#60 Stuttering Variables with Dr. Seth Tichenor
“Not only is it okay to stutter, it’s okay to talk about stuttering.”
Listen to this episode on Apple Podcasts, Spotify, Google Podcasts or your favorite podcast platform. You can also watch the interview on YouTube.
BIO:
Dr. Seth Tichenor is a post-doctoral research associate at Michigan State University in the Developmental Speech Laboratory (PI: Dr. Bridget Walsh). His primary research interests include better understanding and predicting individual differences in the experience of stuttering (stammering), understanding how adverse impact related to the condition develops, and determining how moments of stuttering occur in speech. He practices clinically and is actively involved with various self-help/support and international stuttering organizations. He lives in Lansing, Michigan with his wife (Allison), daughter (Lucy), and puppy (Charlie).
EPISODE HIGHLIGHTS
00:00-00:57 - Opening Remarks
00:57-02:26 - Introducing Dr. Seth Tichenor
02:26-04:45 - Getting to Know More About Seth's Story
04:45-07:16 - The Perspective PWS Can Share to Others
07:17-15:37 - Seth Shares the Experience as an SLP who Stutters
15:37-21:22 - What Makes an Effective SLP for PWS
21:22-23:27 - Seth Speaks on Goals for Stuttering Research
23:27-25:56 - Seth Speaks on His OWN Research
25:56-30:21 -Seth Dives into Variability of Stuttering
30:21-34:26 - Variability within One Individual PWS
34:26-35:41 - Seth Speaks on the Role of Anxiety in Stuttering
35:41-38:57 - Uri Shares an Incredible Story of a PWS in Relation to Anxiety
38:57-46:41 - The Trajectory of PWS
46:41-48:43 - Correction versus Support in Speech Therapy
48:43-50:06 - Closing Remarks
RESOURCE LIST
Dr. Seth Tichenor’s personal Website (full of articles, research and more…)
MORE QUOTES
“If I were talking to a parent of a child who stutters and who has elevated ADHD characteristics, I would encourage them. I would help them more deeply understand what their child is going through with stuttering, just because, my own work in stuttering and ADHD has focused on adults yet there is research with kids who stutter and ADHD showing that, for example those children, they need more time in therapy. And that's not their fault. It's just a fact of what they're going through. So just having these open conversations I think is helpful.” - Dr. Seth Tichenor
“Clinicians shouldn't just pay attention to the variability of overt stuttering behaviors. Really all aspects of the stuttering condition can be experienced as variable depending on the person who's sitting across from you.” - Dr. Seth Tichenor
TRANSCRIPTION
Uri Schneider: All right.
This is a conversation worth having, and one that I've been waiting for a good while and persistence pays off. With the privilege this morning, my name is Uri Schneider, Schneider Speech and Transcending Stuttering, to have with us, Dr. Seth Tichenor and Seth I say is coming in, live from the epicenter of all things on the frontier of stuttering research, which is called the state of Michigan.
There's a concentration of researchers and people of excellence doing such incredible work, not to exclude others around the country, but it's recently struck me how Michigan is stacked. So it's a big treat and you've got the Spartan Stuttering Group swag behind you and maybe Seth will get up and do like a presentation on the board for us.
But it's a big treat to have you. Thanks for joining us. I'll do the the formal intro and then we can just jump in and get really informal.
Introducing Dr. Seth Tichenor
Uri Schneider: So Dr. Seth Tichenor is a post-doc research associate at Michigan state university and developmental speech lab. With Dr. Bridget Walsh, his primary research interests include better understanding and predicting individual differences and the experience of stuttering or stammering depending where you are in the world, understanding how the adverse impact, how adverse impact related to the condition develops and determining how moments of stuttering occur in speech, He practices clinically, and is actively involved in various self and support and international stuttering organizations.
When he's not working, he lives in Michigan with his wife and his daughter, Lucy and their puppy Charlie. So there you go. Welcome Seth.
Dr. Seth Tichenor: Hi, nice to be here.
Uri Schneider: Awesome. Awesome to have you. So Seth, like I said, is at the cutting edge and among the other things coming out of Michigan state and the work that he does with Bridget, he's also involved in some really exciting work with with Scott Yarus and others.
And today we'll get a chance to hear from him from the source. About what they're looking at, what they're thinking about, what they're learning and what that means practically for people who stutter and also for parents and for educators and people who stutter and therapists, of course. So one of the big things everyone knows about what touched on I'm sure is like variability of stuttering behavior and impact that's one paper.
And then your latest preliminary investigation looking at ADD, I think that's super interesting.
Getting to Know More About Seth's Story
Uri Schneider: But I'll let you lead with what would you want people to know about you that's not on your bio?
Dr. Seth Tichenor: Sure. So my name is Seth Tichenor. I am someone who stutters. I'm also a speech pathologist and I'm a researcher. So yeah. So years ago my story in a nutshell, I guess I wanted to become an SLP , really because the therapy that I had for stuttering was really quite poor and I wanted, and I had this notion of, saving children from the terrible therapy that I had really, that I think was the impetus for Me wanting to become an SLP yet along the way. I also had to work on myself a little bit.
