#80 Understanding the Stuttering Brain with Dr. Per Alm

Uri Schneider

Welcome to the Transcending X podcast where we lean into the human experience of adversity to discover ways to transcend and grow through life. I'm your host, Uri Schneider, Director of Schneider Speech Lead at Transcending X and faculty at UC Riverside School of Medicine. Join us as we engage in wide ranging conversations with experts and real life heroes. And through research, insights and inspiring stories, they share the inside story, how they do what they do and what we can learn from them to be our best in our own lives. Get ready to be inspired, informed and uplifted. Let's begin to turn the challenges of our lives into opportunities to bring out our best. What a treat it is. It's Uri Schneider here, the host of Transcending Stuttering and Schneider's Speech. And today, one of my, I wouldn't say childhood heroes, but ever since I started training and studying as undergrad and grad, a name that kept coming up per. Kind of like in a different way, Madonna. Like someone with a name that you've just never heard. It's so mysterious and. And then you get to meet the man. More astonishing. So I'm so excited for today's episode to really interview one of my someone I admire, a hero. And I'll give you the formal intro, but we're in for a treat and we're going to touch on aspects of stuttering and life that we haven't touched on on other episodes. So this is going to be a great one with some really good science and some good theoretical thinking and hypotheses. But we're in the presence of greatness and I'm so glad that you're here.

Param

Okay, thank you so much. Yuri, I don't really know what to say about your kind words here, but it's really a pleasure being here.

Uri Schneider

Thank you. I didn't expect that you would allow me to say that if I told you. I was going to say it before, but it's all true. So the formal bio, just to let everyone in on this. Param is a researcher and lecturer in neuroscience and psychology from Sweden, affiliated with Uppsala University in Sweden. He's also a person who stutters. His research has been focused on understanding stuttering, its causes and mechanisms. A main strategy in this work has been to try to link information from different aspects of stuttering, from its basic causes to what happens in the throat and the mouth, so from the brain to the lips and of course, the lived experience of people who live with stuttering. So thank you so much. And this is going to be a Very wide ranging conversation.

Param

Yes, I do.

Uri Schneider

So as I shared with you before we turned on what would be something that's not in your formal bio that you would want people to know about about you.

Param

Okay. Well, I was thinking a little bit about that. Well, actually I feel I'm. I am a bit proud of, of, of going from a person who really had a great fear of talking in front of people and to really hate that as much as anyone can hate it, I think to, to doing things like this in a second language. And so because I had a really severe stuttering and. Yeah, so that is one thing.

Uri Schneider

Beautiful. So just go a little bit into that. If we were to meet per as a young boy, who would we see?

Param

Okay. Yes, good question. Well, actually I had some slight stuttering at the age of three or so, I think. But it didn't really become a problem until school age, about 8 or 9 or so. And then it get more severe. I guess we do now talk more about that. But this aspect that I have come to realize now quite recently that I. It seems like I had what's called rheumatic fever as a child when I was about six years old. It was a sequel from the Hong Kong flu and I probably got a streptococcal infection. And I have realized also that I probably had a quite mild version of what called Pandas, that's a kind of neuropsychiatric with obsessional compulsive disorder and so on that is resulting from an autoimmune reaction, it caused by streptococcal infection. So actually at that age I was not very well. And I think I come to realize that my stuttering is probably a combination of a genetic heritage for stuttering and this autoimmune reaction caused by the infection. And yes, we'll talk more about that in relation to stuttering in general. But it has been a very important part of my personal experience.

Uri Schneider

That's incredible because those of us that know have seen the important work you've published in the past few years. I mean published for decades, but in the past few years specifically looking at some of those potential triggers and causes and correlates. So it's fascinating. I didn't know that was part of your story.

Param

No, actually I didn't really realize it until I began working with it. So it's been been developing in my insights during the last years.

Uri Schneider

You weren't in Chicago or in Palo Alto in that set of data, correct?

Param

Pardon?

