Stuttering is a multifactorial disorder that disrupts the fluency of speech, which may involve repetitions, prolongations, and blocks. Prior research has shown that approximately up to 11% of all preschool-aged patients can experience stuttering involving emotional reactions.1 Even though many pediatric patients can recover naturally from stuttering by 7 years old, stuttering that continues into adulthood can negatively impact their social, emotional, and occupational well-being. Early intervention can potentially mitigate stuttering in an effective manner, with immediate treatment recommended if the patient shows signs of distress or if a patient’s concern is at a high level.2
In clinical practice, clinicians have recommended that interdisciplinary collaboration for the management of stuttering, involving 2 or more health care professionals with distinct roles working toward a shared goal with the patient. Stakeholders in the interdisciplinary care process for stuttering also include the younger patients and their families since they would also be in the goal setting part of the treatment plan.3 When working toward a shared goal for stuttering care, families may require guidance from the clinicians in learning more about the condition, access to speech-language therapy and additional strategies to support their child.
To dive deeper into the relevance of interdisciplinary care for stuttering,
Can you explain why interdisciplinary care is particularly important in the treatment of stuttering?
Lisa LaSalle, PhD: Interdisciplinary care for stuttering is really important because of the complexity of stuttering. Stuttering is well researched, and we’re working on making it well understood. For that, we often will refer to—we start with the medical professions. If I’m working with a child, I want a pediatrician or the primary care physician. When we move into ages where children and teens may be on different medication, we definitely want psychiatry and we want to have an open conversation with people who are in this field.
We as speech-language pathologists—which I train students to be speech-language pathologists—and also step back and hear their views on the field. We really want to have them think about counseling, and counseling in speech-language pathology involves all the negative emotions that go along with stuttering; that’s in our purview. We love to learn from others about—we borrow from psychology and psychiatry in terms of cognitive behavioral therapy, acceptance and commitment therapy. There’s a lot of other things that are out there that allow us to make ourselves better counselors when the negative feelings are about the stuttering and their communication. When it gets beyond that, then we definitely want the team involved. Unfortunately, in stuttering, there are cases of suicide, there are cases of really extreme concerns, and so we’re part of the team for that.
How important are referrals in managing care for patients who stutter, and how do you collaborate with other specialists?
Referrals are key. If they refer to us and we refer to them, then we’re off to a great start. One example with Gerald A. McGuire, MD, is I’ve been able to refer patients who are already on medications to him to look at dosage, to look at the effects, and then to refer back. There’s also been times I’ve talked to individuals who stutter who are asking about medication. We find from the statistics, it’s about 1 out of 5 who might say, “I’m really interested in medications.” Then we refer specifically for that.
But also, psychiatrists refer to us. Someone’s like, “I’ve never heard of speech therapy. I thought you were going to be the one to help me. I didn’t know that there’s such a thing as speech-language pathology and that I have access to those services.” So, we love that as well.
Finding someone who specializes in stuttering is a matter of looking at the different resources. On our STARS website, we have a lot of resources for someone to start with. But specialty is either board specialized—so we have board-recognized specialists in stuttering is possible that you can find that. Many times, it’s just a matter of asking. “Tell me your knowledge about stuttering.” If someone asks me about autism, for example, I might refer them to a colleague who knows more about autism than I do. It’s a chance to say, “This is my specialty. I can’t wait to start working with you. Learn patient-centered care. Where do you want to take this field, or this practice, this work that you’re doing for yourself?” Especially when we’re talking about teens and adults, they often know—we do motivational interviewing—they know what they want when we ask.
How do you explain the relationship between the physical and emotional aspects of stuttering to patients and their families?
I think the most important is to know that stuttering is a physical condition, and that we have limits to being able to do all the things that might help for a physical condition. The emotional is an overlay on that physical condition, and that also might require extra help. As I was saying, there can be a variety of things with that.
It’s helpful for them to know what we do, and it’s helpful for us to know what they do. That’s part of what we’re doing here at STARS. There are pediatricians on the board and here with us, there are psychiatrists, there are people who work with devices, biomedical devices, and people who do what I call basic research in the field—mouse models and things like that. It’s quite exciting to have all of that come together. I think the more we learn what each other does, the better off we can help people who stutter.
Looking ahead, how do you see treatment for patients who stutter evolving over the next few years?
I think right now, we’re looking at a future of really devices that are going to be AI-driven many times. We’re looking at what it is that the patient wants—the person who stutters. Is that evidence-based? Does that already make sense to us from theories such as the dopamine model of stuttering?
Looking at children, for example, we have a little debate going on in the field about children who first start stuttering. They tend to have parents who are very upset over the beginning of the stuttering, and their brains are so neuroplastic at that stage that there’s a lot we can do for them. I think really where the field is headed is over this debate of: do we treat when we don’t know the risk factors? We definitely want to treat when we do know the risk factors.
The more information parents have at their fingertips right away, they can look up and know, “Okay, yes, my child has high-risk factors. I’m going to take them to a speech-language pathologist. I’m not going to watch and see.” Then we can start to make some sense of what we know about the brain, the genetics of stuttering.
Transcript edited for clarity.