Don’t Say ‘Barbecue’—or Do: LSU Study on Adults Who Stutter Tries New, More Personal Approach
Geoffrey Coalson, associate professor in the LSU Department of Communication Sciences & Disorders, has received $449K from the National Institutes of Health (NIH) for an innovative study on stuttering, looking at cognitive differences when it comes to mental multi-tasking as well as consciously holding back speech, movement, and negative thoughts. The study is called “Inhibition and Working Memory Capacity in Adults Who Stutter.” A somewhat unusual aspect of the study is that Coalson himself is in the population he’s studying.
BATON ROUGE, June 3, 2020
“You’ll hear me stutter; I’m an adult who stutters,” Coalson said.
There are 3 million adults and 15 million children in the U.S. who stutter. What you can glean from these numbers is that four out of five children stop stuttering—usually on their own and by the age of seven. Most of the research that has been done on stuttering so far has focused on predictive factors that tell us which children will stop and which will become adults who stutter. Most of the therapy for stuttering, meanwhile, could be reduced to “slow down, take a breath, and think about what you’re going to say”—a one-size-fits-all approach Coalson does not agree with.
“If that would have worked, stuttering would be the most preferred diagnosis to encounter in the clinic rather than the least preferred, which it currently is—especially in adults,” he said. “But those who stutter know that it’s more than just a speech problem; it’s not only about what you can see and hear at the mouth. There are things upstream that need to be considered. There’s an iceberg of stuttering. What you can see and hear is the smallest part, yet that’s what most people have concentrated on.”
“There’s nothing more personal than communication and when that’s robbed from you, it starts altering who you think you are.”—Geoffrey Coalson
The field of speech-language pathology is broad, covering everything from feeding problems for newborns to swallowing disorders later in life, literacy issues, challenges posed by cleft lip and palate, autism, stuttering, and more. Through his research, Coalson hopes to come up with new tools that could make life easier for adults who stutter as well as for speech-language pathologists.
“Even if it’s right on the edge of what we’ve empirically tested, we want to share the most promising ways to work with adults who stutter,” he continued. “Knowing what not to do is half the game.”
A common misconception about stuttering is that it’s caused by anxiety.
“On behalf of all adults who stutter, I can tell you this isn’t true,” Coalson remarked.
Previous research on persons who stutter has indicated subtle neurophysiological differences between the two parts of the brain that plan and produce speech. It has also been shown that children who begin to stutter aren’t—at the onset—necessarily more nervous than their peers. Stuttering does often lead to anxiety, however, which can make stuttering much worse.
“There’s nothing more personal than communication and when that’s robbed from you, it starts altering who you think you are,” Coalson said. “Even the word ‘stutter’ can be triggering. I grew up in Texas, and when I was in high school and started driving, there was a billboard up by the side of this road advertising shutters, and it was so close to ‘stutters’ that I would take a different route; that’s how much I didn’t want to address the problem. Also, if you ask me to say ‘barbecue,’ which is one of the words I’ve had a hard time saying for most of my life, it won’t make me stutter, but it will trigger the entire history of it.”
His study will focus on executive function, which is how the brain manages tasks, and whether adults who stutter are inherently different from other adults in this regard or simply overrun by competing directives.
As part of his upcoming three-year study, Coalson will assess the impact of triggering words, which are likely to be unique for each person, and something called stereotype threat—when people who are part of a group, such as adults who stutter, are told they are expected to perform worse on a certain task compared to people who are not part of the group—to see specific differences in emotional response. His study will focus on executive function, which is how the brain manages tasks, and whether adults who stutter are inherently different from other adults in this regard or simply overrun by competing directives.
“Adults who stutter get stuck between blocking and pushing through speech,” Coalson explained. “Speak, don’t stutter, speak, don’t stutter. You have to do an enormous amount of problem-solving in the exact moment you’re about to speak to stop yourself from stuttering. You have to inhibit a sound you’re about to make while also ignoring a lifetime of negative feelings and experiences that burst into working memory. That’s a lot of divided attention and dual processing.”
Coalson aims to establish whether adults who stutter have a different baseline in terms of their ability to mentally multi-task in this way, or if just about anyone would find it impossible. He is collaborating with Emily Elliott, professor in the LSU Department of Psychology, who is an expert on attention and working memory, which has both visual and auditory aspects, the latter involving speech and sound. To explain the term executive function, she brings us—figuratively—to a grocery store.
“Let’s say you have $10 in cash and need peanut butter, bread, and jelly,” she said. “As you’re going through the store, you’re thinking, ‘Well, if the peanut butter costs this much, how much am I going to have left to buy the bread?’ You’re maintaining a goal—buying things to make a sandwich—while remembering how much money you have—$10—while doing mental math—adding up the cost of the different items—while, at the same time, presumably walking normally through the grocery store without running into things or talking out loud to yourself like a strange person.”
