MR. BRUCE DEPUYTFrom WAMU 88.5 at American University in Washington welcome to "The Kojo Nnamdi Show," connecting your community with the world. I'm Bruce Depuyt sitting in for Kojo. Most everybody stutters at some point life, usually when we're learning to speak as small children. But for some people, a stutter never goes away resulting in a handicap that is often taken less than seriously. In fact, keeping in mind characters like Porky Pig and movies like "Billy Madison" and "A Fish Called Wanda," stuttering seems to be one handicap that we openly laugh at.

MR. BRUCE DEPUYTBut for the three million Americans who do stutter, the recent hit movie, "The King's Speech" has been a chance to recast that image from bumbling or goofy to confidant and capable. Today, on the program, we will examine the causes of and the treatments for stuttering and we'll take a look at the way this speech disorder is portrayed.

MR. BRUCE DEPUYTJoining us here in the studio at WAMU, Vivian Sisskin. She's a speech language pathologist who, in addition to her private practice, is a professor at the University of Maryland, my alma mater. Good to see you and thanks for coming in today.

MS. VIVIAN SISSKINThank you.

DEPUYTAlso with us here in the studio is Tommie Robinson. He's also a speech language pathologist and he's the former head of the American Speech-Language-Hearing Association. Good to have you with us today.

MR. TOMMIE ROBINSONThank you very much.

DEPUYTWith us on the line is Tracey Wallace an audiologist for the DC Public Schools who lives with a stutter and is here to sort of start us off by talking about her experience. Tracey, thanks very much for being on the program today.

MS. TRACEY WALLACEThanks for having me.

DEPUYTGive us a sense of what maybe your biggest struggle has been as a person who lives with a stutter.

WALLACEWell, I lived the majority of my early life as a covert stutterer so I was one of the few people who stuttered that was able to, in my eyes, successfully hide stuttering. But, you know, internally, it was really struggling with being a false fluent speaker and trying to avoid situations that either caused anxiety or caused frustration because I knew that it would be very hard for me to show stuttering if I, I'm sorry, hard for me to not show stuttering if I was very, you know, anxious or fearful.

WALLACESo my life was just full of opportunities, of speaking obviously in class as a child and then graduate school where I was a very outgoing person. I always have been, but, you know, having to do cold readings or answer the phone or return phone calls, things of that nature were very difficult for me. It was a test every day to try to get through the day without showing stuttering. And so for my life, you know, by the end of the day, I was completely exhausted and thinking at that time that I was successful at hiding it when I didn't show stuttering. But, you know, internally, I was just reconfirming to myself that I couldn't say words so I had word fears and sound fears and situational fears that just kind of chipped away at my spirit every single day.

DEPUYTNow from the perspective of a non-stutterer, it would -- one gets the feeling that you try not to think about it because if you think about it, it makes it worse. Was that part of the dynamic at all for you to block it out of your mind and not have the problem, by virtue of the fact that you were fearful about it, cropping up?

WALLACEWell, you know, as it was, being a covert stutterer, I really tried hard not to identify myself with others who stuttered or with people who stuttered. But it was hard because your life just revolves around speech all day long so you have to talk, you know, when you're at the grocery store, when you're at the drug store, at school, on the phone, people talking to you. So you actually think about the potential of stuttering every moment of your day. And I mean, it gets to be so bad for some of us that, you know, that's kind of all you eat, sleep and drink, is stuttering. I mean, I know I've dreamt many nights about anticipating situations where I might stutter, you know, and so that would be all the time because you talk all the time.

DEPUYTAnd some people will in their own mind make a connection between stuttering and the intellectual firepower, if you will, of the person themselves. Did you worry that you might be thought of as not as smart as the others and if that was the case, perhaps try to overcompensate by showing that I've got this issue? It's a language issue. It's a speech mechanics issue, but it's not a reflection of my capabilities, my mental acuity or what have you.

WALLACEYeah. I mean, you know, with just examples of that -- I mean, most people who stutter have a very hard time saying their name and actually the word stutter. So, you know, you're always having to introduce yourself so, of course, if you're, you know, at a table with a lot of people or in a group situation and everybody's going around introducing themselves and it comes to you and you say my name is, you know, to everybody else it's like, oh, my God, she doesn't know her name, you know. So they automatically think, you know, you're not as bright. You're an idiot or you're having a dumb moment.

WALLACEBut the reality is, is that you're just stuttering on your name. Well, most people don't think that you're stuttering on your name because that would be the last thing that would probably come to their mind. So, you know, those kinds of things happen, not just with your name, but with other, you know, words as well. Or even a person who stutters knowing an answer, not really raising their hand to answer, you know, may be viewed upon as being not as bright because you don't know the answers. But obviously, you're avoiding stuttering, you know, and obviously not participating in things because they think that, you know, you're just non-social or you just don't have the answers.

