Ludo Max's talk in Paris

I am going to write short summaries of the conference talks so everyone gets an idea what was talked about. It would be shame if the non-attendants missed out on a good conference. Of course, I have to simplify and my notes are definitely not perfect. And I did not understand each statement, question or answer! But I am sure that this applies to all attendants! I will give my opinion at the end.

Ludo Max gave the first talk. He is a professor at the University of Connecticut, south of Boston. I visited him in October of last year. He is originally from Belgium.

He didn't really say anything revolutionary new. His approach to stuttering is still the following:

1) Use the most plausible flow diagram of the processes that generate (speech) motor control.
2) Test the various components for people who stutter.

He argues that this is what real science should be about: namely testing theories. A key component of the model is the efference copy concept. In order to correct for imprecise muscle movement, the brain needs sensory feedback. For example, if I reach for the glass and I miss it by 1 cm, my finger and my visual cortex generate a "not touching by a bit" information. Then the brain can correct for this. However, this is quite slow as the brain needs to wait for the sensory feedback from my finger and my eyes, then combine and process the information, and then send the "not touching by a bit" information to my motor regions. This mechanism will fail if the brain has to do too many movements in a short period of time like in speech, and therefore it has invented the efference copy, which is effectively parallel processing. So once the motor command is sent to the muscles, a copy of the comman is sent to a region that predicts what the sensory feedback should be at the same time as the muscles are executing the command. So the expected sensory feedback is ready and waiting for the actual sensory feedback. Time is saved, because the actual feedback does not need to be analysed any more but only compared to the predicited sensory feedback.

Ludo showed results from his experiments. Actually, I participated in one of them. It is a nonspeech experiment that involved making reaching movements in the presence of a visuomotor rotation. You have to move your finger towards a target, which is easy enough. However after a while they manipulated the visual field by a rotation and you are actually missing the target by a bit. After a few minutes of irritation your motor control system gets used to this shift and automatically corrects for the rotation. The experiment tests how fast you can adapt, which depends on your inverse internal model (I think) which is part of the motor control framework. Ludo found a noticeable but not dramatic group difference between controls and people who stutter. He also talked about an experiment involving a formant shift, but I do not have anything written down on it. He also said that the visuomotor rotation experiment is currently being repeated with children, but the boring targets being replaced by basketball baskets. Ludo also talked about a new set of experiments he is conducting to find out whether differences in the control of orofacial movements lie in the sensory and/or the motor domain. The experimental setup involves being stuck into an apparatus that monitors your orofacial movements, which looks a bit like a chastity belts for your mouth!

Christy Ludlow asked a methological question. I did not really follow on what, but the gist of it is that the interpretation of the experiment is not completely clear-cut and other effects could distort results allowing for alternative interpretation. I asked Ludo whether he had tried to correlate the group difference in the visuomotor experiment with stuttering severity. I suggested he could divide the sample into three: controls, mild stutterers, and severe stutterers, and see whether the controls-to-mild difference was in between the controls-to-severe group. He replied that he hadn't done this but might do.

In my opinion, Ludo is a good scientist and in principle doing the absolutely scientifically correct thing, namely to start out with an established or candidate model and then test the different components. However, in the given circumstances his approach is probably not leading to significant results in the near term, because the setup, the result and the interpretation of the experiments is very sensitive to all kinds of experimental and theoretical issues. But he can prove me wrong! First, experiments like the visuo-rotation experiment seem to get only group difference results, i.e an average difference, because people who stutter do not have failures but only defficiencies. There is a high overlap between control's and pws's performance: some stutterers have in fact better skill than many fluent controls! Only their group average is lower. So deficiency is not a sufficient condition for stuttering. Second, there might well be sub-types distorting results. Third, the model is a functional model but processes of speech motor control might well be implemented differently in different people. So they might have the same functional ability but the brain actually uses different pathways. Fourth, in my opinion, most of the differences we see in stutterers across several areas are simply consequences or a side-effect in a stuttering brain, and not directly involved in causing stuttering. Fifth and probably most importantly, the experiments are quite hard work. You need to recruit the subjects, setup the experiments, be scared of all kinds of experimental artefacts. To me, his approach makes more sense from the perspective of a researcher interested in speech motor control with a focus on stuttering as opposed to a researcher only interested into stuttering.

Human language and brain plasticity at McGill

Maybe some of the researchers here are interested in this conference on language and brain plasticity:

International CRLMB symposium on human language and brain plasticity at McGill:
Mechanisms of Learning, Brain Plasticity and Critical Periods

The Centre for Research on Language, Mind & Brain (CRLMB) is pleased to invite you to join us for a two-day symposium on language, learning and brain plasticity, to be held on

20-21 June 2008 at McGill University (Moyse Hall) in Montreal

The symposium will examine recent advances in understanding mechanisms of language learning, and provide an overview of current developments in brain plasticity and critical periods. The goal of the symposium is to facilitate the interdisciplinary exchange of ideas among researchers whose complementary interests provide an important foundation for issues related to first and second
language learning and cognition development.

The meeting will feature presentations by eleven internationally renowned scientists whose work has contributed new and innovative perspectives on the neuro-cognitive basis of language learning and other cognitive processes. The topics to be addressed include: constraints on statistical language learning; the neurobiology of critical periods; and (psycho)linguistic perspectives on second language acquisition, among others.

Please help us to advertise this event by posting the enclosed Symposium poster
and give this email the widest possible distribution by forwarding it to your colleagues.

