Stuttering Most experienced speech pathologists will attest to the fact that physicians tend to view the problem of stuttering from one of two extremes. At one end of the continuum, it is not uncommon for a family physician or pediatrician to attempt to assuage a mother's concern about her child's dysfluent speech with easily given advice tantamount to "Ignore it and it will go away", or "This is just a phase - he will outgrow it". At the other extreme we find that a psychiatrist may classify severe stuttering in an adolescent or adult as being a manifestation of profound and deeply underlying psychodynamic processes. While research indicates that the majority of children between the ages of 2 and 5 years whose speech is dysfluent will eventually be able to speak normally without professional intervention, the uncomfortable fact remains that a substantial number of these children become "full-blown.. stutterers. Similarly, some adult stutterers have psychopathologic disorders, but most of them do not. The article on stuttering in this issue of the Journal by Drs. Einer Boberg and Robert Shea (page 357) should help the physician avoid tak-

ing a biased position when confronted by patients who stutter. As the authors point out, the exact nature of the disorder remains unknown, but the "telltale" signs that indicate when an apparently mild fluency problem is "at the brink" are known and can be easily recognized by the physician. I would only amplify Boberg and Shea's list of diagnostic indicators by pointing to the diagnostic strategies suggested by Adams1 for distinguishing incipient stuttering from "normal nonfluency". Briefly stated, Adams points to five behavioural characteristics: (a) the frequency of nonfluency in the stutterer is usually double that in the nonstutterer (approximately 10 per 100 words spoken versus approximately 5 per 100); (b) the frequency of repetition and prolongation of sounds by the stutterer is 4 to 10 times that of the nonstutterer; (c) the number of repetitions of syllables may be as many as 5 in the stutterer in contrast with 1 to 3 in the nonstutterer; (d repetition and prolongation of sounds by the stutterer are marked by an abrupt, abnormal cessation of voice and air flow, while this is not so in the nonstutterer; and

(e) the stutterer more typically substitutes the "uh" sound for the correct vowel in a repeated syllable (e.g., "puh-puh-puh-paper"). Boberg and Shea offer information that should help the physician make appropriate referrals. Their report on the recent remarkable gains made in the modification of stuttering with the use of behavioural strategies should encourage physicians to refer their patients to specialists with appropriate training, such as speech pathologists and behaviourally oriented psychiatrists and psychologists, who can identify stutterers who have psychopathologic disorders or other concomitant problems. Additional appropriate referrals can then be made when required. MICHAEL WEBSTER, PH 3) Professor, faculty of health professions Associate professor, faculty of medicine (otolaryngology) Director School of human communication disorders Dalhousie University Halifax, NS

Reference 1. ADAMS MR: A clinical strategy for differentiating the normally nonfluent child and the incipient stutterer. J Fluency Dis 2: 141, 1977

Announcing

Nicholas M. & Hedy J. Munk Geriatric Award This $10,000.00 Award will be presented on alternate years commencing in 1978, it will enable the honoree to continue post graduate training in the research, prevention; identification and treatment of diseases and disabilities associated with elderly persons. ELIGIBILITY - Any physician under the age of 40 who has demonstrated special merit in the field of geriatric medicine and wishes to pursue a career in the medical science of geriatrics, or whose achievements and work in geriatrics indicates promise of future success in this field. Preference will be given to those wishing to pursue their careers in Canada or Israel. HOW TO APPLY - Nominations may be submitted by anyone and must be in writing. Unless otherwise specified, submissions will not be returned and must include: 1. The complete name and address of the nominee; 2. A full, up-to-date curriculum vitae; 3. A one-page statement detailing the nominee's plans for utilization of the Award; 4. A statement from other than the nominee, indicating the nominee's suitability for the Award. All nominations must be received on or before September 15, 1978 to be considered for the 1978 Award. MAILING ADDRESS - Nicholas M. & Hedy J. Munk Geriatric Award Attention: S. Ruth BAYCREST CENTRE FOR GERIATRIC CARE 3560 Bathurst Street Toronto, Ontario M6A 2E1

Stuttering.

Stuttering Most experienced speech pathologists will attest to the fact that physicians tend to view the problem of stuttering from one of two extreme...
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