WALLACESo yeah, those things, unfortunately, happen to people who stutter all the time. I know in my case, because I had a lot of word and sound avoidances, you know, I had a huge vocabulary of words that I had developed because I was always trying to find a synonym for the words I couldn’t say. So I mean, for those reasons, you know, I would probably assume that probably a lot of people who stutter are extremely bright. I mean, I know a lot of people who stutter that have stayed in college, you know, more years and have changed their major, you know. And they've gotten all this education, but their fear was having to, you know, having to interview for jobs after they graduated. So rather than graduate and get a job and stutter, you know, they stay in school and learn more information. So those kinds of thoughts of just people who stutter not being as smart, you know, are very, very common, but the reality is, is that's far from the truth.

DEPUYTAre you able to instill in the students that you're working with a sense that I'm living proof that you can overcome this and that you can really put your -- or hold your stuttering in check as it were?

WALLACEWell, with regard to the students I serve, because I do work with the special needs population, you know, I definitely use my stutter as an example when I talk with students about just coping with a disability. And I can understand when a lot of kids, you know, want to hide their hearing loss or hide the fact that they have to wear hearing aids because of just feelings of just, you know, not being the same as everybody else, sticking out in the crowd so I definitely talk about my stuttering all the time.

WALLACEI mean, now I'm at a point in my life where I embrace my stutter. I embrace the person that I am and so I use it to my advantage and not really as something that weighs me down. But, you know, it helps out -- I mean, I think I'm a more insightful counselor to my students, you know, because I'm a person who stutters.

DEPUYTTracey Wallace is an audiologist with the DC Public Schools starting off our conversation on stuttering today. Thank you very much, Tracey, for being with us. I really appreciate your time and your description of what you've been through. Our phone lines are open as we talk this Tuesday on "The Kojo Nnamdi Show." Bruce Depuyt sitting in for Kojo. Phone lines are open, if you care to join us. The number here is 800-433-8850. Again, 800-433-8850. You can send us an e-mail, the address, kojo@wamu.org Tommie Robinson, my guess is you've heard stories like Tracey's and others similar?

ROBINSONVery much so. I think that it's a constant song that we sort of hear relative to individuals who stutter. I think that the issue with Ms. Wallace is she was able to predict and work through a lot of her difficulties and oftentimes our patients are not able to do that. I primarily work with preschool children and school-age children, being at Children's Hospital, which is where my real job is. And so I see it in every aspect all across the walk of life. But she was able to do some very wonderful things to help her get through these situations.

ROBINSONBut one of the things that she said that really stuck out and it is that it looks like she's working to her potential. A lot of individuals who stutter and adults who stutter, and I'm sure Vivian will agree with me, don't work to their potential because they're hiding and avoiding those situations where they might have to communicate with individuals.

DEPUYTVivian?

SISSKINYeah, the actual therapy process for stuttering deals with self acceptance as a person who stutters and being able to identify yourself as a person who stutters so that you stop hiding and concealing. One of the hallmarks of stuttering is concealment, which leads to a lot of the struggle you see in speech itself.

DEPUYTTalk about the mechanics. What's happening? What's going wrong that the speech doesn't flow, that the words don't come and there's that hesitation, particularly as it would appear on the first syllable?

SISSKINRight. And very often it is on the first syllable, but not always. We see symptoms of repetition, prolongation, a silent block where you can't get any sound out, you sort of lock up and these are basically the core symptoms of stuttering we see in young children that Tommie was talking about. And we also see in the school-age children and adults as well.

SISSKINBut what happens fairly quickly in the early elementary school years is that the stigma of stuttering, frustration related to stuttering, negative listener reactions in response to stuttering cause children to begin to put their stuttering, what we call, it goes underground where they begin to become more covert. They begin to hide and they start using strategies that initially are very helpful and allow them to get through the word.

SISSKINHowever, over time, they become learned maladaptive strategies and they lead to struggle. So the struggle that you often see in stuttering, referring to facial grimacing, tension in the vocal chords, eye closure and not only physical struggle behaviors, but also linguistic struggle behaviors where you'll see people repeating previous words they said or including um, um, um in order to get through the word or changing words as Tracey was mentioning.

DEPUYTYes.

SISSKINYes, word substitution and word avoidance. This is the struggle that becomes the handicap in stuttering.

DEPUYTBut I guess I'm wondering what's the origin point or what's the origin or to the extent that there are multiple things that can cause this problem to pop up. Can you give us a sense of what some of those are?

