Stuttering Risk: Neurophysiological and Genetic Findings Versus Psychosocial Insights. A Proposalfor a Resolution

In the search for the causes of developmental stuttering the findings have constantly proved contradictory. Despite the huge body of knowledge about stuttering its cause is still considered to be unknown; the psychological background is recognized as important, but stuttering is currently regarded as a pure neurological problem. It is generally agreed that therapy should be multidimensional but in fact there is a widespread opinion that the dysfunction has genetic roots. This surprising lack of agreement is blocking the advance of research and the development of therapeutic approaches. In addition, there are serious shortcomings in the currently favored methodology of stuttering research: evidence-based medicine and practice have reduced the amount of high-grade evidence research data to such an extent that much useful information has been lost; the relevance of functional magnetic resonance imaging is controversial, and the hope that one day genetic engineering will correct stuttering-related mutations without severe side effects is unrealistic. A change of approach to research and therapy is required. If this cannot be found on the basis of a generally accepted notion of the cause of stuttering, it must emerge from the search for the best existing therapeutic approach. Conclusion: The present paper offers an evaluation of the basic finding of modern outcome research that the factor of a specific therapeutic approach has less impact on outcome than the common factors, especially the clinician-client relationship. In Speech Language Pathology, and notably in stuttering research and clinical practice, it would be wise to implement this understanding in the form of empathy-based therapies. The requirements for developing the skills for this approach are discussed.