Karsten Steinhauer, PhD
(Organizing Committee & Chair in Neurocognition of Language at McGill)

No speech but singing with TMS

Check out this cool demonstration on how TMS (transcranial magnetic stimulation) knocks out the speech regions. Watch how his speech stops when TMS is turned on, and how TMS has no impact when he is singing the ryhme! Does this effect sound familar? We who stutter can sing fluently and not speak fluenty!

Here is the Daily Telegraph article, and here is the direct link to the video.

(Thx to Dave Rowley for this tip!)

Newsflash from Paris conference

I just made my way back to Luxembourg from the one-day conference in Paris. Have you ever been confused of the difference between "efficiency" and "efficacy"? Here is a good example: I took the TGV, the world's fastest train (the most efficient in terms of speed), but completely ineffective (i.e. in terms of actual output), because my return journey took 5 hours instead of the 3.5 hours with the old trains or the 2 hours in the morning!!! Some troubles on the rails which caused a late departure and reduced speed limits!

Here are my talking points:

1) We are currently seeing second generation brain imaging studies. I am very impressed with the latest very cool brain graphics, better scanners and the latest signal manipulation, interpretation (e.g. fiber tracking) and statistical software. The latest studies are now much more reliable than the first generation. I would even go as far as to say that we should forget about all studies older than 2-3 years, except maybe keep a summary in our minds with the meta-analysis by Brown et al.

2) All groups (Chang et al, Watkins et al, and Kell/Neumann et al.) have confirmed the presence of a white matter defficiency in the left frontal cortex, first found by Sommer et al. with more primitive and low resolution DTI scanning. What they disagree on is the exact location, however there are most likely differences in the sample and methods.

3) There was an interesting observation that stuttering and other disorders often show (similar) abnormalities, but that these abnormalities do not necessarily translate to dysfunction. A fascinating interpretation could be that a brain loaded with abnormalities actually shows a decreased (global) brain plasticity to compensate for a defficieny. And the people with disorders are just the biased sample of people who have failed to compensate adequately.

4) Rita Samelin talked about MEG and told us that she is going to take a second look at stuttering, after her first MEG study on stuttering where she showed some reversal in activation for people who stutter. MEG shows electrical activity down to a 1ms resolution, and she now has a working method to determine the time sequence of events. I am very keen to see what she will find as this tool has never been applied to stuttering!

5) No theoretical breakthroughs at all. The consensus seems to be to wait and get more empirical observations from the second generation brain imaging, especially in terms of correlating activities between different regions first.

OK. That's my first twist to a very interesting conference. I'll talk about each presenter over the next weeks. And pictures!!

Off to the Paris conference

Sorry for not posting. I am very busy studying for an exam and playing an international chess tournament. Tomorrow, I am taking the train to Paris for a day to attend the workshop of neurology of stuttering. It should be very interesting. I will try to make notes and write posts.

Food allergy and stuttering

A reader wrote to me:

I’m 38 and started stuttering very late at about 8. I went to speech therapists etc and generally lost respect as the “techniques” never worked or helped me. After a conversation with a friend, I tried a different approach about 3 years ago. I got anti-anxiety meds that helped me greatly. I realized I had some “wires” crossed and started to dig deeper.

I saw various doctors and tried various homeopathic pathways. Which were hitting around the problem, but never got super close to answers. I was tested last fall for food allergies and the results were astounding; I was allergic to food and a diet change transformed my life. My speech improved very quickly and I also felt better. I was still having ups and downs but they were less severe. I went to see a couple gastroenterologists to explore the food allergy further. I would, at times, wake up with a headaches for seemingly no reason. My fluency would have ups and downs (however less severe) even when I would eat “safe” foods. My gastro said I might have an enzyme deficiency and prescribed some Creon (enzyme) for me. The Creon also changed my life.

I probably have never digested food well. When I eat, my body could not cope and it would ultimately engage my sympathetic nervous system instead of my parasympathetic nervous system. Thus, I would immediately go into fight or flight anytime I ate. This would increase my overall body tension and create an ever moving target with regard to my fluency. Good days, bad days, always unexplainable. My body became more and more averse to certain foods and I became more and more allergic to foods b/c of my difficulty in digesting them. This tension/anxiety would focus in my neck area and I would stutter. I cannot explain how much changing my diet and the digestive enzyme has helped me.

I would be really interested if anyone else out there has pursued this avenue

Are you close to or travel to Montreal/Toronto?

If you are close to or travel to Toronto or Montreal, you can help Sarah Smits-Bandstra in her research! Click on the picture to see the details...

Different types of researchers

In my experience, there are four types of researchers:

a) the full-time scientists that look at stuttering by opportunity and chance
b) the scientists that focus their academic career on stuttering but do not treat but teach.
c) the generalists that focus on all aspects of stuttering from research, teaching, and treatment.
d) the practitioners who focus on treatment and teaching but do research part-time.

Type a are mostly geneticists and neuroscientists. They are in my view the best scientists for experiments. They now relatively little about stuttering as a disorder, and live in their experimental paradigm. They just happen to fall on stuttering. Without bias, they just look at stuttering. They are mostly funded by general research councils, and publish mostly in non-stuttering focused journals. I trust them most in terms of experimental results.

Type b knows a lot about stuttering and are professional scientists, and direct their research according to what they perceive as an important experimental question. They say: I have a theory and I want to test it, whereas Type a says I have an experimental method and I want to use it. They publish in both stuttering and non-stuttering journals. They also get their funding from research councils but they might rely more on money pools with a focus on speech and language or communication sciences. Such research resources are often dominated by some professors. Especially junior type b are relatively sensitive as not to offend such an important person who might be editor of a stuttering-related journal or a powerful member of a research council. This is especially true in the UK, and also to some degree in the US and Australia. At least four have told me that they try not to provoke or openly criticise work by a big name, because they are scared of having a paper rejected or getting no funding. Actually, they like me because I say what they do not want to say out of political reasons! So view my blog also as the voices of some in the research community!