ROBINSONYeah, I think if we truly had the answer to it...

DEPUYTBy the way, as I'm talking to you guys and to the folks listening at home and in their car, it's amazing how conscious one becomes of one's speech. I find myself speaking much more slowly and deliberately and frankly trying not to stutter.

SISSKINThat'll help. That'll make you stutter, yeah.

ROBINSONIf we truly had the answer to that question we'd be sitting on a goldmine. There could be a number of what we call ideological bases or causes to the whole notion of stuttering. It can be rooted from an organic standpoint. We see individuals who've had traumatic head injury, who've had stroke, who all of a sudden begin to stutter and that it's linked back to the, to the organic origin or some maladaptive behaviors associated with brain function and so forth and so on. We like to think that that is the cause, but can be manifested in number of different ways. It can certainly be linked to the whole notion of language and how it's constructed.

ROBINSONIt can be linked to the emotional elements associated with communication. It can be linked to psychological traumas in one's life. So there could be a number of different causes associated with stuttering. And each -- once you've seen one person who stutters, you've seen one person who stutters. Because there's so much variability in how that individual displays his or her diffluent behaviors or his or hers stuttering as well.

ROBINSONI don't know if Vivian wants to add.

DEPUYT(unintelligible) ...

SISSKINYeah.

DEPUYT...I hear what you're saying. But it's too bad because we want that one cause...

ROBINSONYeah.

DEPUYT...where we can get at it and solve everything.

SISSKINWell, we do know a lot more than we used to know. The idea that stuttering was caused from childhood trauma, poor parenting, weakness, nervousness, those ideas are pretty much gone today. New research in both brain imagining and in genetics and in language as well, have pointed to a number of ideas in terms of where we might go when looking at causation. We do know that for 50 to 60 percent of the people who stutter, there is a genetic link of some sort.

DEPUYTBut not a cause, but the link.

SISSKINYeah, a predisposition. We also know that the brains of people who stutter look very different under functional imaging studies. And so there is both -- there are both structural and functional differences in the brains of people who stutter versus the brains of people who do not stutter. And we also know that -- and it's looking more down this line, if we can come to some kind of idea of what causes stuttering, if we can actually come up with one.

SISSKINThere might be something in terms of motor weakness and motor dis-coordination at the time that language becomes complex. Because we do see that language complexity breaks down stuttering.

DEPUYTVivian Sisskin is a speech language pathologist in private practice and a professor at the University of Maryland. Tommie Robinson is likewise, a speech language pathologist and the former head of the American Speech-Language-Hearing Association. The lines are full. We've stuck a cord with this topic. We'll continue our conversation. We'll take your calls, more of the Kojo Nnamdi show here on WAMU. Bruce Depuyt sitting in on this Tuesday, back with more after this.

DEPUYTWelcome back to "The Kojo Nnamdi Show," here on WAMU. I'm Bruce Depuyt sitting in for Kojo. Great to have you with us today. We're talking about stuttering. Joining us here in the studio, Vivian Sisskin, a speech language pathologist and professor at the University of Maryland, Tommie Robinson, former head of the American Speech-Language-Hearing Association. I'm not going to give out the phone number because the lines are jammed. We're going to be going to the phones momentarily.

DEPUYTSo Debbie and Matt and Bill and the others who are on the line, please stay where you are. We're going to get to as many of your comments and questions as we can. I have to ask you about the movie, about, "The King's Speech." Clearly that has brought this forward, I think, for a lot of us and I -- I mean, I love the movie. I thought the portrayals were great. I thought everything about it was great. And I’m sure it was a -- just a universal experience for everyone.

DEPUYTWell, that's what a universal experience is. A universal experience where you are rooting for George to overcome his painful stutter as portrayed by the actor in the movie, Colin Firth. And, you know, you want to will the person to the, sort of, smooth confident speech that you know they're capable of. But it's, you know, obviously much more difficult than that.

ROBINSONI personally think it's fantastic and it certainly has painted stuttering in a more positive light than we've seen in the past. I have the opportunity -- I teach at a number of universities in the area as well. And my students say, Dr. Robinson, I've never been moved like this before. And they were crying as we saw the movie in class. And it really sparks lots of conversation. We can go back and forth to talking about examples that we've seen the movie and relate it to teaching.

ROBINSONSo it's a fantastic phenomenal teaching experience as well.

SISSKINAnd people who stutter who saw the movie went in groups. They were so excited to have a movie where they could be proud to watch the role model on the screen stutter rather than having a character who's made fun of who is a buffoon or someone who is less. And they reported that they had incredible connection when he was trying to give that speech and they remembered feeling situations just like that themselves.