“That’s an everyday example of an executive function task,” Elliott continued. “Now, if someone comes up to you and starts a conversation, without executive function, you’d risk leaving the store with just the peanut butter and the bread. You’d never have your jelly.”
“In the moment of stuttering ... you feel like you’re not in control.”—Geoffrey Coalson
Coalson translates the grocery store scenario to the context of stuttering.
“The person in the store has time on their side,” he said. “But for a person who stutters, you must now shrink all of that monitoring and management down into a fraction of a second right before speaking—every time you speak—to stop yourself from stuttering. It’s a finely grained motor change—akin to threading a needle—that is very difficult to make. And if a person who stutters also have to regulate negative thoughts, an internal conversation, at the same time that they have to inhibit speech, they’re going to be less able to do either one, or both.”
As an adult who stutters, Coalson can describe how it feels.
“In the moment of stuttering, you could just as well be in a different room; it’s almost an out-of-body experience,” he said. “You know when you’re about to stutter and you know you should be able to stop yourself from stuttering, but that’s not how it feels. You feel like you’re not in control.”
When he has long moments of stuttering, lasting up to 20 seconds, that feeling grows stronger.
“You’re just watching yourself thinking, ‘I hope this ends because this is awful,’” he continued. “So, if you ask me, as a therapist, to just relax and thread a needle at the same time, that might not be the most responsible thing to do.”
Coalson is acutely aware of stereotypes associated with stuttering and hosts a support group for adults in Baton Rouge, part of the National Stuttering Association. He also has two young daughters at home who both stutter—there’s a strong genetic component to stuttering; the inheritability rate is 80 percent—and helps them navigate negative comments in their daily lives, including on the news.
“Joe Biden is an adult who stutters, and we’ve all heard the negative comments about his speech patterns,” Coalson remarked. “‘He doesn’t know what he’s talking about,’ or, ‘He forgot his name.’ You don’t hear him stutter because he’s avoiding words and suppressing his stuttering so much that it sounds like uncertainty or confusion. So, even if you hide stuttering to nearly imperceptible levels, you’re never truly off the hook in the ears of the listener. It is painful to hear those comments, but it also gives me a lot of vigor to do what I do. And I can tell my kids, ‘You can be president if you want to,’ something I couldn’t have imagined even five years ago.”
Saying that stuttering is more than a speech production problem but instead involves cognitive processes in the brain can sound scarily close to saying that people who stutter are unintelligent, which is absolutely false.
Research on stuttering has in some ways been trapped between general misconceptions and pop culture definitions (‘She’s just nervous’ or ‘He’s just not talking perfectly’) and outright stereotypes (‘They’re slow, mentally speaking’)—or, rather, not reinforcing those stereotypes. Saying that stuttering is more than a speech production problem but instead involves cognitive processes in the brain can sound scarily close to saying that people who stutter are unintelligent, which is absolutely false.
“One of the reasons we know relatively little about stuttering is because we’ve all agreed, or been told, to not talk about it,” Coalson said. “Because of the stigma that’s attached to stuttering, which I’ve observed and also experienced. There was an old theory that stuttering was an emotional problem, stemming from overly critical parents. That’s been debunked. Today, researchers agree that stuttering has nothing to do with intelligence and nothing to do with emotional disorders. But the hesitancy to implicate anything that even indirectly reinforces a stereotype about stuttering is real. That’s stymied a lot of fruitful research.”
Therapy for adults who stutter has also suffered from an implicit goal, which is for the stuttering to completely cease.
“If the only acceptable outcome is fluency, that’s a recipe for disaster and relapse,” continued Coalson. “There are days when I stutter quite a bit and actually prefer to stutter rather than try to fix it all the time. The relentless attempts to control speech, the constant monitoring and pressure, can consume your life and often cause more harm than good.”
That point of view also informs his research on improved therapies.
“Maybe it’s not possible for the stuttering to permanently go away, but then, what else can we do? What’s the next acceptable option,” he asked. “Clients likely have specific goals in mind, like being able to talk with a person of interest to them, or order what they like from a menu as opposed to what they can just because it starts with the wrong or right letters, or talk on the phone and let the other person know, ‘No, the signal hasn’t dropped; I just stutter.’ Those are realistic goals and concrete skills that most people would be happy to be able to walk out the door with.”
“We are here to improve their ability to communicate,” Coalson concluded. “Fluent speech is a much lower priority.”
On this project, Coalson will collaborate with Courtney Byrd, founding director of the Michael & Tami Lang Stuttering Institute at University of Texas at Austin.
Last year, Coalson also wrote this opinion piece in The Advocate.
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