Type c is a bit of a generalist. They do teaching, treatment, and research. They are quite focused on stuttering journals, and are at all the conferences. They mostly publish in stuttering journals. In general, they are not full-time and not very good scientists, but are good all-rounders.

Type d are practitioners first. They treat patients, but are too energetic and intelligent to just do their job and go home at 5 o'clock. They are closely connected to the stuttering associations. They are very much focused on treatment, and do research in the area. It is often non-funded research, small pools of money or funded by private money.

In any research team there might a bit mixture of researchers.

I forgot Type e)

e) They stutter, generally have a good science background, and follow research in stuttering. They do not do any experimental work nor treatment nor teaching. They do meta-analysis of research and try to understand what stuttering is about. They do it all for free. Some even write blogs! :-)

Fall in different ways

Oren asked me:

I'm interested to know whether you have the same sensation for all types of stutters (repetitions, prolongations, pauses, etc.)? If not, how is the sensation different for each stutter type?

I think it feels the same before the event. There is some mental blockage, i.e. I know what to say, my brain gives the signal you can say it, but then I sense that I cannot. Whether this translates into repetition, prolongation or pause is secondary. Like if I fall, I can struggle not to hit the ground, I can fall on my knees, or use my hand to soften the fall. The share of different behaviour is either learned or based on where I am in the sentence I guess... So I would say that I do not know which symptom is going to happen. I often notice that if I try to suppress on symptoms like a block then I have a pause. Or if I stop hesitations and fillers, I have blocks.

First donation!

Yesterday I received the first donation for TheStutteringBrain! It is good to know that someone thinks I am doing a good job and actually supports it with an action!

Natural dysfluency vs stuttering?

Another reader asks the following the question:

Do you -- as a person who stutters -- differentiate between disfluency and stuttering? Are they the same?

As a person who stutters, I can clearly sense a difference between natural disfluencies and stuttering. Natural disfluencies feel like a mental hesitation that is translated into disfluent speech. I do not know what to say or changed my mind, and I just say "ehhh" or "mmm" or do no continue or extend the syllable I have started. Or sometimes it feels like a glitch in my motor control in the same way as I sometimes make wrong hand or arm movements. It's more like "Funny.. why did I do this? I am clumsy today", and then I just do the correct one with ease.

Stuttered speech feels to me very differently. To start with, I know exactly what I want to say or at least I have the sense that my brain knows what it wants to say without me necessarily consciously knowing what it will be. :-) So I have this "your message is ready and we are ready to go live" feeling, but I can't get it out or I know it is going to be a struggle. It is also associated with other symptoms like tension, loss of control, and also some kind of blockage in the brain. It kind of feels like it involves more than just this local glitch. My whole mental space seems to become restricted to the moment of stuttering. And I know that it is not just a glitch, but will continue with the next sentences. I also feel that I have lost the control of my body posture.

Overtly when only listening to speech samples, it might well not be possible to distinguish clearly between natural disfluencies and stuttered speech, but internally it is most definitely very different. So I think a person who stutters has also natural disfluent speech like a fluent speaker and in addition he or she stutters.

What is your experience? I would like to hear from people who stutter, but also from others who listen a lot to stutterers. Can they detect the difference between natural disfluencies and stuttering?

The last provacative question

And here is the last question I was asked by the reader:

Do you think non-stuttering researchers do better research in stuttering, they seem to get more funding and on "the cutting edge" of modern stuttering research.

Let's start with therapists. For the typical adult cases, I am convinced that people who stutter or stuttered can well compensate most if not all of their lack in an appropriate qualification or training, as long as they are qualified or trained in something that requires some kind of self-control, moderate intelligence, and learning ability. For difficult cases with psychological issues, a professional is needed.I have also seen so many "therapists" who are just not very good: BEING A NICE SMILING CARING PERSON DOES NOT MAKE YOU A GOOD THERAPIST! :-). For children you need a professional to diagnose children and deal with the parents. So you need to know all the kinds of developmental disorders that can happen and exclude them. But some part of the therapy itself again could well be done by any people who stutter or parents who are not completely out of their mind. So I could well see myself organising a therapy for adults, but if I had a stuttering child, I would take him or her to a generalist speech and language therapist first to exclude other disorders and then discuss with a specialist one on what to do. But I would probably most of the training with the child myself, because as a parent I have more "access" unless the child wants someone else.

For researchers, my answer is a clear yes, but out of statistical reasons. A good researcher has to have an above-average intelligence. So from a pool of 100 researchers, there is on average one that stutters. So if I impose an equal ratio, I would decrease the quality of researchers because I have to hire some less qualified stuttering researchers than qualified non-stuttering researchers. But I guess I am not answering the question, because he most likely means: Does the fact that you stutter makes you an even better researcher, assuming you are a good researcher? Is there an added-value? There are three reasons in favour. First, the researcher is probably truly interested in the research, and does not mind to work on the topic above his calls of duty. Second, he or she understands some issues much better. I have often seen researchers misinterpreting certain behaviours of people who stutter or being unaware of certain issues. Third, the stuttering researcher might have a better connection to the consumer associations, and finds it easier to recruit for experiments or get invited to conferences. He or she is also not open to suspicion that they are only nice to stutterers because they need subjects. On the other hand, a stutterer might hold biased views, and might be reluctant to accept "hurting" experimental results. Let's say he finds strong evidence for Freud's anal displacement theory, he might ignore it, not publish it, or minimize the results. A neutral researcher just reports what he or she finds.