ROBINSONAnd I think people who don't stutter who've seen it, they finally get it. You know, they finally get the notion that this is something individuals can't help. And I'm hoping that this will be the lesson to lessen the bullying and the teasing surrounding stuttering.

DEPUYTYou know, there -- most people -- a lot of people have seen the movie. I'm going to go see it again because I think it's one of those movies where you get even more the second time.

ROBINSONSure.

DEPUYTAs we discuss it, we're not going to, let's say, give anything away. But the scene toward the end, you know where I'm going, is one of the most -- I mean, I'm practically weeping as I even try to describe it. And it was emotional seeing it.

ROBINSONYeah.

DEPUYTIt's just wonderful film making, wonderful acting, very human because everyone is trying to overcome something. You know, and that's -- so I do think it transcends stuttering in that sense. We're all dealing with something and we're able -- even if we're not a stutterer, you can look at King George, Colin Firth and see your own struggles as sort of in him. Debbie in Fairfax, you're first as we go to the phones. You're on the air. Go right ahead, please.

DEBBIEHi. I have a husband who stutters and a teenage daughter. I am fairly well versed in the causes and the potential, why did this happen, et cetera. What is a real stutter? My question for the panel is moving forward from, "The King's Speech," which did have a profound effect on us all, how do we change public perception of the stutterer so that, for example, a child who starts to stutter at a young age does not, you know, endure, as the gentleman said, the bullying, the teasing and then subsequently become an under the radar stutterer as an adult.

DEPUYTThank you.

DEBBIEAnd then have to work their way back to being, you know, an extrovert stutterer. How do we change public perception?

DEPUYTThanks, Debbie.

SISSKINI think part of that is getting stuttering out in the public discussion like we are today. I -- there have been a number of newspaper articles, there have been a number of shows dealing with stuttering, talking about it, having people understand that it is a neurological, a biological problem and not something that's psychological. And I think that we need to get that information out to the schools as well.

SISSKINSpeech language pathologists in the school have unique opportunities to spread the word to teachers and parents. And I like to, for my -- for the children and teens that I work with myself, I like to empower them with the notion that they have the ability to become open and talk about their own achievements and their own struggles related to their speech. And let their classmates know that they're someone who stutters and I am confident and I am a good communicator and I'm going to stand up and give this public presentation in front of my class as a person who stutters.

ROBINSONEducation is definitely the key. And there are some resources out there. Information through the American Speech-Language-Hearing Association, as well as the Stuttering Foundation of America...

SISSKINAnd the National Stuttering...

ROBINSON...and the National Stuttering Foundation.

SISSKIN...National Stuttering Association.

ROBINSON...Association, that's it, yeah. They all have educational materials. And I think the earlier we start to introduce these materials, the better chance we have of educating people from a broader standpoint. Thanks for that questions. That's a very good question.

DEPUYTPerfect segue, I think, to the comment or question that Matt in Germantown has. Matt, welcome and go right ahead, please.

MATTYes, thank you Bruce. Yes, I'm a person who stutters. I've never called into a radio show here. So...

ROBINSONI'm glad you did today.

MATT...but I just wanted to let people know that there is a support organization for people who stutter. It's the National Stuttering Association as was briefly mentioned. They have a great website, www.westutter.org,and there are local support groups in all parts of the country that are run -- that is run by the National Stuttering Association. The support groups are safe spaces where people who stutter can meet and talk about stuttering and the challenges and the issues that we face.

MATTThe NSA also puts on a national conference every year with 500 people who stutter, a gathering for several days to go to workshops and listen to speakers. This year's conference is in Fort Worth, TX in July and David Seidler, the screenwriter for, "The King's Speech," is the keynote speaker. So as I said, it's a great organization. They have a great website and for people who stutter and for parents of people -- of children who stutter, it's a great resource.

DEPUYTAre there things, and you don't -- I'm naturally wanting to sort of learn more. Are there things that people do in day to day life that you wish they wouldn't or things that they could do that they don't?

MATTWell, one of the frustrations for a lot of people who stutter is when people finish our sentences for us. You know, so just give us time to say what we want. But it's tough because people don't really know what's going on when you're stuttering. And so...

ROBINSONAnd they think they're being help...

MATT...and recognize that.

ROBINSON...they think they're being helpful.

MATTRight, exactly. So and just as was said, I think, that is -- more is learned about stuttering, you know, it's a very misunderstood disorder. It's not caused by nervousness or anything. As was mentioned, there are neurological origins to it. And so, I think, as the public gets educated, it will help.

DEPUYTMatt, thank you very much. Vivian, you mentioned the brain scans and what we see about how the brain of a stutterer functions particularly during times of speech versus someone who doesn't stutter. What in particular do MRI's or CAT scans show us?