Uri Schneider

You didn't grow up in Palo Alto or Chicago. So you're not part of that data set?

Param

No, no. I grew up in south of Sweden.

Uri Schneider

Beautiful. So one more question just to explore. This is, as you think back to your life arc, what were some formative experiences that were formative, however you want to go with that.

Param

Yes, I think actually when it comes to stuttering, I, I had quite major problems for stuttering when I was in teenage and young adult years and I went to stating therapy and at that time in Sweden, as in Scandinavia and much part of the world, the main focus was on acceptance of stuttering. So actually a work with speech techniques were almost taboo. It was not, it was into something really bad that would only make your problem worse. So but I, I think that I was formed from that, that I, I began in a kind of opposition to try to explore things that were not available that time. So nowadays I, I, I don't like polarization. I think it's very important to get things together. But it's easy to start up in one camp against another camp, so to say.

Uri Schneider

That's certainly been a theme in these conversations and episodes, how people that have enough experience start to see these camps and you're either with us or you're with them.

Param

Yeah.

Uri Schneider

So what were you saying about that? Like growing up, your experiences in Sweden were very much acceptance based.

Param

Yeah.

Uri Schneider

And speech strategies and things like that were taboo. And then you said you had a kind of like anti establishment spirit. What meaning? How did that manifest?

Param

Yes, I was, I was a part of the introducing fluency efficiency shaping techniques in Sweden and Scandinavia, for example.

Uri Schneider

Amazing. So from the boy that you described to the researcher that I have the privilege to sit with today, what drew you? It's like it's not the intuitive outcome of meeting the boy you described. So what drew you to this work and gave you the gall to do the work that you do?

Param

Frustration? Well, I would say that basically I think it was one thing that, I think early struck me was that I did not understand my stuttering and I all, all I think I when growing up had the feeling that I did not really stutter because sometimes I could talk fluently but then I always failed to keep up the fluency. So I just had a feeling if I just pick myself up, I can be fluent all the time. But I failed. So and, and that started a wish to understand stuttering. And that has been the driving force, I think. And I started actually in mechanical engineering. That was my education basically. So I worked for five, six years as a mechanical designer, so in machine industry. But during that Time I got involved with the self help group movement in Sweden and got financed a project to develop a material for study groups for study groups of persons who started to learn more about research and treatments and so on and stuttering. So. And. And that resulted in the publication of a book, a popular science book on stuttering, stuttering treatment in Swedish and Danish. So. And during that time I got in touch with researchers at the hospital in neuroscience. I wanted to get them to do research on stuttering, but they said that they don't really have the time, they need a doctoral student and they encouraged me to go that way. So I moved from engineering to study psychology and medicine and from there going into this field, if you see a.

Uri Schneider

Problem, you can't always wait for someone else to address it.

Param

No.

Uri Schneider

That's incredible. That is so incredible. So, and now just like a retrospective on the career from being a mechanical engineer with person who stutters and kind of having that holy grail search of looking for the understanding of stuttering that would help you crack it and help others gain understanding and insight. As you look at the decades and the thrust of where the field has come and gone and coming back to what excites you and what frustrates you, like what are you excited to see researchers and clinicians doing and what are some things that you might feel like you wish they do less of?

Param

Good question. I think that. Well, I am quite excited about the development of research in this field. I think it's moving forward quite rapidly now, so I think lots of things are happening. But I also can become a bit frustrated when I see things coming back over and over again, which I thought we in a way had left. It's. It's about this pendulum from polarization from one camp to the other. And yeah, if I should wish something, it is the end of the camps to try to solve disagreements by really, really having dialogues to. And because for example, now there is this question about neurodiversity, something that is a part of the normal speech, speech variations or is it a kind of problem that we should get rid of. And as I mentioned before, my background is that they come from this acceptance and I've moved into medicine, so I'm in a way have become a representative of the medical view. But at the same time for myself I think I now I don't study very much, but when I talk here, but I do still stutter and I don't require myself to be fluent. I just want to be able to talk and express myself and if I have some Stuttering that don't really bother me. So in that way I'm for acceptance. But I also know that stuttering can be a real severe communication problem. So I think it's an ethical question partly that make available the choice to people to make up their own choice how to handle the stuttering and maybe handle it differently during different periods in their life. In one period fluency may be important. In another period it is not. For example.

