May 7-13, 2012 is National Stuttering Awareness Week and watching the Academy Award winning film, “The King’s Speech”, is the perfect way to mark the occasion. It tells the true story of George VI of England, the stutter that threatened his reign, and Lionel Logue, the Australian speech pathologist who helped mitigate his disability. For much of the twentieth century, there were two broad, separate approaches for treating the king’s disorder:  fluency shaping and stuttering modification.  Logue used a battery of techniques on his royal client, including diaphragmatic breathing, masking, shadowing and speech pacing, all of which are common practices in fluency shaping to this day. But, observing that certain situations and people exacerbated the king’s stutter, Logue instinctively added psychotherapy into his treatment plan. Using reverse psychology, by having George VI concentrate on improving the physical aspects of his stammering the therapist was able to unearth the psychological basis for it, and the monarch was able to come to an acceptance of his condition.   Logue’s approach was integrative, holistic and ahead of its time.

Client-led integrative therapy for stuttering has evolved from scientific and technological developments in the field throughout the last century.  The establishment of the University of Iowa Speech Clinic in 1927 ushered in an era of treating psychological effects, especially anxiety, rather than focusing on “untreatable” core behaviors.   This trend shifted in 1965, when behavioral psychologist, Israel Goldiamond, successfully used delayed auditory feedback (DAF) to correct a core stuttering behavior:  non-fluent speech.   The predominant theory changed again with the first brain imaging study of stutterers in 1992.  That study revealed two neurological bases for the disorder :  overactivity in the speech motor control area; and underactivity in the auditory processing area. Newer technologies are being used today to stimulate underactive auditory areas of the brain and studies have also found a link between dopamine levels in the speech center and stuttering.  Too much dopamine results in oversensitivity of this part of the brain causing stuttering, but this can be offset by using dopamine antagonistic medications, such as risperidone and olanzapine.

Logue seems to have intuitively understood that there is no “one size fits all”  type of therapy. Each treatment has its shortcomings; stuttering modification requires the client to confront fear-producing tasks in order to overcome them; while fluency shaping ignores the psychological causes of the condition; and the present-day emphasis on electronic devices and medications often precedes substantiation of their efficacy.  But in combination, the strengths of these different treatments can overcompensate for their separate drawbacks.  In 1995, ASHA (American Speech Language Hearing Association) legitimized the integrative approach by incorporating it in their practice guidelines for stuttering treatment.  So while “The King’s Speech” may have taken movie-making license with the true debilitating nature of George VI’s stammer, it is a fairly accurate depiction of how communicative disorders were perceived and treated in the last century.   By the end of the film, a must see for every speech language pathologist, we are left with the sense that Logue‘s integrative treatment plan was the right one…, at least as far as his king was concerned.

If you are an SLP specializing in stuttering or any other communicative disorder and are looking for new Speech Language Pathology Jobs, please contact the Centra team at 800 535 0076 and let us help you “get it right.”