SISSKINWell, we see a lot more of the brain is activated during speech in people who stutter versus people who do not stutter. Sort of, more of the brain lights up. You might say there's inefficient brain going on. We also know that there is under-activation of the auditory areas which are very involved in speech as well. There is differences physically as well and structural, like the giroification (sp?) areas and white matter reduction in connections to the auditory and speech areas. So we are looking at differences neurologically that point to, again, a biological cause for stuttering.

DEPUYTWhen you say the movie, Tommie -- Dr. Robinson, was it -- did you look at the therapeutic techniques, the modalities, you know, with a kind of a chuckle to see, well, that's how that they did it then. Or were there aspects of it that you could see in a therapeutic setting today?

ROBINSONWell, I did have a...

DEPUYTWas it a period piece or...

ROBINSON...it was. I mean, to start -- yeah, it was certainly a period piece because we were a brand new profession then, you know. And looking at his credentials, it was absolutely not surprising at that time. I think that the piece that's the most important thing is the relationship that he had with his patient. That is a piece that is so important to today's therapy. We can teach techniques all day long. But that counseling piece and establishing the relationship so that you get truths relative to what individuals are feeling and what they're saying and the impact it has on their lives. That was the most important things.

DEPUYTPart of it, in talking about George's childhood or traumas from early life, they seem to go at that and then veer away from it.

ROBINSONSure, sure.

DEPUYTAnd I didn't quite -- that was the -- maybe, the one aspect of the movie that I am, like, well, what are they -- where are they going with this?

ROBINSONWell, it was rooted in that old Sigmund Fraud, psycho sexual stages of development and how it played a role in causes. But, you know, if I'm not mistaken, I think what Sigmund Fraud said was, you bring this thing to the service and then you move on. You don't dwell too much on it.

DEPUYTGotcha.

ROBINSONOnce you've brought it to the surface, you have the ideological basis and then you, sort of, move on.

DEPUYTI was going to go to Bill in Columbia but he left us. Let me skip down to Elizabeth in Chevy Chase. Hi, Elizabeth, welcome, you're on "The Kojo Nnamdi Show."

ELIZABETHYes, I wish to share a story with you. I'm a second of four generations of a family that stutters. And I stuttered until a few years ago after spending a year taking a training course at the American Art Museum. I stuttered so badly before that -- I was 46 years old at the time. I'm now 77. I stuttered so badly that I had to write everything. And the more I became involved with having to write everything, the worse it got, naturally.

ELIZABETHBut during that period of time of the training, I had to force myself to speak. I stuttered as I spoke with strangers that came in as we gave tours. But when I started up by telling that everybody has a count and mine is stuttering, then I began to calm down. And it didn't make me not , but it made me stutter less over the years. So here we are from 1976 to 2011 and I am more able to speak without stuttering.

ELIZABETHMy son is a physician. He's a stutterer. He has not been able to correct his entirely, but his personality allows him to go forth. My grandfather was the head of a magazine and the head of the society and could speak in front of all sorts of people, maybe, not a 100 percent well. In his mind, he spoke better then when he spoke with me. When he spoke with me, it was sounding like two machine guns.

ELIZABETHSo the attitude -- he lived to be 81 and he died in 1959. So you…

DEPUYTWhen you say -- I'm sorry to interrupt. When you say that your son's personality allowed him to go forth, what -- tell us what you mean by that?

ELIZABETHWell, he's a physician, but he also speaks all over the country. And I keep saying to him, why do you do this to yourself when you're a stutterer? And he said, momma, I've got -- I'm used to it. He's, what, 53 years old. And he -- his personality has allowed him to eventually make up his mind that it's not going to stop him. He will still stutter when he's giving a speech.

DEPUYTAll right. And so what, Elizabeth, thank you very much.

SISSKINI think what Elizabeth is referring to in -- when she's talking about going out and speaking a lot is this notion of desensitization. And many people who have recovered from stuttering on their own without professional help, have gone out and talked and talking and talking and desensitized the fear of stuttering and to the point where they feel comfortable getting up in front of people and not feeling that stigma and that fear and shame.

DEPUYTWe have an e-mail from a listener in Potomac who says, "My child stutters. Kids make fun of him so much that he comes home crying. The teachers don't seem to care because it's, 'on the playground.' What can he do? What can I do? Are there things that I can do to show the school that this is bullying?"

ROBINSONI think this is a good example where he's got to advocate for his child and teach his child how to be an advocate for himself as well. I think that he needs to work very closely with the speech language pathologist at his school. Develop an educational program in each of the classrooms. Make sure that the teachers are aware of this and that they are monitoring all types of bullying behavior. Bullying behavior is not limited to one thing.