So it is a mixed bag in my view. Both kinds of researchers are needed really. And I have also not seen any evidence that research councils favor researchers who do not stutter. I would guess that the opposite might be more likely.

A provocative question Part II

And here is the second interesting question:

I am impressed that you are able to go to all these International stuttering conferences and to present posters. Do the leading authorities in the field of stuttering take you seriously or are you just a consumer with a PhD who ask good questions? Why don't you study stuttering for real, in a lab?

All the conferences are open to everyone, so no magic there. The same is true for presenting posters. Stuttering conferences virtually never refuse any poster or talk proposal, and at best correct the bad English! Of course, I need to find the time and money to attend. I have managed to reduce the fees, which is a sign that my blog is gaining traction.

The question on whether the leading authorities take me seriously is a very interesting one! Who are the leading authorities? The one that do the key note speeched at conferences or the real leading authorities? My experience is the following: The very good ones (mostly with a natural sciences background) take me seriously, and I am in close contact with some of them. Maybe at the beginning they see me as a consumer and might be a bit patronising, but as soon as I hit them with good or surprising arguments, they are a bit shell-shocked but recover and are happy to discuss research. The other leading authorities simply completely ignore me. I like to think that they are mostly not very good scientists (or have personality disorder!) and became authorities more based on their social, networking, management, lobbying & bullying and marketing work. They do not want to loose their face, or they simply do not understand what I mean. One professor once told me as I tried to convince him that brain imaging is the future: What do you know with a PhD in physics? This person is now co-author on precisely such a brain imaging article! Finally, my work so far is more brainstorming and spreading the news rather than proposing a theory that can be discussed or writing papers. So I am not actually doing real science and not very open for criticism. But, I am currently working on these stuff and hope to send in some articles for review. Also, the stuttering field is not known to be very outspoken in public. Rarely, are there intellectually fierce exchanges on conferences. Many also like to talk to me because I tell them what is going on in their field or we discuss fields where they are not experts either!

So why do I not work in a lab? That is a good question. Maybe I should go into research. I actually had some opportunity, but I only want to go if I really believe that it is worthwhile for me. Also, I still have a few plans for my consultancy work in finance. And, I am a better theorist than experimentalist.

BERCOW REVIEW

Ley Geddes asked me to post this link to his video here. He is lobbying for better services for children who stutter:

The BERCOW REVIEW of services for children and young people with speech, language and communication needs has published its Interim Report; the Final Report is due in July. See: http://www.dfes.gov.uk/bercowreview

The Interim Report states that 'communication is at the core of all social interaction. Communication is a key life skill. Communication is a fundamental human right'.

The good news is that Our Prime Minister, our Secretaries of State for Children, Schools and Families and Health, and the leader of the review, have already accepted the principle of Early Intervention.

But, on the other hand, governments are often tempted to spend their money - our money - on higher profile or more politically expedient projects.

A great deal of research and well documented clinical work supports the claim that 9 out of 10 children can be saved from a lifetime of stammering. Please ask if you would like to see a summary of some of the relevant cases and the results of current work.

If you understand what life with a stammer can be like, or simply feel that it is time to write this wrong, please support this call for the introduction of an Early Intervention policy for stammering.

If you are in Great Britain, and want help with your or a child's speech, or want to support the work of our leading stammering charity, please contact info@stammering.org

A provocative question

At last after years of blogging, a reader finally asks the right question :-)

I do wonder: Do you have more credibility (than the average consumer who stutters) because you have a PhD in theoretical physics and high IQ, despite your lack of background on formal SLP coursework and training. With a Science PhD: you understand the research methodology process and are able to ask good questions on stuttering research?

The short is: Yes and no! The long is as follows

1) The truthfulness of a statement depends on the strength of the supporting and opposing arguments, and not on the proposer of an argument. So, if Einstein gives an argument to support the statement that 1+1=3, he is wrong, even if it is Einstein, and if Adolf Hitler, a little child or myself say that 1+1=2, then we are right. Science has, well let's say should have, an in-built disrespect for any authority, and 100% respect for reality in form of scientific experiments and logical/mathematical reasoning. So it does not matter who gives the argument, whether they are trained practitioners or work as researchers in stuttering, have a PhD in science, or have no education whatsoever. This includes serial killers.

2) Of course, experts in a field have a much higher probability of making correct statements or of giving correct supporting or opposing arguments than non-experts. However, you cannot argue that an argument is correct because X or Y has made it. Many are confused, because they think "X is true because Prof Y has said so", when in fact they really mean "X has a high probability of being true, because Prof Y is an expert in the field". And many more are just blinded by authority or experts.

3) Have you ever asked yourself: Who determines who an expert is? In my experience, three modes are possible. First, a non-expert realises that you have more expertise than herself, and calls you an expert. For example, a journalist that had half a day to dive into a subject. This myth is then propagated and the person labeled expert obviously is not protesting. Second, experts are self-declared. You just need one self-declared expert, who then nominates others as experts, and so on. Third, an institution is self-declared, and by its authority confers expertise to people and other institutions! You see that the process is rather fluid.

