely impacts the long-term result for the individual. I think some parents are supportive and others are not, and that impacts the child, too. So there are many ingredients that influence stuttering, but the emotional and psychological issues are enormous, and they can elicit the fight or flight response...and the impact and weighting of all these factors adds to the outcome. But I think it is important to emphasize that contrary to what some people may think, I know of no credible research that supports parents as the cause of stuttering. Once stuttering is evident in a child, the parent can certainly influence it one way or another, but to point a finger at them as the culprit causing the problem, is short sighted and not supported by the facts.
Beck:And so I believe you're arguing essentially for a multi-factor etiology, and I would have to agree, that makes the most sense to me. Can individuals stop themselves from stuttering without professional help?
Ramig:Yes, it's certainly possible. But it can be very difficult, and perhaps the exact same effort and determination that will lead to success in one person, may not in another. We know that when some people try to not stutter, the more they hold it back, the worse it can become for the individual. So the variation is enormous.
Beck:Let's spend a few moments on management and intervention.
Ramig:Sure. Like with so many disorders, the first issue is gathering an excellent history, so we want to obtain all the information we can from the parents through one-on-one interviewing, and from the person themselves through language samples and other testing. We're also interested in their environmental issues, situations and stresses, and getting a really good understanding of their stuttering and it's impact -- before we suggest treatment options. We try to look at how advanced the stuttering is, and other factors. For example, is there tension in his/her speech? Are there pitch-rises, prolongations, is there a family history of stuttering, are there concomitant non-stuttering speech or language concerns? And another very important issue is educating the parents to understand what's happening with their child and what we can accomplish as we work together.
Beck:And that's an important point, too, which we sort of mentioned earlier, to effectively manage it, one has to first understand the unique dynamics of the particular situation. What percentage of pre-school children who stutter, will resolve successfully without intervention?
Ramig:Depending on whose research you quote, anywhere between 40 to 70 percent of all stuttering in the pre-school years will resolve without intervention. But I must emphasize these percentages refer to very young children who are stuttering. We would not say that these percentages pertain to persons who have more persistent stuttering that has existed for 2-3 years and more.
Beck:So the question is...how to identify which children need intervention?
Ramig:Right. Although we are aware of some indicators or danger signs that may increase the child's chance of a persistent stuttering problem, we cannot definitively tell who will and who will not go on to resolve, or who will go on to stutter. If we knew, it would be great because then we could prioritize our treatment focus on those children who are less likely to self-resolve.
Beck:And since we cannot "withhold" treatment, such as would be required to conduct a scientific experiment using a control and an experimental group on diagnosed children, we cannot get a grip on the success or failure rates of the treatment, as we cannot tell if the child would've become fluent or not without treatment?
Ramig:That's the problem in a nutshell. We certainly know that all children who stutter are not referred to us. Many are probably handled by the pediatrician, and we don't have definitive criteria and guidelines which can identify particular children who require intervention to obtain fluency. So the only thing to do is approach each child carefully, with knowledge, with the parents, and with an understanding that each child is unique, and there's no "cookie cutter" management approach, but there are many excellent therapies that can really impact stuttering and the long-term outcome.
Beck:Peter, it's delightful speaking with you. Before I let you run, I just want to mention for SLPs and moms and dads, that your book offers many hundreds of treatment and therapy room activities for treating all ages of children who stutter, IEP models, handouts for parents and teachers written in English and in Spanish, assessment protocols, and other very pragmatic tools. Thanks so much for your time and expertise.
Ramig:My pleasure, Doug. It's been fun for me, too.
For more information about
The Child and Adolescent Stuttering
Treatment and Activity Resource Guide
Thomson Delmar Learning
ISBN 1-4018-9719-3
Please visit:www.delmarlearning.com
www.delmarhealthcare.com
www.thomson.com/learning