That's when I finished my undergrad in 2010, I went to the university of Pittsburgh for a post-bacc. My undergrad degree is not in speech and hearing sciences. and that's when I met Scott Yarus and he and I have continued our our really good relationship, for the past 10 years, which is crazy.
It's been 10 years. But yeah that's where I stayed from for my master's. And I've been a speech language pathologist ever since. Really along the way, I, have created a lot of ties to the stuttering community. Cause that's something I really never had when I was younger.
So I think the first person I met who who stutters was at Pitt. So yeah, it, wasn't very connected in the stuttering world as a younger child and adolescent and even in college. Openly talking about stuttering wasn't something I really did. Yeah since I got my masters, I've really been all gung ho in the speech therapy world, I've worked in medical speech pathology.
That was where my CFY was actually, and I really enjoy medical speech. Since I stutter and since I have this stuttering connection, stuttering is really where my passion lies. And gosh, what else can I say? Went back for my PhD, really liked research and that's the world I still live in.
So it's this fun world, where I get to, where I get paid to, as my wife says, I get paid to think and write some of it down. So that's my job nowadays. While also working a little bit therapeutically with people who's who stuttered. So my my primary job really is research at this point.
What else can I say? Yeah.
The Perspective PWS Can Share to Others
Uri Schneider: That's an amazing story, to go from and I know for us, one of the most powerful things is to see young people who stutter who get this crazy idea, like maybe I have some perspective. That the world needs to learn from. And maybe I have some insight as to what would be helpful to other young people.
And I think it's profound and to encourage young people to to capitalize on that, to leverage that inner inside story, like how old were you when you had that thought of pivoting from being on the receiving end of therapy that was less than satisfying to your needs to the idea that you might have a way to contribute to make it better for others?
Dr. Seth Tichenor: It's a good question. When I first seriously considered it, I think I was in college. Because I think the therapy experiences that I had as a young kid in elementary school, I think soured me so much to speech therapy that when I went to middle school and high school, and I had a better speech therapist who wasn't so fluency focused, who, the goal, she tried to, have these more holistic goals that were much more appropriate for me.
Yet I just was not in a place where I wanted it anything to do with that. So I think for the longest time I was soured to the idea yet I was in college that I that I started thinking about it. And I will say that I totally agree. With what you're saying in terms of, I think that's certainly I don't think to be a good therapist for folks who stutter, you need to be someone who stutters.
There are certainly very many good therapists that themselves are not someone who stutters. That said some of the best therapists I know who work with folks who start are themselves folks who stutter so I completely agree. I think there's power in that. I think there's like working with someone and knowing that, they're going through things you've gone through with things that are very similar to what you've gone through, I think, can be a real way to build.
Empathy and understanding in therapy where I mean you Uri as a speech therapist know that sometimes that's the hardest job of the therapist, is really getting that buy-in that connection that that one-on-one trust where I feel like with folks who stutter that I work with, like the fact that I know what they're dealing with helps to build that faster than I think would happen otherwise.
Seth Shares the Experience as an SLP who Stutters
Dr. Seth Tichenor: That said, so on the other side of that, I've certainly experienced and I've had a lot of friends who are therapists, who also stutter, who have said very similar things that, that the most negative reactions that that, that. I've gotten as a speech therapist who stutters have been from speech therapists who don't stutter, right?
Because it's this view of you still have this condition. You're still, struggling with this. You're still working on this. How can you help someone else? And it's just this very closed-minded view that. Really just shows their misunderstanding of what stuttering is. Yeah still lots of that.
And I actually a funny story years ago when I was going through my masters, I went back to my hometown in Indiana and I met my old speech therapist from elementary school and I told her I was going back to school for speech therapy. And her response was you never stuttered this much when you were with me, which is ridiculous when you think about that.
Cause well, yeah. The reason is because you were trying to make me a covert stutter and failing and right. And of course I stuttered now more because I'm more open about it. So yeah. Really it's a weird dynamic, right? Being someone who stutters and a speech therapist yet, I wouldn't trade it for anything.
Uri Schneider: Well, Seth, if you don't mind, before we jump into the research, there's some really great stuff you just said there. So could we just stick on this for a little bit? Is that all right? Sure. Of course. Here's an ironic one for you. I'm going to do some advertising right now, full disclosure. I don't stutter.
How's that? So the irony is that often we talk about the benefit of openness. So sometimes I'm asked and I think of it as honestly, one of the greatest compliments, which is also ironic when parents or people who stutter say, wow, you really seem to get it. You must stutter, oh, okay, but your dad stutters.
Like he really gets it. And I think there's something there to Seth's point. And I just want to piggyback on that, that and I love how he flipped the starting point of what makes more sense in the sense that. Let's start with the idea that someone who stutters has the lived experience has insight that cannot be taught through a textbook.