4) Are you an expert in stuttering by being qualified to practise as a speech and language therapist? No. In my experience, 99% of those just out of training have no clue about stuttering, and 95% of those with long-term experience had relatively little exposure to stuttering and hold naive or old-fashioned views. Moreover, having a degree does not necessarily make you a good therapist at all! The same is true for a medical doctor. Some of the best I have seen are people who stutter that managed to control their stuttering. I would only call those experts who specialise in stuttering, e.g. for children or intensive speech therapy. But even for those experts, you can ask the question: "So if you are an expert, how come my child is still stuttering or Tom is still stuttering despite many therapies?" The fact is and many therapists would agree that they the experts don't know who is more likely to recover or which therapy is most effective. So the gap between a non-expert and an expert on therapy is really fuzzy, much more than between you and a math professor. And, of course, they can never really understand what it is like to stutter. It is a bit like the pope talking about sex; how can he talk about it when he never (probably) had sex? :-)

5) Lets look at the researchers. If you do research in stuttering, are you an expert in stuttering? Many are experts in stuttering first, and then conduct research. Maybe I am a bit biased here, but they often lack a thorough research training. You need to go through the PhD experience of focusing on a subject in detail for three years, and you need to have been exposed to constant reality checks and peer reviews. Rarely do practitioners have such expertise nor harsh reality checks, and when they conduct research it is often not very good, especially in statistics and methodology. There are exceptions. On the other hand, you have the hard-core scientists like geneticists or neuroscientists who research stuttering, but sometimes have glaring gaps in their overall understanding of the disorder. Some even prefer it this way, they work on the basis: Give me a disorder and I scan it or look at the genes. They do not want to be biased by expertise. That's fine. Some try to do it all, which is great. But no-one is an expert in all research fields. Many are expert in one field and semi-experts in the others. And I feel that I am a semi-expert in all fields.

6) Regarding myself. I stutter so I know what it feels like. I have talked to many others so I understand the variety, though I understand that I am not a good listener! :-) Then, I have been at many different therapies (probably more that therapists who work for one school) with many different therapists. A few therapists even suggested that I would be a good therapist, but I have doubt because I still stutter. How credible is it if I say "I ccccann reddduce youuur stttutering?" Regarding research, I am a trained scientist with PhD experience in an intellectually hard discipline. I feel like all the scientists in stuttering research who study the other fields where they are not experts.

To summarise, everyone can discuss research and treatment, and focus should be on their arguments and not on who they are! Given my science background, I am as able as the researchers in stuttering to discuss research at the same levels as they for fields where they are not working in. This means that I have a higher chance to get it right than the non-scientists, a lower chance than the expert in the field, and an equal chance as the experts in fields where they are not an expert.

And if you don't find me credible, STOP READING MY BLOG! :-)

Paris Conference open to everyone

I have just spoken to one of the organiser of the conference. He is a PhD student there and helped Chris Kell to organise the conference. He said that everyone is welcome, and that they appreciate as much advertisement as possible.

Here is the poster of the conference: click to get a bigger picture. Looks like they have done a fantastic job at bringing good people together. I have just booked my TGV train ticket. TGV is the fastest train in the world and I have never traveled on it. I will definitely blog from the conference to keep you updated!!

IFA Congress in Sao Paulo in August 2009

The 6th World Congress of the International Fluency Association (IFA) will be held in Sao Paulo (Brasil) from August 5th to August 8th 2009. Deadline for submission is October 10th, 2008. Early Fee deadline before May 28th 2009. Download this pdf for more information here.

Or contact: Claudia Regina Furquim de Andrade (I hope she is not a stutterer with such a long name! :-) clauan at usp DOT br, and John van Borsel for scientific committee, john dot vanborsel at ugent dot be.

Humans nearly wiped out 70'000 years ago

I have decided to add exceptional scientific research to my blog from time to time, that is not directly related to stuttering. I want to share my fascination with the scientific research out there, that allows us to understand our world better every day, often with surprising answers. I am always impressed how it all fits together harmoniously. And, the confidence gained should comfort us that science will find out what stuttering is all about. I have no doubt about this!

My first post links to this article: Humans nearly wiped out 70'000 years ago. Apparently, humans went through a dramatic phase 70'000 years ago when we were reduced due to severe droughts to a few thousand people, as compared to the insane 6.6 billion that we are today! It is fascinating how geneticists can make sure statements from long long time ago just by looking at the (mitochondrial) DNA. Often, such periods of extreme stress are periods of extreme selection, and we might well have gained part of our cognitive and communication abilities from our ancestors' suffering! What doesn't kill you makes you strong! :-)

My posts ordered by topic

I discovered a cool new feature. I am now able to give labels to my posts, and then group the posts by labels. You can see my first try on the sidebar under "View my posts on". I have always been looking for such a tool, because I do not view my blog as a diary where the posts become irrelevant after a few days. At least that's my personal construct! Now, you can browse my blog at will focusing on a single topic. In this way, there is much more depth to my blog. Of course, I need to review each post and give it one or more labels. This will keep me busy for a few days, but should be a useful exercise, much like reading your diary from 20 years ago!

Please have a look at the new feature, and you can also suggest other topics that I should label! Thanks!

More pictures from Antwerp

(Source: Daca)