ROBINSONThis is inclusive. And, I think, that education is the most important piece associated with this.

DEPUYTWe'll take another break. We'll come back with more of our conversation with Dr. Tommie Robinson and Dr. Vivian Sisskin. More of your phone calls as well as we continue here on "The Kojo Nnamdi Show." Back after a break.

DEPUYTWelcome back to "The Kojo Nnamdi Show" here on WAMU 88.5 FM. I'm Bruce DePuyt from News Channel 8 sitting in for Kojo today, talking about stuttering with Tommie Robinson, a speech language pathologist, and the former head of the American Speech Language Hearing Association. Vivian Sisskin is here, a professor at the University of Maryland and a speech language pathologist in private practice.

DEPUYTI have never seen phones light up like this in my life. Let's get back to the calls. Akima, I hope I'm saying that properly, in South Riding. You're on the air. Go right ahead, please.

AKIMAOh, hi. My problem is7 I started stuttering when I was young and I had to overcome that by speaking fast. And coming here to America has made it worse, but I -- people, every time they have to try and figure out how --why I speak so fast. And it's funny when I explain to them that I used to stutter, and for me, not the stutter, I had to speak very fast. And also, like right now, I'm looking for a job and everywhere I go they say before you go in, can you speak very slow. And at times I had to pose, you know, I had to think what I had to say and it makes it worse when I do that.

DEPUYTHmm, interesting.

AKIMAAnd my question is if my boss come to me and said (unintelligible) he can't understand you. So I (unintelligible) I don't know how to overcome this.

DEPUYTAnd do you think that speaking quickly is a managing technique?

AKIMAYes, it has. I don't stutter much when I speak fast. It's only that they don't understand me. And when I think about it, that's when I'm like, oh, my God, how do I (unintelligible) so that they can hear me.

ROBINSONAkima, is the rate that you're speaking now, is that fast or slow for you?

AKIMARight now I'm -- my way of -- that I'm talking to you, but when I get excited or when I'm around people who know me...

DEPUYTMm-hmm.

AKIMA...I just go like, everybody like, oh, my God, you speak very fast, how do you do that? And they think that's it's something that I wanna do, but I can't control it.

DEPUYTIt's interesting. I would -- I would describe her pace of speech as normal, maybe a little quicker at the beginning, but then more normal after that, but that's just me.

ROBINSONI think it's a great rate for you, and you should practice speaking at that rate. And I also think that you're controlling quite nicely at this particular rate as well. So you should probably try videotaping or audio taping yourself so that you can get a feel for this rate as much as possible, so you can relate to different situations.

AKIMAYes, I have. Because when I leave a voicemail on my message at work, when I listen back to it, I was like oh, my God, I had no idea how fast I was speaking.

ROBINSONThis is a wonderful rate. It's a great rate for you to manage your speech.

DEPUYTIn terms of job interviews, university settings where you might have an admissions interview, what can we say? What can a stutterer do to convince the person there across the person they're across the table from, that sure, I stutter, but it's no reflection on my smarts, ability to do the job, even if it's an interacting with the public kind of gig. I mean, you know get over it.

SISSKINWe advocate to do the thing that most people fear the most, and that's advertise that they're a person who stutters. But to do it in a very positive way, just like you just did, in a very positive way.

ROBINSONJust like you just did.

SISSKINSo instead of apologizing for your stuttering, I'm sorry if you don't understand me, I'll repeat it, you might say something like, you might hear some hesitations or some pauses or repetitions, that's me. I stutter. And move on with your topic. If you -- if someone asks you about how we would be with oral presentations, you might say something like, I stutter during my presentations, however, I communicate rather well.

AKIMAOh, thank you so much.

DEPUYTThank you very much. I appreciate your call very much. Can you talk about why group therapy has proven to be a successful tool for you in therapy?

SISSKINOh, yes. That's one of my favorite milieu to work in is group therapy. I work with adults and with children in group therapy because of the element of support. A while back Tommie said that if you've seen one person who stutters, you've seen one person who stutters. And I think it's really important to understand that there are individualities, but there are so many commonalities as well. And everybody sitting in the room during group therapy has the same thread of fear of speaking, shame when there's listener reaction. Shame when you show the kind of stuttering that you don't want to show.

SISSKINIn the group therapy setting, the opportunity for support to say, this is what I tried, it helped me. When somebody comes in with a success, I spoke in front of my class. I gave a talk at my job. I ordered the food that I wanted to eat, and everybody goes woo-hoo, yeah.

DEPUYTNow, when you say that, I just want to make sure it's clear to the audience, something I read I think in the New York Times said that people will often order the menu item they know they can say, and not the thing they want.