They know what it's like to stand in that place and to have that experience. And then Seth was very compassionate and encouraging that you don't have to be a person who stutters to be a good therapist for others who stutter. And yet obviously our field is filled with people with the best intentions, but not all are dedicated and understanding and skilled in what it takes to be good at being an ally and a guide for people who stutter. But I just think it's interesting too, instead of starting it at the reference point of how could someone who stutters be a good therapist, maybe. Yeah. That's really interesting to say how could people who don't stutter get to that level?
I think that's
Dr. Seth Tichenor: really cool.
Yeah, in fact tha t question is also , something that we who work in stuttering would love to help non stuttering clinicians do, right? Like we want to help clinicians be or effective, more compassionate better better therapists better stuttering allies.
It's just, it's a very hard thing to do. It's a hard thing to It's a hard thing to train. It's a hard thing to work on yet. I think a lot of good work is happening. It's just, I think it's hard because it's hard seeing the benefits and the change over time. Sometimes when, you still have, when you still have conversations with clinicians at ASHA, who come up to you and they're, surprise you stutter in your work and you work in stuttering, right? So it's hard seeing, or, feeling the positive change that I know happens and is happening. While you're still interacting with folks, who's still just who still just don't get stuttering.
That's a lifelong thing to chip away at.
Uri Schneider: And as much as one could say, If someone who stutters is being taught to be fluent, and there's some sort of logic there. If you don't stutter, if you're fluent, you'd be a better communicator. There are plenty of fluent people that are not very good communicators, right?
So there's a fallacy there. I think there's also the fallacy that not every person who stutters is a great therapist for others who stutter. So I think there are some common core ingredients, but I loved what you said. And I think it's food for thought whoever's listening or watching. What are your thoughts, in terms of what would you like to see practically incorporated into a world where there are more guides who are empathic and skilled and professional able to create opportunities and to advocate and to open doors and to change the culture in a community, in a classroom, in a greater community, what are those things and how could that happen?
And I'm excited to see, and I haven't been able to get enough of your attention, Seth, but hopefully I will for the Transcending Stuttering community of therapists that are coming together through this cohort learning and growing through an ongoing community that goes over time and uses a framework so that you can really personalize and individualized what you think and the way you engage different people.
And you incorporate the stages of change and you incorporate the family. And as you said, a therapist could even have the right goals. But if they're pushing it at the wrong time, you weren't ready for it or in the wrong manner. If someone's pushing self-acceptance for a 14 year old, it's tough because at 14 developmentally you want to just fit in and the way self-acceptance is going to get flexed or explored needs to be done in line with that age.
That stage that maturity and also that own person's journey of what they've been through and what they haven't. So I just want to make one plug for the Transcending Stuttering community. That is what we're doing and it's, and the most beautiful thing, Seth, that I love to share with people like you and others.
One of the complaints I got was that we have a community of hall of fame, ASHA fellow level clinicians. We have mid-career people and we have people just at a school. We also have a beautiful collection of people who represent. Much needed representation and diversity is lacking in our field that needs to be worked on.
And we also have a lot of people who stutter, who are those SLP professionals, who are also people who stuttered. So one complaint I got in the breakouts, someone said to me, listen, every time I go to a breakout, I don't ever get to be with someone who's a professional and a person who stutters. I want to be with those people because they know what's up.
So in our community, that's the culture and feeling is that those are the people that have wisdom that needs to be heard. And that's part of the whole emphasis of this whole series and conversation here.
Yeah.
Awesome. And the other thing that's cool about you Seth, and I think I just want to highlight so that people, when they read your stuff and if you're not reading stuff, you should chase it.
And he has an amazing website I think is pretty outstanding where he's put everything together. So I will drop it in the notes, but I'll just tell it to you as well. Or sethtichenor.com, right? sethtichenor.com. If you see the title of this, you can just see how he spells his name. And it's sethtichenor.com and he has all his research there, so you can pour through it, but what's cool is some people are in the ivory tower and they're not clinically active, not even clinically certified. So I think it says a lot when someone is able to dance both in the world of research and teaching at the highest levels and also, meeting people where the rubber hits the pavement, frontline meeting them where they're at. I think that makes you a better clinician and a better researcher. Power to you
Dr. Seth Tichenor: you're one of my heroes.
One of the things, yeah. One of the things I always say is I don't, yes, my primary job is research and I really like research stuff.
But I also never want to give up. The the one-on-one interaction I get in therapy. There's a reason, that I became a speech therapist and I have my C's and I don't want to give that up ever. Yeah it's hard juggling multiple balls. But I think you're totally right where me being a researcher makes me a better clinician and me having that clinical groundedness and maintaining that helps me in my research for sure.
Totally.
What Makes an Effective SLP for PWS
Uri Schneider: There was another thought. I was just going to throw out there just as a food for thought for anybody, but also it piggybacks off of what you said. And I love listening to the guests that we have and you're right up there. One of the, one of the targets that we have in is Transcending Stuttering, and the metrics that we have for the speech therapist is not only do you know the research, not only can you set an established goals and write good reports, are you a person that's ready to get out of your comfort zone?
Are you able to model problem solving? Are you able to model and embody so many of the things that we ask other people to do? So when we're on one side, the professional side, the guiding side for someone who's looking to be their own hero, we tell them all kinds of things. We feed them, all kinds of things.