We only look under the lamppost

I have become more and more aware of a fallacy committed by researcher in stuttering; a fallacy that is hard to avoid unfortunately but not very strongly stated anywhere. Many are not really aware just how prevalent and strong it is.
It is the looking-under-the-lamppost fallacy. Here is the story: A policeman sees a person searching the ground in the light cone under the lamppost at night. The policeman approaches, and notices that the man is a bit drunk and is looking for his key. Trying to be helpful, he asks: So where exactly have you lost them? The drunk points with a finger to a location a bit further away from the lamppost. Surprised, the policeman says: So why are you not looking there? Well, it is too dark to see anything. I have to look for my keys somewhere, don't I? I don't want to give in, and there is a small chance that I actually lost in around the lamppost!
In the last years, the view that we should study children rather than adults to understand the causes of stuttering has become increasingly popular and rightly so. I wrote a post about it. I also heard it repeated again at the Antwerp conference by Nan Rantner and Ed Conture. And indeed brain imaging work has moved in this direction, with work by Chang and by Watkins. Children's brains are still fresh, and unspoilt from decades of stuttering.
However, current stuttering research is not exactly doing what it preaches. In fact, the absolutely most important time window in children is completely, and I mean completely, ignored. It's the time before onset of stuttering and at onset. The dormant phase where the deficiency is present but unnoticed. I just know of one study that looked at infants. 99.999% of the research starts a few weeks and months after onset. Many researchers do work on children precisely, because they want to avoid the complexity of adult stuttering. However, they are not consequent enough, and stop at onset. Onset of stuttering is an arbitrary moment for the search of causes of stuttering. Think of a rock emerging from a receding tide. Is the moment of emergence relevant for the existence of the rock? No!
I am sure some of you are not happy with my comments. After all, how can researchers study kids before onset because the kids don't stutter yet? And who am I to criticise the researcher when I have no solution ready. First of all, my criticism is valid irrespective of whether I have a solution: if you are over-weight, and I point it out without offering a solution. Is my observation incorrect? Second, I have never seen the fallacy stated clearly and explicitly. In fact, every study on kids on onset should have a health warning: "We did this study knowing full well that the time before onset is as or even more important that the weeks and months after onset to discover the causes".
And, there are possible avenues. Of course, 20 children at onset means that you need at least 20 times 20, 400, children before onset to get the stuttering children. So any reasonable study would include 1000 children. That's difficult to do. What might be possible is to only monitor all children from stuttering families!

A picture from the Antwerp conference

(Source: Jelena)

In the picture you can see Dave Rowley (organiser of the Oxford Disfluency Conference) and myself surrounded by speech therapists Jelena (on my right) and Daca (spelling?) from Serbia and Suzana (on my left) and Mirjana from Croatia who organised the last ISA congress in Cavtat. Please note, I drank the orange juice! If you have other pictures from the conference, please send them over.

Trying out Medication: Week 30

Here is an update on the self report from a reader: last posts. I want to clearly point out that I have never tried medication. I got several emails from you asking me about my experience. I am only reporting on the experience by the reader. I also emphasise that it is a case study and should not be over-generalised. As you can see from his report, medication is not a wonder drug presently. His report fits with what many others have told me. Initial success (not sure how much placebo, but it could be a lot) but gradual (but not complete in their experience) relapse with side effects still present and a search for a better solution, a clear indicator for an insufficiently high benefit/cost relation.
Here is what he reports:

I have been taking olanzapine (Zyprexa Zydis) since September 2007 and my experiences so far are as follows:

The first 6 weeks after taking the drug I felt completely fluent....I had no hesitations in my speech and all facial contortions and secondaries were gone. Since then some of the blocks have started to creep back into my speech and I have some hesitations with the usual things i.e. name / introductions etc. I have good and bad days, some days I feel good and am basically fluent and feel at ease with speaking and on other days I feel almost as bad as I did before I started taking the drug. However, on the whole my speech is better for taking the drug and all facial ticks have stopped since day 1 of taking the drug which is a good thing. I have tried to increase the dose but all this did was leave me feeling tired, so I reverted back to the 5mg daily dose. In fact I am finding that taking the drug on alternate days seems to give me a better flow of speech on the whole. The drug has affected my weight - I have put on around 10-15 lbs, however I am working to get this weight off as we speak.

In summary - The initial amazing results were not maintained, however my speech has improved through taking the drug. The facial ticks have all gone and also the blocks are easier to plow through. The drug is not a cure, but it can offer some benefits, but these have to weighed against the negatives of potential weight gain + the effects on your metabolism/blood work/lipids etc. I am continuing to take the drug as my bloodwork remains stable and the weight gain will be dealt with via diet and exercise. I am awaiting to hear about the phase III pagoclone trials as I would switch drugs as pagoclone offers the benefits without the side effects that zyprexa carries.

Neural Basis of Stuttering Paris Workshop

There is an interesting up-coming conference on the neural basis of stuttering in Paris on May 16th. Such a workshop / conference is long over-due! Many good people are attending. I met up with Ludo Max, Christy Ludlow, and Soo-Eun Chang last October.

I'll try to get more information. Here is what I found on Alexandre's blog:

Thème : The Neural Bases of Stuttering

Programme :
9h30 : Ludo Max (U. Connecticut) Critical sensorimotor mechanisms
10h15 : Soo-Eun Chang (NIH, Bethesda) Childhood stuttering
11h30 : Anne Foundas (U. New Orleans) Anatomy of stuttering
12h15 : Christy Ludlow (NIH, Bethesda) Pathogenesis and pathophysiology
14h00 : Riitta Salmelin (U. Helsinki) Cortical dynamics
14h45 : Kate Watkins (U. Oxford) Sensory-motor integration
16h00 : Henny Bijleveld (U. L. Brussels) Neuroscience and therapy
16h45 : Chris Kell (ENS) From pathology to recovery

Organisé par : Anne-Lise Giraud, Chris Kell, Christophe Pallier, Richard Frackowiak
Sponsorisé par : IFR49 et Association Parole Bégaiement

Lieu : Ecole Normale Supérieure, Salle Dussane 45 rue d'Ulm, 75005 Paris

Solutions to Logical Fallacy IV-VI

Here are the last three fallacies.

IV: Statistical Fallacy

A researcher says: "We have tested 100 kids who stutter on 20 variables and found 2 that were significant (p<5%). Therefore, I conclude that onset of stuttering is correlated to these two variables."