Uri Schneider

I have chills. The way that was articulated and the way you frame that, certainly my hope is that this episode and this entire podcast and everything that transcending stuttering has evolved and is evolving to be is a place for different voices and there's not one way.

Param

And yeah, I think that's great.

Uri Schneider

The only thing that's not welcome is intolerance. If we can't, if we can't give the mic to the person on the other side and hear them out, as long as they speak with mutual respect and decency, that's not welcome. But otherwise that's what this is all about. So that was so beautifully said. I think the pendulum is something my father always talked about and a lot of people may not appreciate it, but if you look at the history of the profession and self help and the line between and then the dynamics and then self help kind of, we're over here, leave us alone, you know, stop trying to fix us. It's us and them again. And then you create these, at least in the U.S. you know, places for professionals and people who stutter to meet together. National Stuttering Project and NSA and friends and others, that's really a much more robust model and we have to make sure we don't slide backwards into the camps. I interrupted you.

Param

Well, you know, I just want to say that, that this neurodiversity movement, I really do respect and understand where they're coming from. And I can see that there's a lot of disappointment in treatment of stuttering. And also like fluency shaping technique, I mean it's not a free lunch. You have to pay the price. With attention and practice and, and failures, you can't guarantee fluency. So I think we both, we need to mix both views.

Uri Schneider

Yeah. And the other thing you said that was such a few words but so profound and un underappreciated. And then we'll move into the guts of what our topic for today. But this is no less important. At different stages in life, a person is ready for different things and is ripe for different things. There are things a 7 year old cannot do a 19 year old can do. It's not about early intervention and then the window closes. On the contrary, there are things that are possible later that weren't earlier. And when you mismatch the wrong expectations and inputs and kind of good segue into the brain research, but you know, when you mismatch things, dopamine isn't good or bad, it's about when and where it shows up. It serves a purpose in. In different ways.

Param

But yeah, yes, I can mention we have a colleague in Oslo, in Oslo, Norway, Hilda Sonsterut. She did a PhD a few years ago and she developed a form that was about asking the client or patient about what is important for them in therapy. And I think that is something that we really need to appreciate that the therapist, so to say, should not have so much preconceived ideas about what is important for the person they have in front of them. Be open to that.

Uri Schneider

Yeah, it's really the practice of person centered care, which is.

Param

Yes, yes.

Uri Schneider

Is said broadly but practiced scarcely. And it's hard. It's hard when especially sometimes the professional comes in as the know it all and sometimes it's the client or the person who is pushing the professional to be the know it all to be the boss. And it's a dance and it's an important dance and it's one that we work on. Great transition to. One of the biggest indicators that I look at, at least in my style of working with a person, is I look at their temperament. And that was impressed upon me by Ed contour. Great Ed contour in a presentation and live conversation that we had in Scottsdale, Arizona. So something that I know you're very interested in looking at is what role temperament can Play. Is stuttering LinkedIn to a reactive temperament? I thought maybe you could just walk us through. For people and for myself, it's excellent to always sharpen what is temperament and. And what is the kind of theory here that maybe stuttering is interacting with it? And what are your findings or what can you share with us?

Param

Yeah. Yes, thank you. It would be interesting to hear more about it and your experience as a clinician about this because I don't really. Yes, yes, I can mention that. I'm not a clinician, unfortunately, so don't have that experience. So.

Uri Schneider

But you're totally welcome to flip the table. You know, you can share your piece and I welcome being interviewed.