If we don't stutter, we better be human. We better be real. We better be people who know how to grapple with our own stuff. And I think if you're not a person who stutters and you haven't been grappling with that, as your obstacle as a part of your development, we all have something. And I think that as parents, as adults, as teachers, the more we can be open and honest with our own vulnerability and how we've adapted, where we still want to get greater.
When we bring that into our interactions, forget about professionally with our own kids or with young people in our care or whatever young people get it, that authenticity is going to go so much further than trying to project some sort of like fake plastic perfectionism as it's, I've got it all figured out, so I think everybody can leverage that. Whether you stutter, you don't stutter. That's what makes you.
Yeah.
Dr. Seth Tichenor: It's funny because what we, what you and I thought we were going to talk about, isn't what we're talking about, but that's completely fine. Like you're describing what I think is really effective and good stuttering therapy.
And I think one of the hard things about showing students and teaching students what it's, what good stuttering therapy looks like? What it's or how to be an effective stuttering clinician is that I think more so in maybe this is more true in stuttering than in other domains in our field.
Yet, there truly are no cookie cutter approaches to stuttering where like this person who's across from me. Like yes, there might be similarities with, these other individuals I've worked with, but how I treat this person is completely individual to who they are as a person.
What they've gone through, what they're going through right now, how they're thinking about stuttering and how they've thought about stuttering, it's this whole conglomeration. And how, and the best way to engage this person in therapy is so individualistic. And I think that's what makes stuttering therapy really hard on the one hand yet.
I also think that's what makes it really rewarding. Because you get to do this very this very individualized sort of treatment that is very conversational. It's very, back and forth. It's this, interaction between you as a clinician. On the other side, I think it's also what sets folks who don't do a lot of starting therapy off it gets stuttering therapy as it's,
Because it's hard to just jump in and treat, without recognizing how this fluid exchange works.
Totally.
Uri Schneider: So it's funny, you said we're not talking about what we said we were talking about, but that's exactly what you told me we were going to do. We're just going to flow.
So here's a funny graphic. My dad sent me yesterday, which captures that thoughts app and also the way stuttering therapy looks in my life. So I'm just going to share my screen. So this is the plan and this is the process. And I think to set point, like I think a lot of therapists would love to see a linear.
Here are the steps of the hierarchy we're going to follow, and we're just going to go like this. And it's just going to look like that. And that's the way things are going. What could go wrong? Seems reasonable. And then on the other hand, as you said, if we understand that the process for all of us looks more like that, I think the challenge, and again, I think the magic of what the Transcending Stuttering community is about is first of all, different people, different perspectives, but the framework you've got to have something that helps you navigate through a labyrinth like that, because otherwise, as you've said, it's going to be exhausting and frustrating because you just keep hitting a wall. So having a way to find your navigational way through that, I think is key. And as you said, I think it's both meaningful, but also stuttering therapy's for me, I'm just saying what keeps me on fire,
the curiosity to see how this same experience, the same condition, the same treat. And this is by the way, this is an alley-oop Seth t o variability . The same thing on the one hand represents or expresses itself differently for different people in the physical sense. And then of course, the way it interacts with their psychosocial, emotional life, it can impact two people so differently.
I often give the analogy of if I got a coffee stain on my shirt and another person got a coffee stand on their shirt, same steam. One of us might, I won't say who to, one of us might run home and not be able to carry on the day without changing our shirt. And the other one would be like, perfect it matches the other spot. And that's a great way that I often talk to parents that why temperament matters and so on. So the same physical experience can be experienced very differently and both experiences are valid, but it's more than just measuring what's at the lip. So for me, it's the curiosity of seeing the interaction between understanding the scientific condition, the genetics, the neuroscience, all of that.
And then on also understanding people and humans and how humans grow and struggle and persevere.
Seth Speaks on Goals for Stuttering Research
Dr. Seth Tichenor: That's also, I think one of the more exciting horizons of stuttering research that I'm excited to be a part of and to see is just so much more work on individual differences in stuttering, because I think, so I think this is a fair statement.
Saying that the vast majority of research in stuttering has focused at the group level, right? How is this group of adults, kids, preschoolers, who stutter fundamentally different from this group of other adults, kids preschools who do not stutter. And certainly there's a lot of value in, in these larger group differences and we've learned a heck of a lot about the stuttering condition through those, through those sorts of research paradigms, that I'm really excited to focus more on what makes this person , who stutters, experienced stuttering differently from this other person who stutters.
Cause I think that's where for a lot of these of these clinical applications in. In how do we more effectively treat this specific sort of person? That's where I think we're going to learn a lot. For the next five, 10, 15 years of stuttering research, I think we'll go in this direction a lot.
And I think a lot of research is already going in this direction really focusing on individual differences. So it's an exciting time that I'm excited to be a part of.
Uri Schneider: Listen. I think COVID made everything really exciting. There were a lot of things this year that were pretty exciting, challenging.