Explanation:
The researcher has committed the mistake of over-fitting the statistical model, because the more variables you look at the more likely one correlates by chance! And if he uses p<5% as a threshold, one in 20 variables will [Correction: is likely to] show a correlation by chance. Moreover, he has only looked at p-value, but effect size is absolutely crucial. The p-value only says whether two distributions are from the same underlying distribution, and any outlier or systematic error can easily lead to low p-values. Therefore, he needs to look at the size of the difference as well.

V: Treatment-Sucess-Factor-is-Cause Fallacy

A person who stutter says: "After I have come to terms with my childhood trauma and undertook psychological treatment, my stuttering vastly reduced. Therefore, stuttering must be caused by a traumatic experience in childhood."

It is true that his psychological treatment has helped him greatly. However, the cause might still be of non-psychological nature that triggered psychological issues that affected his stuttering severity. If you have a car accident and are in shock, psychological therapy might help you to overcome it, but that does not mean it has causes the accident.

VI: Timing fallacy

A researcher says: "We have recently launched a large-scale study to study kids around the onset of stuttering, because we want to find out what causes stuttering."

The researcher assumes that the causes of stuttering lies close to the onset of stuttering, but that could well not be the case. For example, genetics clearly played a role in many cases of stuttering, and the genes were there from the beginning onwards. Or a neurological incident in the womb or later like a virus infection or a head injury could be the cause, but is not close to the onset of stuttering.

Solutions to Logical Fallacy I-III

Here are the solutions to the first three sentences that contained a logical fallacy. I showed the six sentences on a poster at the Antwerp conference, and during the poster session people had to guess what the fallacies were. And they won Belgium chocolate! (actually I gave everyone a piece, either for brilliance or effort! :-) The three who gave the clearest correct answers were Dave Rowley, Robin Lickley, and Luc de Nil. The majority knew that they were wrong, but they were unable to clearly formulate why the reasoning was not correct.


I: Correlation-Causality Fallacy

A parent said: "My kid started stuttering after our car accident. Therefore, his stuttering was caused by the accident."

Explanation:
It is true that both events, onset of stuttering and car accident, happened close to each other, but a correlation (relationship between them) must not imply that the accident caused stuttering. There are alternative interpretations. For example, both events happened by chance around the same time, and only a study of 1000 car accidents can exclude the chance factor. If all kids that are in a car accident start stuttering, the chance interpretation needs to be rejected. But, of course, there are millions of kids who had a car accident and did not develop stuttering, and the vast majority of kids who do stutter did not have had a car accident. It helps to look at all cases, and not just focus on one single one.

Concept:
If A and B are correlated, the interpretation "A causes B" is only one of four possible interpretations. The alternative interpretations are:
1) the correlation between A and B happen by chance. (The car accident happened randomly, and by pure coincidence the kid started stuttering around the same time.)
2) B causes A. (The onset causes the car accident, e.g. the kid was acting strangely before the onset of stuttering and the concerned mother crashed the car out of nervousness!)
3) C causes A and B. (The parents' house was burgled, the kid started stuttering and the parent crashed the car!)

II: Correlation-Causality Fallacy

A therapist said: "We have compiled reliable statistics on 1000 kids over the last 20 years, and we notice that many kids start stuttering around the time of the birth of a younger sibling. Therefore, the emotional effects must cause stuttering at least in some kids."

Explanation:
It is true that many kids start stuttering around the time of the birth of a younger sibling. This is a subtle fallacy related to the third alternative interpretation. Imagine the onset of stuttering is at the age of 20, how many would have younger siblings born at that time? None! What is the most likely age that anyone has a younger sibling born? Around the age of 3, because parents have their children in one go and spaced by two or three years. I use empirical data from a large-scale fertility study and found that 25% of kids between the age of 2.5 and 3.5 witness the birth of a younger sibling. Therefore, both onset of stuttering and the birth of younger sibling are individually linked at age 3, and therefore age 3 links both event.

III: Trigger-Cause Fallacy

A therapist said: "We have compiled reliable statistics on 1000 kids over the last 20 years, and we notice that a traumatic event is often close to onset of stuttering. Therefore, traumatic events can cause stuttering."

Explanation:
It might well be true that the occurence of a traumatic link is statistically closer to onset of stuttering than it should be. However, this does not imply a causal link. We need to be more careful with the word cause. In fact, an alternative and most likely interpretation is that a traumatic event is a trigger (the last drop) that makes stuttering appear. The kid might well have started stuttering anyway even without a traumatic event, but the traumatic event led to a shock and accelerated the appearance. In fact, it might even delay appearance but we would never be able to witness such a delay because trauma and onset is more spaced in time. Think of your old car, it will break down earlier if you do a long journey now and in 2 weeks later if you postpone the journey by two weeks. Surely, you would not assign a cause to the journey!

Antwerp Conference Day II

Over all, a very well organised conference with good speakers... Congratulations to the organizers, especially Kurt Eggers.

We are in Day II of the Antwerp conference. This morning we had a talk by Ed Conture on his Diathesis-Stressor Model of Childhood Stuttering, and by the conference organiser Kurt Eggers who talked about his PhD research on temperament and attention. Kurt showed his results on the 16 temperament dimensions, and shows two variable below p<5%. However, I do not find this a very strong result, especially because he did not indicate the value itself and he did not show the effect size. These are essential parameters to interpret results and should be in any scientific talk. So it might well be a marginal result and not very clear signal. Also, a measurement error analysis lacked, but I can hardly fault him on this issue as NO-ONE does it in stuttering research. I am convinced that if everyone includes such an analysis, it will reduce the number of significant results considerably. The article is going to be published soon, so maybe I know more then. Concerning Conture's model, I am not convinced. I asked a question about whether emotional aspects are important before even before onset, and he said yes. I find this hard to understand. I can see that the model or a similar framework is useful to explain why some kids recover and some don't but not for onset itself.

