Listen to the lessons of The King's Speech
A film that shows King George VI struggling with a stammer could raise awareness and change treatments, says Peter Howell.
The recently released film The King's Speech
looks set to sweep the board at the Oscars later this month, and actor
Colin Firth has been widely praised for his depiction of King George VI
as he seeks to overcome a debilitating stammer. As a scientist who
studies stammering (or stuttering as it is also called), I liked the
film. Many people still poke fun at those who stammer, and find their
difficulties amusing. Perhaps the film's success, with raised public
awareness of the condition, will help to address such prejudice.
We cannot be sure of the accuracy of the historical events the film portrays, although many of the scenes seemed to me to ring true. In many ways, we understand a lot more than we did in George VI's day. In others, we are just as blind. Although 1 in 20 children stammer, most grow out of it. Of the 1 in 100 people who still stammer as they enter their teenage years — including, it seems, George VI — few go on to recover. For them, it becomes a question of how to manage the condition. This is an important lesson from the film: we should not give false hope to the parents of children who are unlikely to recover from their stammer.
Techniques to control stammer in adults can be effective, as the film shows. But without spoiling it too much for those who have not seen it (and you should!), it is fair to say that getting people who stammer to repeatedly shout rude words would no longer be suggested as a technique, if it ever was.
Those who stammer, however, do often find they can speak fluently when they are prevented from hearing their own voice. The film illustrates this when George VI is shown speaking fluently when music is played. Playing their speech back to people in real time, but delayed or shifted in frequency, can also help. We still do not fully understand why this happens, but prosthetic devices are available that produce this effect and bring about improvement. The most discreet of these cost up to US$5,000, although opinion in my community is divided as to whether such technology is appropriate, because the stammering returns when the device is switched off.
More controversially, some researchers believe they can induce fluency in people, children in particular, using verbal operant procedures, similar to the reward and punishment techniques used to train dogs and other animals. The most common of these is the Lidcombe Program, developed by researchers at the Australian Stuttering Research Centre at the University of Sydney. Although some data suggest that the technique works, the numbers are too low to draw firm conclusions. A major sticking point is that there is no commonly agreed method to diagnose the disorder in childhood. The Australian group considers children who commonly repeat whole words as stammerers. In my view, this is wrong and could skew the results.
Much of the controversy over treatments such as the Lidcombe Program and prosthetic devices centres on whether the benefits linger when the treatment ends. Such carry-over would demand that stammering is at its heart a learned behaviour that can be undone. I do not think it is.
So,
what causes people to stammer? And how can we distinguish between
children who will recover from their stammer, and those who will not.
These are questions of great importance for both sufferer and society.
Comparison of people who do or do not recover suggests that several
factors are important. Biological (genetics and brain differences),
linguistic and motor factors, and type of stammering symptom are
reliably reported to differ between such groups.
Much attention in the media has focused on a 'stuttering gene' after the discovery of genetic mutations in members of a consanguineous (inter-marrying) Pakistani family. The gene identified codes for proteins involved in cellular lysosome function, which removes damaged molecules and viruses. Other geneticists, including Simon Fisher, director of the Max Planck Institute for Psycholinguistics in Nijmegen, the Netherlands, point out that the lysosome function is broad and more research is needed on how it could affect the central nervous system of people who stammer.
A study on a Chinese family suggests a more plausible genetic basis, as it reported mutations in genes that seem to affect parts of the brain (the basal ganglia) previously implicated in the disorder.
My work has shown that the severity of stammering symptoms in eight-year-old children can be used to predict whether the children are likely to still stammer as teenagers and adults. Wider discussion is needed about how this information should be used by therapists — for example, whether to intervene with treatment. As most people will recover in time, watchful monitoring of children for signs that their stammering is worsening may be a better approach.
If Colin Firth's performance is a fair reflection of George VI's speech, then the types of stammer he produced — prolonged consonants and repetition of the first part of words — would, as a child, have suggested he had little chance of recovery. We should make more effort to pass this information on to parents. Expectations must be realistic, but, as The King's Speech shows, they can still be optimistic.
We cannot be sure of the accuracy of the historical events the film portrays, although many of the scenes seemed to me to ring true. In many ways, we understand a lot more than we did in George VI's day. In others, we are just as blind. Although 1 in 20 children stammer, most grow out of it. Of the 1 in 100 people who still stammer as they enter their teenage years — including, it seems, George VI — few go on to recover. For them, it becomes a question of how to manage the condition. This is an important lesson from the film: we should not give false hope to the parents of children who are unlikely to recover from their stammer.
Techniques to control stammer in adults can be effective, as the film shows. But without spoiling it too much for those who have not seen it (and you should!), it is fair to say that getting people who stammer to repeatedly shout rude words would no longer be suggested as a technique, if it ever was.
Those who stammer, however, do often find they can speak fluently when they are prevented from hearing their own voice. The film illustrates this when George VI is shown speaking fluently when music is played. Playing their speech back to people in real time, but delayed or shifted in frequency, can also help. We still do not fully understand why this happens, but prosthetic devices are available that produce this effect and bring about improvement. The most discreet of these cost up to US$5,000, although opinion in my community is divided as to whether such technology is appropriate, because the stammering returns when the device is switched off.
More controversially, some researchers believe they can induce fluency in people, children in particular, using verbal operant procedures, similar to the reward and punishment techniques used to train dogs and other animals. The most common of these is the Lidcombe Program, developed by researchers at the Australian Stuttering Research Centre at the University of Sydney. Although some data suggest that the technique works, the numbers are too low to draw firm conclusions. A major sticking point is that there is no commonly agreed method to diagnose the disorder in childhood. The Australian group considers children who commonly repeat whole words as stammerers. In my view, this is wrong and could skew the results.
Much of the controversy over treatments such as the Lidcombe Program and prosthetic devices centres on whether the benefits linger when the treatment ends. Such carry-over would demand that stammering is at its heart a learned behaviour that can be undone. I do not think it is.
“Much of the controversy centres on whether the benefits linger when the treatment ends.”
Much attention in the media has focused on a 'stuttering gene' after the discovery of genetic mutations in members of a consanguineous (inter-marrying) Pakistani family. The gene identified codes for proteins involved in cellular lysosome function, which removes damaged molecules and viruses. Other geneticists, including Simon Fisher, director of the Max Planck Institute for Psycholinguistics in Nijmegen, the Netherlands, point out that the lysosome function is broad and more research is needed on how it could affect the central nervous system of people who stammer.
A study on a Chinese family suggests a more plausible genetic basis, as it reported mutations in genes that seem to affect parts of the brain (the basal ganglia) previously implicated in the disorder.
My work has shown that the severity of stammering symptoms in eight-year-old children can be used to predict whether the children are likely to still stammer as teenagers and adults. Wider discussion is needed about how this information should be used by therapists — for example, whether to intervene with treatment. As most people will recover in time, watchful monitoring of children for signs that their stammering is worsening may be a better approach.
If Colin Firth's performance is a fair reflection of George VI's speech, then the types of stammer he produced — prolonged consonants and repetition of the first part of words — would, as a child, have suggested he had little chance of recovery. We should make more effort to pass this information on to parents. Expectations must be realistic, but, as The King's Speech shows, they can still be optimistic.
Peter Howell is professor of experimental
psychology at University College London and author of Recovery from
Stuttering. e-mail: p.howell@ucl.ac.uk
Source: http://www.nature.com/news/2011/110202/full/470007a.html