But there's no doubt. We're in a time in the world where new things are emerging and we're being catapulted forward. And I think that for those of us that stayed healthy and can keep our dignity and can grow through this. Yeah. On the other side of this, I think certain things like this interview and this episode and this podcast and, zoom and normalization and acceleration of things that otherwise would have taken much longer to become the norm are incredibly at our fingertips.
So not the next five to 10 years, but how about for the next five to 10 minutes?
Seth Speaks on His OWN Research
Uri Schneider: What can you tell us about your thoughts from your findings and from your forward thinking about what you've done on your own and with Scott looking at variability and maybe bringing us what you uniquely have is a connection between the research and then frontline, how people, parents professionals might be able to put that into play.
Dr. Seth Tichenor: Sure. That's a large question. So I'll chip away with it.
Feel free to take it anywhere
Uri Schneider: you want. You can make it as, you can handle the big questions. I'm just tossing it at you, take it where you want.
Dr. Seth Tichenor: I'm just saying, feel free to, say more specific things if you need to. Yeah. Scott and I,
Dr. Yarus, is my PhD advisor. He and I started this project, gosh, three or four years ago now where , where the goal was really to use surveys, widely distributed to adults who stutter really to better understand adverse impact related to the stuttering. And when I say adverse impact, really, the negative thoughts, feelings, behaviors that result or arise from just living with this condition from just being a person who stutters and the real world limitations that stuttering causes in your life. So when I say adverse impact, it's this very broad term, right? It's these negative personal reactions and the broader limitations of living with stuttering. So really this project, we wanted to understand one what is adverse impact?
What are these larger forms of it? What are these more nuanced views? Because, really, we don't know a whole lot about what it's like living with stuttering. We don't know a whole lot about how people cope with stuttering, . What leads an adult who stutters to react more negatively to stuttering in their life.
What are the risk factors associated with that? And also on the other side, one of the more protective factors, right? What helps someone react less negative, negatively to be more resilient, to where stuttering. Yes, they stutter. Stuttering, isn't that big a deal in their life.
What makes that person experienced stuttering in that way so that we can help other people who stutter, experienced stuttering in that way. So we've we've done a lot of surveys on this topic. Really just chipping away at that central question.
Seth Dives into Variability of Stuttering
Dr. Seth Tichenor: You mentioned one of our more recent ones that specifically focused on variability. Certainly for decades, right? Like researchers and clinicians have certainly paid attention to the variable nature of more overt stuttered speech. So like randomly today, I think I'm having like an easier talking, an easier talking day, I'm not trying to be fluent. It's just a, like for whatever reason talking isn't as hard know hard today as it might be on some other day. That's just a fundamental fact about stuttering, right? It's just highly variable. That. That sort of core characteristic has has for many years play clinicians who have tried to count and assess stuttering, so that they can get this real or true full measure of someone's stuttering.
Yet, Yet, we really don't know a lot about how these how these other aspects of the condition are variable. So how variable is adverse impact, are some forms of adverse impact, less variable are some forms, more variable? That's study really looked at that question.
And found the overarching highlights was that yes, more overt stuttered speech is highly variable. Yet these more internal aspects of stuttering, like physical tension or more covert forms of uttering switching words, avoiding situations, things like that. Those are still fairly variable and experienced as fairly variable significant, by significant population of adults who stutter what is least variable is how much stuttering affects you, overall. So are you more negatively affected, less negatively, actively effected that sort of construct is more stable over time yet? There's still a lot of people who experience a fair degree of variable variability even on those measures.
So I think the takeaway from that study that you mentioned really is that clinicians shouldn't just pay attention to the variability of overt stuttering behaviors. Really all aspects of the stuttering condition can be experienced as variable depending on the person who's sitting across from you.
So it goes back to what we were saying before. There are no cookie there are no cookie cutter approaches, right? This person who's sitting across from you you as a clinician should assess their experience of stuttering with respect, to with respect to all of these factors while also having, while also having it in the back of your mind that how stable these factors are in this person really is an open question.
Uri Schneider: So I think it's a, such an important overdue exploration that you and Scott are really, breaking wide open and shedding a lot of light. We're talking about the variability within a person of the, like you said, you might wake up one day and it's a pretty sick stuttering day and you might wake up another day and it's like slightly cloudy, but mostly sunny.
And not as much physical tension and not as much stuttering on the surface stuff going on. Not because you're managing it, but just because that's the way stuttering is I like how Chris Constantino says, "stuttering can be defined by the thing that never behaves the way you want it to."
You want it to come on hot and heavy. You're ready for it. It ain't showing up the day that you just pray. This is going to be the day that it won't mess with me. Boom, big and proud, big and loud. And that doesn't dictate how you deal with it. And that doesn't dictate what kind of day it's going to be.
But the nature of the thing it morphs, it's not, it doesn't follow that line. So another interesting thing, which I don't want to go into yet, but also is the variability person to person. But what you're talking about is variability within one person, right?
Dr. Seth Tichenor: So it's really both, yes. Yes.
How someone experiences stuttering changes certainly day to day, minute to minute, hour to hour yet, yet there's also a whole lot of variation in how this person experiences stuttering compared to this other person.