Blogging from the Antwerp conference

I am at the Antwerp conference, sitting in the meeting area. There were three good talks: by Nan Rantner on psycholinguistics, de Nil on neuroimaging, and Ambrose on genetics. Ambrose was reporting on genetics linkage studies, and pointed out that they found that males and females should different significant linkage to chromosomes: males on Chromosome 9, and females on Chromosome 21. That's quite interesting, and I will investigate further. Luc de Nil reported about work of one of his PhD students with MEG to study auditory (in)activation, and they found that pws differ in both. More soon.

Phase III Pagoclone is going ahead

I heard rumors that the Phase III trial for Pagoclone is going ahead, and there was a meeting to discuss the formalities of the trial. I am sure we will have more information soon.

Stuttering: a developmental disorder?

Sorry for the few posts over the last weeks. I am currently on a France round trip, and I will be at the Antwerp stuttering conference on Friday and Saturday. I will report on the conference.
Today, I want to talk about stuttering as a developmental disorder. The term is misleading. Let's assume stuttering is caused by genes (as it is in some families), how can you possibly label stuttering a developmental disorder??? After all, the body has developed smoothly according to what the genes instructed! The final results might well show deviations from the normal population that became apparent during the development of the child, but that is hardly a developmental disorder per se? On the other hand, if stuttering is caused by a neurological incident like a virus infection or head injury, the smooth development of the brain according to what the genes instructed has definitely been disrupted, and we can call it a developmental disorder.
People seem to define a developmental disorder, a disorder that becomes apparent when the child is in development. So it is based on symptoms. This way of thinking is highly misleading and confusing.

Can you spot the fallacy?

I am preparing my poster for the Antwerp conference next week. It is going to be about fallacies when assigning causes to onset of stuttering. Here are the examples. Can you spot the fallacy? Please post your answers. I will publish the solutions after the conference next week! The winner will be awarded the Mr/Mrs Fallacy title and can write a guest post! :-)

FALLACY I

A parent said: "My kid started stuttering a few days after our car accident. Therefore, his stuttering was caused by the accident."


FALLACY II

A therapist said: "We have compiled reliable statistics on 1000 kids over the last 20 years, and we notice that many kids start stuttering around the time of the birth of a younger sibling. Therefore, The emotional effects must cause stuttering at least in some kids."


FALLACY III

A therapist said: "We have compiled reliable statistics on 1000 kids over the last 20 years, and we notice that a traumatic event is often close to onset of stuttering. Therefore, traumatic events can cause stuttering."


FALLACY IV

A researcher says: "We have tested 100 kids who stutter on 20 variables and found 2 that were significant (p<5%). Therefore, I conclude that onset of stuttering is correlated to these two variables."


FALLACY V

A person who stutter says: "After I have come to terms with my childhood trauma and undertook psychological treatment, my stuttering vastly reduced. Therefore, stuttering must be caused by a traumatic experience in childhood."


FALLACY VI

A researcher says: "We have recently launched a large-scale study to study kids around the onset of stuttering, because we want to find out what causes stuttering."

Crackpot Award for Sigmund Freud

I am awarding a Crackpot Award to Sigmund Freud for his outrageous pseudo-science. His theories about stuttering are not only completely unsupported by any evidence, no he has also consistently misrepresented his case studies. And so have many followers of his. They are a good example of what happens when an ambitious, cocaine-taking, intelligent but pseudo-scientific mind starts day-dreaming without constraint from reality-checking experiments. His criminal negligence regarding the accuracy of his theories has done more than anyone else to confuse the weak minds of the 20th century. His influence still lingers heavily today in stuttering theories about the influence of the subconsciousness and traumatic experiences in childhood.

He has done more harm to people who stutter than any one else, certainly more than any previous crackpots. If anyone thinks of Freud as a great mind who has led to great breakthroughs, think again. Here is what wikipedia says:

Although Freud's theories were influential, they came under widespread criticism during his lifetime and afterward. A paper by Lydiard H. Horton, read in 1915 at a joint meeting of the American Psychological Association and the New York Academy of Sciences, called Freud's dream theory "dangerously inaccurate" and noted that "rank confabulations...appear to hold water, psychoanalytically" [21]. Peter D. Kramer, a psychiatrist and faculty member of Brown Medical School, said "I'm afraid [Freud] doesn't hold up very well at all. It almost feels like a personal betrayal to say that. But every particular is wrong: the universality of the Oedipus complex, penis envy, infantile sexuality." A 2006 article in Newsweek magazine called him "history's most debunked doctor."[22]

Freud's theories are often criticized for not being real science.[23] This objection was raised by Karl Popper, who claimed that all proper scientific theories must be potentially falsifiable. Popper argued that no experiment or observation could ever falsify Freud's theories of psychology (e.g. someone who denies having an Oedipal complex is interpreted as repressing it), and thus they could not be considered scientific.[24] Author Richard Webster characterized Freud's work as a "complex pseudo-science"[25].

H. J. Eysenck claims that Freud 'set psychiatry back one hundred years', consistently mis-diagnosed his patients, fraudulently misrepresented case histories and that "what is true in Freud is not new and what is new in Freud is not true".[26]

Mikkel Borch-Jacobsen claims that "The truth is that Freud knew from the very start that Fleischl, Anna O. and his 18 patients were not cured, and yet he did not hesitate to build grand theories on these non-existent foundations...he disguised fragments of his self-analysis as ‘objective’ cases, that he concealed his sources, that he conveniently antedated some of his analyses, that he sometimes attributed to his patients ‘free associations’ that he himself made up, that he inflated his therapeutic successes, that he slandered his opponents."[2]