Information for GPs

Look here for quick information about stammering, how to refer to the Michael Palin Centre, therapy approaches and costs for adults who live outside Camden or Islington.

Information about stammering (also known as stuttering)

  • 5% of children are expected to stammer at some point. 1% of adults are thought to stammer.
  • Stammering is: repeating words or part words; prolonging sounds, blocking. This may or may not be accompanied by additional struggle, physical movements and muscle tension.
  • Stammering may be covert. Outward signs of stammering may not be observable because the individual is selects particular words which they feel are ‘safe’ or in other ways avoids stammering openly.
  • The impact that stammering has on an individual may be considerable and does not necessarily correlate with how much they outwardly appear to have difficulty. If someone feels anxious or worried about their stammer, embarrassed about it, or reports that they are avoiding talking or participating because they stammer, or feel unable to pursue desired life goals because of stammering then referral is appropriate.
  • Some adults who stammer have high speech-related anxiety and may meet the criteria for social anxiety. Similar mechanisms may maintain anxiety for people who stammer as do for people with social anxiety (Iverach et al., 2017).
  • Outward stammering varies with context – the person who stammers may or may not stammer noticeably in their consultation with you.

Find out more about physiological factors that are involved in stammering

  • Stammering tends to run in families. If there is someone else in a person’s immediate or wider family who stammers, or who used to stammer, then that suggests an inherited or ‘familial’ vulnerability.
  • So, what is inherited? Brain imaging studies have shown that people who stammer tend to process speech signals in the brain slightly differently than people who do not stammer. They also seem to have slight structural differences in some areas of the brain. These differences in brain structure and function, which appear to develop early in childhood, are likely to be key in understanding why stammering develops for some people.
  • Research has also shown that people who stammer, as a group, tend to be slightly slower at making the movements involved in speaking, for example getting voice started in the larynx or moving from one speech sound to the next. The implication of this is that speaking rapidly potentially puts a lot of pressure on a vulnerable speech motor system and this can destabilise fluency. Taking time pressure off, for example by speaking a little more slowly, is often helpful.

Find out more about how language skills may contribute

  • Language processing factors may also contribute. Some people who stammer relate to the idea of needing more time to gather their thoughts before speaking, especially when wanting to say something more complex. People may stammer more when they are under time pressure and don’t have enough time to organize what they want to say.

Find out more about how environmental factors may be relevant

  • People who stammer often say that they have more natural fluency when things are going fairly smoothly in life and when they are speaking in relaxed situations, for example when speaking with people who know them well. Conversely, people may stammer more in situations which are more challenging, such as talking to someone for the first time, speaking in a group, interview or meeting, or speaking on the telephone.

Find out more about the roles of thoughts and emotions

  • Stammering is not caused by anxiety. Some, but not all, people who stammer do experience higher levels of anxiety in social situations, often because of their past experiences. Other emotions that people may experience include embarrassment, being ashamed about stammering, feeling down or depressed because of it, or feeling guilty about not speaking fluently.
  • Many people find that this is a valuable area to focus on in therapy. There are different psychological therapies which are commonly included in therapy for stammering. Cognitive-Behaviour Therapy (CBT), Acceptance and Commitment Therapy (ACT), Solution Focused Brief Therapy (SFBT) and other approaches all offer ways to work with thoughts and feelings and build confidence and self-acceptance.

What therapies are effective?

  • Cognitive-behaviour therapy (CBT) has been shown to reduce speech-related anxiety in people who stammer (Menzies et al., 2008).
  • Speech restructuring techniques (teaching control strategies) have been shown to reduce the frequency of stammering in adults.
  • Communication skills (social skills) training is also indicated particularly where high anxiety about stammering alters communication confidence (Iverach et al., 2017)
  • Therapy which offers individuals the chance to integrate fluency control, CBT and social skills training is likely to be most effective.
  • No ‘one-size fits all’.

What is cluttering?

  • Cluttering is another fluency disorder. It can co-exist with stammering but is different from stammering.
  • Characteristics:
    • speech does not sound ‘fluent’ and is difficult to understand
    • excessive levels of normal disfluencies such as interjections or revisions
    • little or no physical struggle when speaking
    • rapid and/or irregular speech rate
    • sounds ‘jerky’ and too fast
    • pauses are too long, too short or in the wrong place
    • syllables are telescoped or slurred together
    • language may be disorganized
    • Other associated difficulties include: distractibility, limited attention span, hyperactivity, auditory perceptual difficulties, learning disability not related to reduced intelligence, social or vocational difficulties arising from cluttering. (Source: The Stuttering Foundation. www.stutteringhelp.org)

Acquired stammering following a neurological or psychological event

  • The individual has no previous history of stammering.
  • Sudden onset related to neurological or psychological event or process.
  • Referral to MPC is appropriate when: neurological and psychological investigations have been completed; speech and language therapy assessment has been completed to rule in or rule out dysphasia or dysarthria.
  • Less literature available – response to treatment difficult to predict.
  • Other services need to be involved / prioritised where trigger event is part of a long-term vulnerability, progressive condition, psychologically complex in nature.

What does the Michael Palin Centre offer?

  • Expert speech and language therapy delivered by speech and language therapists who are internationally-renowned specialists in the field.
    • Therapists formally trained to deliver CBT (Oxford Cognitive Therapy Centre, Anna Freud Centre) and ‘third generation’ CBT (Acceptance and Commitment Therapy / Mindfulness Based Approaches).
    • Therapists trained and experienced in other counselling approaches (Solution Focused Therapy, Neurolinguistic Programming)
  • One-to-one therapy sessions
  • Collaborative working style which means that each individual is helped to explore, and work towards, personally meaningful goals.
  • Use of a range of outcome measures to track impact of therapy.

How to refer to the Michael Palin Centre

  • Adults who stammer living in Camden or Islington can refer themselves via the website
  • Adults who stammer living outside Camden or Islington need a GP referral.
    • Address to the Administrator, The Michael Palin Centre for Stammering, 13-15 Pine Street, London EC1R 0JG
    • Call us to talk about a referral if you wish: 0203 316 8100
    • We can only see individuals from outside Camden or Islington if we have a written agreement from the referral GP that their assessment will be funded. Therapy should it be recommended also needs to be funded.
    • Fee for an assessment: £500
    • More information about fees here

Other resources for adults who stammer

The British Stammering Association – www.stammering.org (general help and information about stammering)
 
The City Literary Institute – Speech Therapy Department – www.citylit.ac.uk (information about group therapy courses for adults who stammer)

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