So it's really both,
Uri Schneider: Right.
Variability within One Individual PWS
Uri Schneider: So let's go down the whole of the individual person for a second.
I would love for you to maybe just add your thoughts. People will often say if I'm seeing a lot of variability in this person, or maybe thinking about themselves, Maybe that suggests I'm not stable. Maybe that suggests there's something not right with me or something not right. Could you reflect on mental wellness, emotional wellness, physical wellness, any thoughts about the pillars that might be going on for a person, whether stability of or the variability of stuttering relationships to that?
Would you like to just, I think, cause I think one of the misnomers is that someone who stutters is an anxious person. And they must stutter more because it's sitting on top of anxiety at those moments. A lot of people come up with ideas of how to make sense of this. And I was just wondering if you wanted to just share some, myth busting information, and then maybe any information or insight that might be useful for people.
Dr. Seth Tichenor: Yeah. So I think, one of the things I think is frequently, one of the first steps in therapy is just this, helping to tear down those misconceptions of what stuttering is, what it should be, what it clearly isn't. Because I totally agree. Where, like you'll have folks who stutter who were very frustrated that what they're experiencing changes. It's not constant. And the the natural conclusion is then it's changing. It's not constant because I'm doing something wrong or something I shouldn't. So it's it's, separating out those things I think is actually very powerful, right?
Incredibly powerful, otherwise you
Uri Schneider: get into a shame machine of shoulda coulda, woulda, this wouldn't be happening.
Right exactly.
If I would do what I'm supposed to or, someone tells me I should just do this, and then everything would be fantastic. And that's just a vicious cycle of beating yourself up and it's not factual.
Dr. Seth Tichenor: Helping someone really be mindful of separating out what is happening to them for versus how, what they are doing. As a reaction, I think can be what's the word I'm looking for? Relieving almost right.
Uri Schneider: A big relief talk. People talk about it as like a relief off their shoulders, because there's the feeling that you're dealing with something challenging.
And then there's a feeling on top of that feeling. I'm not dealing with it the way I should be dealing with it. And then there's the guilt that it just compounds upon itself. But when you just demystify, you see what is and what it is. That in and of itself relief just a weight taken off the shoulders and it, you still contending with and choosing how to adapt, but at least you don't have all these extra layers.
Dr. Seth Tichenor: One of the things that, or one of the things that van riper talked about in, decades ago was, was helping someone who stutters in therapy realize one, what's not their fault. And two, what they're doing, that's either helping or not helping. And I think so much of stuttering therapy falls along those sorts of decision trees, because, when you're stuck, when you're in a moment of loss of control, like just helping someone realize what they're doing, I think can be just a huge game changer in helping them react less negatively.
And again, that's really, that's really the goal. These, a person who stutters. I have neurophysiological differences in my speech and language networks that have people who don't stutter don't have, right? So none of that is my fault.
And what I can control right, is everything I layer on top of that sensation that my speech and language has gone wrong for that millisecond. Learning to react ness less negatively, I think really is the goal. Yet that's a very hard thing to do.
That's a, that's a lifetime of work.
Seth Speaks on the Role of Anxiety in Stuttering
Dr. Seth Tichenor: One thing I did want to comment on really quick you're is that you brought up the anxiety piece. I think I would push back against the idea that. That as a group, like you see these this group of people whose, who stutter are fundamentally more anxious in this group of folks who don't stutter.
What I would say is, like he we've been talking about anxiety, Is a very common reaction to just dealing with stuttering. That said certainly there are people who stutter who do have these high levels of just baseline anxiety, just like we see in the normal population. But I would push back against these, like hard line hardline interpretation that, anxiety is this fundamental characteristic of the condition. Certainly it can be in some people who stutter. You get it still in an individual assessment.
Uri Schneider: If there was any confusion I'm with you a thousand percent. I'm thinking about the intra-personal experience. I'll just give a quick anecdote and then I'll pitch that one question.
Uri Shares an Incredible Story of a PWS in Relation to Anxiety
Uri Schneider: and we actually, it's a good lead in also to ADD, because ADHD also has to do with, different biochemical differences in the brain and how that relates to stuttering. And I think there's some intuitive and some counter intuitive findings there. And also often comes down to variability within groups of people that share these two traits.
But I was at a wedding of someone who stutters. He was one of the people who stutters that stutters the best I've ever met. Meaning super strong, super intense, super frequent. And for him, the combination of that experience, coupled with very unfulfilling and hurtful experiences in the hands of people who I think meant well, but he describes his self-worth as below zero.
When we met, he was like 17, 18 years old. And long story short, we never would have worked together and we ended up working together on zoom. And he got married and at his wedding, I had the privilege to dance there. And I think, talk about goals for therapy. I think has anyone ever thought of that as a goal?
Young person thinks they could never be a father, young person thinks they can never get married. Young person thinks they can never get a job as a police officer or in the military, how cool would it be? To like measure progress towards the ability, how much, and you have this in the Oasis, but if we could personalize it.