ROBINSONRight. Right. Right.

SISSKINAbsolutely.

ROBINSONAnd that's the other thing. I used group therapy a lot too, but in addition to what Vivian is saying, I also do role play types of things, you know. If you're gonna go out as a group to a restaurant, let's download that menu and let's practice before we go out and figure out what we're gonna have and that kind of stuff.

DEPUYTSo someone is the waiter and the other person's the customer?

ROBINSONAbsolutely.

DEPUYTNow Don in Alexandria sends an e-mail, and he says, "It's hard to believe that there's no relationship between nervousness and stuttering." He says, "I've had friends who clearly were worse when they were forced to speak in front of group or in other stressful situations. I've not had this challenge, but when younger, I was very shy about public speaking, and would grow extremely nervous in front of a crowd."

SISSKINI think that what most people who stutter would say is that I don't stutter because I'm nervous...

ROBINSONRight.

SISSKIN...but I'm nervous because I stutter. And certainly nervousness, anticipation of stuttering, worry that you will show stuttering, those were all -- make stuttering worse. And there's no question that there's a link between them, but again, a causation is not really there.

ROBINSONAnd it's hard to say, you know, the other piece rather that we can't forget is everybody becomes nervous in oral presentations and those types of things. So it's a matter of ruling all of that out as being a part of a typical behavior and those of an individual who stutters.

DEPUYTUnless you have overweening ego and then you become -- in that case you become a talk show host.

DEPUYTCarly in Washington, you're on the air. Go right ahead, please.

CARLYHi, how are you guys?

DEPUYTDoing great.

CARLYGood. I was actually calling because when I was a young child, I -- and maybe this is my karma, I actually picked on a kid that stuttered, and then I started stuttering. But what happens now, well, like what happened, like, when I was younger, I began taking language classes, like Spanish, French, and now I speak them darn near perfectly, fluently. And I think that the correlation of me being, like, able to pick up on like accents and things that people say helped me speak those languages. However, when I do try to speak those languages, I stutter.

CARLYAnd it doesn't come across as I actually can speak those languages. So I guess what I'm saying is it's been the experience of me trying to talk like this kid who stuttered because actually I thought it was kind of cool, and I actually wanted to talk like that. I picked it up and I did, which was funny, but now I pick up languages and accents really well, and I speak them darn near fluently. But it's (unintelligible) ...

DEPUYTYeah.

CARLY...really, you know, distracts me or it's like the -- it's like anticipation of stuttering that's really bad.

DEPUYTCarly, thank you very much for your call. Go ahead.

SISSKINI can address the bilingual issue if you'd like.

DEPUYTOkay, yeah.

SISSKINMany people who speak more than one language do stutter in both. They might have more difficulty in one than the other, and very often it's related to their comfort in that language.

ROBINSONRight.

SISSKINSo if they have come from another culture, and are now living here, they might have more trouble when they go back and speak their first language, when they go home. So there is variability, but they generally stutter in both languages.

DEPUYTIs this an area where medication is effective? Is there anything out there -- is there anything in the pipeline that could be beneficial in this area?

ROBINSONGo ahead, Vivian.

SISSKINOkay. There's been a number of clinical trials with medications, particularly with medications that alter the dopamine levels in the brain. A more recent trial has been with a drug called Pagoclone which affects the GABA in the brain, and the -- there are a number of trials around the country. There were 16 centers or so, and it was a long-term study of looking at how it affects stuttering. There were some positive outcomes, but not enough I think to convince people that this is the way to go for a good outcome for curing stuttering or getting rid of it.

SISSKINIt reduced the stuttering symptoms about 20 percent, in the clinical trial, compared to five percent for placebo.

DEPUYTWe have an e-mail from Gina who says, "My grandson, an early talker, developed a stutter when he was about two. It lasted a couple months. Now he's almost four and has started reverse stuttering, repeating the last sound of words. Any thoughts on this?"

SISSKINThis happen happens to be my current area of research, so I love the idea that somebody's calling up with final part word repetition. I couldn't have a better day. I will pay that person to come see me in my office. No. Yes. So there are a number of kinds of dis-fluencies that are not necessarily stuttering. I think it's interesting that the caller called it reverse stuttering. We call -- we're calling this atypical dis-fluency, and sometimes we see the final syllable of a word repeated, something like ones, uns, uns, uns, or going, ing, ing, ing, ing, and it's very much unlike stuttering, and we're not calling it stuttering at this point. We may...

DEPUYTAre you calling it dis-fluency, is that...