How much do you agree or disagree with these statements? And if you have a dream of getting married, like boom, you're dating, that's huge, that's already progress. So it's not that the marriage is an objective goal for everybody, but for the individual person, that was something that was out of his realm of dreaming.
But the cool thing is he still stutters beautifully and Oh, I see you got, I just I'll tell you. When I met him, I said to him his family sent him and we met on zoom by himself. They said he stutters so much. It'll take him quite a long time to get one sentence out. And there is a time constraint in our appointment.
So I said, why don't you have him just right ahead of time, if he chooses to, what's been his relationship with stuttering since he was young. And what evolved was, I got a message before the appointment. It was like 10 pages handwritten. They were not a very tech savvy family. So handwritten first time he'd ever written that much.
And I read it back to him in our first meeting. And I said to him, you've got an amazing ability to express yourself in writing. I think one day you're going to write a book. You got to keep all these papers. And I have all of them. Now it's like a hundred pages. And you got engaged. He's been interviewed for two magazine articles and he uses his name proudly as a person who stutters and at the wedding.
He's a person who stutters and he still stutters in a community that is not the most known for seeing diversity as something to celebrate, let's say, or different abilities as being embraced as easily as it might be in other communities. He is an all-star. And what people ask me all the time is how does he have so much courage?
How is he, so how is it possible? One human being can be so strong. And I think it just, again, turns on its head. He does not have anxiety. Okay. He has a very strong stutter, but he's one of the least anxious people I've ever met. And as Seth is saying people who stutter coming all stripes and all colors, shapes, sizes, and everything.
So looking at people individually is so important.
The Trajectory of PWS
Uri Schneider: And to bust that myth right up front my question, and you can come back to it or we can move. Was, are you in favor of what are your thoughts of, for someone who is experiencing stuttering, looking at overall wellness? As something that could be useful.
Cause last week we spoke with Michael Sugarman. We did a whole thing on mindfulness. We talk about physical wellness and fitness and diet and exercise, not as a cure and not as a standalone, but as one of the influencers or factors that can help a person.
Dr. Seth Tichenor: So I think that ties in with, why I'm interested in the broader forms of adverse impact anyway, is because I think this umbrella of adverse impact is much larger and more nuanced than I think we, as a field, as speech language pathologists generally think it is right. I, I think the common view in just everyday clinicians is that the negative results of living with stuttering are speech. Are just speech related or I think there's so much broader than that, right?
So you brought up the ADHD study that we just did, right? Folks who have concomitant conditions like ADHD and stuttering they experience so much more adverse impact related to this stuttering. I have, one of the things that's one of the papers that sitting on my to-do list last year, Scott Yarus and Scott Palasik at the university of Akron, we did a study on suicidal ideation.
If this is a topic that's, that's very near and dear to a lot of our hearts too, because those of us whose for those of us who stutter his topic is often triggering, right? Just because it's real and this study. The the main result is that, for folks who have higher levels of adverse impact related to stuttering, higher levels of suicidal ideation.
There's also there's also a ton of research. That's coming out on these larger life consequences of living with stuttering, such as, not going into the field. You want to go in not having the salary you want. The list goes on and on one study that I think I'd love to do is actually something you mentioned with your client, you were describing about, Hey, Hey, I can't get married because I stutter, Hey, I can't have kids because I stutter one of my very best friends, that's exactly his view.
He's purposefully not had children just for fear of passing on stuttering. And. And that's his choice, it's a real concern yet. I think it shows the larger life impact that stuttering can have on a person's life that we as clinicians we don't frequently think about. Generally.
Uri Schneider: Yeah. And I think, from a clinical point of view where that, that last anecdote you shared just hit me really hard. I'm thinking of. So what would be the change? What would potentially open that up for somebody that age, I hope he's in his twenties, at least when he's thinking about having kids or not having kids, but okay.
Whatever age he is obviously it would be best. That's not a conversation at age 25, what experiences would help that person at what point in their life to open up the constructs of how they look at what's possible in life and what they entertain and what they don't. So certainly, as you said, Most of us just don't think of that.
So we're meeting the four or five, six year old, and whether it's explicit or implicit, we're messaging an intolerance and that's passed on and transmitted whether it's explicit or implicit. And I think just
exactly.
To me, that's a very nuanced way of saying what I think are other ways that are spoken about that are maybe a little more strong and forceful and loaded.
I just think for all of us to think about the messages we send, all young people. And what that looks like when you roll that trajectory forward, like 10 years, 20 years, and two degree, a two degree difference. You roll that forward five to 10 years. It looks very different. It's very far apart because of that time.
What are your thoughts about what could make a difference for that parent teacher? That therapist meeting that five, six, seven, eight, nine, 10, 11, 12 year old.
Dr. Seth Tichenor: So this is
a fantastic question and it's something I don't have an answer for yet. Yet Bridget Walsh and I, we are doing a longitudinal study just on this very topic.
How does adverse impact change over time in children? How does it develop? So we're doing a longitudinal yearly surveys with children, age three to 18, just the whole wide gamut of stuttering surveys for kids. Surveys per for parents surveys for SLPs. We're wrapping up year one of the project and we already have a hundred and 160 some families, I think.
So it's a really good, exciting project funded by the NIH. If you'd like to participate, send me an email Set@msu.edu. I'm happy to connect you. But we're going to learn a ton about, exactly what you're saying, what makes this child more at risk later in life? And I think I hope through this project is that, we can find these red flags that we can identify these children earlier.
So that we can prevent these more negative effects of stuttering from occurring later in life.
Uri Schneider: As you said, we don't have the answers, but being mindful of these things is like more than half the battle in my opinion. So once you understand what's at stake, you're going to be more thoughtful.
I just, would you agree, Seth? I just want to, I'm listening to our conversation and I'm also thinking about a parent of a young person who stutters or a teacher and I'm thinking how it could hit them. Just so we're clear the child who stutters one, shouldn't start to connect the dots and think they're going to have suicidal ideation, correct?
Dr. Seth Tichenor: Oh, no, I'm not saying that. I'm just,
Uri Schneider: You didn't say that but I just want to, from your own words, someone, a kid has add in a kid who stutters, he's got both of those gifts. And so from a research point of view, looking at that population that share that trait, there's a higher rate of people that can end up having very negative thoughts to the point of.
Going to the suicidal ideation side. And then,
Dr. Seth Tichenor: So the suicides, it is a separate study from the ADHD study. So those things don't go together. But what I would say for a child of a kid who stutters and who has elevated levels of ADHD characteristics, certainly that child may have a harder time with stuttering just because of who they are, they're dealing with these multiple conditions.
If I were talking to a parent of a child who, who stutters and who has elevated ADHD characteristics, I think I would encourage them, I would help them more deeply understand what their child is going through with stuttering, just because, my own work in stuttering and ADHD has focused on adults yet there is research with kids who stutter and ADHD showing that, for example those children. They need more time in therapy. And that's not their fault. It's just a fact of what they're going through. So just having these open conversations I think is helpful.
Uri Schneider: And the tone of that therapy, would it be fair to say set?
Correction versus Support in Speech Therapy
Uri Schneider: The tone of that therapy is also to be, to provide that longitudinal or long-term support more than correction. In other words, a lot of people think more therapy, more fixing. Would it be fair? Like the thinking about those kids deserving more time is to give them that supportive space.
Sure. I think that's fair. .
Dr. Seth Tichenor: Generally when I think of effective stuttering therapy it's in terms of support, not correction, correct. Yeah. Yeah. No, yeah, for sure.
Uri Schneider: Yeah, I was just thinking, so Seth. Seth's work is so critical and I encourage everybody to follow, sethtichenor.com, that's the site.
Yeah.
And you can contact him through there to participate in some of these studies. One thing that happened this past Sunday, I met parents of a kid who fits a similar profile of a couple of things we talked about. And the first thing we do in the Eval, what's the first thing we want to find out.
We're not measuring stuttering. We asked the parents, tell us three things about this kiddo. Something either as a characteristic, a strength and accomplishment, a hobby, whatever. So the parents oh, you want him to answer? No, we want you to answer, okay. You want him to answer? It was as if there was a misunderstanding, so no, we want you to share.
And the dad started going and going. He had such a long list. And then he says to himself, as he's saying, this list is, I don't think my son's ever heard so many things, so nice. So good. So complimentary. And I was like, So I think, yeah, exactly good job and put a spotlight on that. And I think one of the ways that we can minimize risk and really look out for some of these adverse experiences is by looking at what are the beneficial, favorable advantages to shine a light on the strengths and to shine a light on the things that a young person can leverage and celebrate.
In addition to everything of who they are. But certain things can come hard, but they should also be celebrated and in therapy and in talking about things that are hard, celebrate the things they're great at. And then that's what they're going to see when they look in the mirror. That's what they're going to identify with.
Closing Remarks
Uri Schneider: So I think your work is informing our work and really moving the field forward. So I want to thank you for that. Any final wisdom that you want to just leave everybody with a thought or a hope or a indication of what's coming or what you're wishing,
Dr. Seth Tichenor: I think one of the things I always tell adults families, kids who stutter it's okay to it's okay to talk about stuttering.
And not only is it okay to stutter, it's okay to talk about stuttering. So that's my final word of wisdom.
Uri Schneider: What better way to finish a podcast called transcending stuttering. That's all we do. So I'm glad it's a good thing to talk about stuttering. So if you're interested, I'll make one last mention.
Transcending stuttering for SLPs. The cohort community is rocking and you can check at schneiderspeech.com/SLP. We welcome you to join the community. And if you're a person who stutters or someone who cares about people who stutter, you can get more free information and more at schneiderspeech.com/TSA.
Thank you, Seth. It's been it's been a treat looking forward to the next time.
Dr. Seth Tichenor: Yeah, thanks for having me. This was fun Uri.
Uri Schneider: I appreciate
it. Thank you so much, everybody have a beautiful day. Stay safe, stay well. Hopefully we'll see you at the NSA conference in Austin, in July and or the friends conference in Colorado in July.
For those of you that can check those conferences out. Those are amazing opportunities, both for people who stutter and for professionals.