SISSKINWe're calling it dis-fluency, atypical dis-fluency. We have seen -- there have been case studies of this kind of stuttering pattern both in the typical developing population, but we're seeing more of it in the autism spectrum disorders population. But we're seeing it across both. We just recently did a therapy trial case study with one of these cases as well. So highly unusual, but very interesting.

DEPUYTNile in Vienna, you're on the air, as we go back to the phones. Welcome. Go ahead, please.

NILEMany thanks for taking my call. My question is as follows. Growing up in Ireland in the early '70s where the Catholic church had a huge influence on education, I'm a predominantly left-hander from golf, to pick up a spoon, to answer the phone. When I was -- when I started school at four or five, the first few years of my life my left hand was tied behind my back and I was forced to write with my right hand. And I wonder as I got older if because that happened did it send mixed signals to the brain, and that would have caused my stammer?

NILEWhen I was -- also, I was forced -- I had taken elocution lessons then in my teenage years, and now, as I've gotten older, I have found that there are certain words beginning with a C or an S or a P that I find that I cannot say because I find that there is -- the words were trying to come out, but either there's no air coming out or I find that I find get the word out quick enough because maybe the brain is sending mixed signals.

NILEI'm also ambidextrous, and I just wanted to know (unintelligible) such as exercises or maybe go to a group where I can get some information about trying to help my speech. And I'll take my answer off the air.

DEPUYTThank you.

ROBINSONYou know, there are a number of myths that we had about stuttering, and that was, you know, thinking many, many years ago where we talked about the cerebral dominance theory, and that was disproven. I would think that your stuttering has more to do -- and here again, I really don't know, I don't know your etiology. I've never, you know, you're not in my clinic so I'm just making some -- some guesses here. I would think that your stuttering is more -- has more to do with the neurological organic bases associated with stuttering than the handedness, per se.

ROBINSONSo I would encourage you to seek the help of a speech language pathologist, and get involved in some groups, you know. Call the stuttering -- what is it, the Stuttering...

SISSKINThe National Stuttering Association.

ROBINSON...Association, yeah. There are support groups locally in the Washington area that meet monthly.

DEPUYTWe have an e-mail from Darren in Rockville. "For me, overcoming my fear of stuttering has been one of the most difficult parts of therapy, but also one of the most freeing. Being able to say what I want when I want has been a great milestone in sharing who I am with those around me, stuttering and all." Molly in Washington D.C. Go ahead, please.

MOLLYHi. I just wanted to say that my son, who is now 11, started stuttering when he was two. And then his pediatrician kept saying ignore it, it's normal, it's normal, it's normal, until he started to sob and cry when he was about three and a half, and say, why won't you help me talk. At this point, we started an Odyssey Through Speech therapist, and we ended up with Dr. Robinson. And I just wanted to say, Dr. Robinson, that you changed my son's life.

ROBINSONWell, thank you very much.

DEPUYTThat's great.

MOLLYHe's never stuttered again. He doesn't even remember that he used to. He used to call it bumpy talking, and he says, I don't know what you're talking about.

DEPUYTHave we talked enough about -- and then I don't want to talk about any one person's case, but have we talked enough about what works, about, you know, what you do to get where you want to be?

SISSKINI think it's a wonderful opportunity just to mention some things about young children, and when parents should go for referrals 'cause I think this caller brings up a very good point. Pediatricians know that 60 to 80 percent of children spontaneously recover without any help. They grow out of stuttering without any additional help. But I think the piece that -- they're getting half the story. The piece that the pediatricians are not getting is that most of the spontaneous recovery occurs within six to 18 months post-onset.

SISSKINSo when you have somebody -- a child who has been stuttering for a couple of years, they're beginning to be what we call outside the window of spontaneous recovery, and they should really seek help at that point.

DEPUYTTommie Robinson is a speech language pathologist, and the former head of the American Speech Language Hearing Association. Vivian Sisskin is a speech language pathologist and professor at the University of Maryland. Thank you both for being here. A tremendous conversation, really enjoyed having both of you here.

DEPUYT"The Kojo Nnamdi Show" is produced by Diane Vogel, Brendan Sweeney, Tara Boyle, Michael Martinez, and Ingalisa Schrobsdorff, with help from AC Valdez, Kathy Goldgeier, and Elizabeth Weinstein. Diane Vogel is the managing producer. The engineer today, Andrew Chadwick. Thank you, Andrew. Dorie Anisman has been on the very busy phone lines. Podcasts of all shows, audio archives, CDs and free transcripts available at our website kojoshow.org. You're also invited to join us on Facebook, or send us a tweet @kojoshow. I'm Bruce Depuyt. Good to be with you today sitting in on "The Kojo Nnamdi Show." Thank you for listening.