Param

Yes. Okay. But what's temperament? Well, in psychological research, temperament is defined as the biological aspect of personality. You could say what we are born with. And there seems to be differences, for example, that some children are more reactive than other children. They're reacting with stronger emotions, stronger aversion, and so on. And there has been a theory, basically, I think it's very old theory. I think it can have roots to Wendell Johnson and further, but it has been like the last two decades that stuttering persons often would be characterized by having a more sensitive and more emotionally reactive temperament. And the theory would be that in some way, if you experience some disfluency as a child, you would be expected to react stronger to these disfluencies and you would get like muscular tension in your larynx and so on. And that would start a vicious circle for the development of stuttering. And that would put an emphasis on the psychological emotional aspects of stuttering as a part of the course of tattooing.

Uri Schneider

So, and then. So what would you say in terms of that link and what's the contemporary view on that and any personal insights both from, from your research and your personal experience?

Param

I think it's an interesting question. And actually when I was a doctor student, I began, I had actually my first research paper in English I wrote. It was about emotions or stuttering. So I started out with a positive view of this idea, so to say. But then when I started to look more closely at available research, I became more critical in questioning. I think that when looking at the data, I think we always should look at the data and follow the data. It the strong finding that children who begin to stutter are not characterized by shyness, social anxiety and so on. There are actually prospective studies on community level where they follow the children from age 2. And actually there's a slight difference in the opposite direction that, that children who will later begin to stutter show a little less shyness at age 2. And, and that was a non statistically significant. But I think it actually may be a real tendency. But if we're going up the age, we can see that there is on group level a small difference, a small statistical difference in emotional reactivity. And it seems to be real. But first it's important to say that this is. If you're having a statistical significant difference, it doesn't mean that you can separate the groups based on that. It's. If we're looking at this difference, there's about 85% group overlap and that's the first thing. So when it comes to emotional reactivity, most stuttering children are absolutely the same as all other children. So just at the group level. But you cannot really say something about the specific stuttering child based on this. The second is that it seems when looking at the data I have found no indication, no support that this actually increases the risk for persistent stuttering. And then on the contrary, it's a bit counterintuitive, but it seems to that children who have high emotional reactivity at age 3 seems to have a pretty good prognosis to recovering. So it actually seems to be the opposite. How could that be? Well, when looking at the data from children and also adults, it seems it's quite clear that there is a higher frequency of traits of ADHD in persons with data. Not all of them, but the minority of persons who start to have traits of adhd. And one aspect of ADHD can be this like being more than emotionally reactive, being easierly frustrated and so on. So I think that the research on emotional reactivity that these results actually reflect a subgroup with traits of adhd. And often children tend to show traits of adhd, especially at age of three. Three year olds are quite hyperactive. And it seems that there are stuttering children who maybe for some developmental aspect of the dopamine system, they have a period of stuttering at age 3 and they also quite hyperactive at that age. But then when the system mature at age 5 or 6, the stuttering goes away, the hypertivity goes down and they stop stuttering. So I think that basically emotional reactivity is not based on the data, is not an indication for persistence or stuttering.

Uri Schneider

So there was something, there were three things that I wanted to just reflect. You said one line. It'll be the first thing. I'll. I'll take issue or disagree or suggest an alternative. You said we should always follow the data. And I heard a beautiful quote that said I look at 1 second. Data is an indicator, not a directive.

Param

Okay.

Uri Schneider

We should look at the data, be informed with data and not go blind. None of us would drive a car. I think I have enough gas. I think I'm going within the speed limit. We should have data, but it shouldn't drive us. We should be informed. What are your thoughts on that?

Param

Yes, related to data. That's a good point because the data may be wrong or maybe incomplete. But I think we have to deal with the data in some way, not deny the data. And that may be a better way to express it.

Uri Schneider

Absolutely. We can't put our head in the sand.

Param

So. But, but I would be interested to hear more about your experience from the clinical perspective and from Edward Contours, if you want. So.

Uri Schneider

Well, far be it from me. To speak on behalf of Ed, but I'll share. I'll be happy to respond to that. I did. I just don't want to lose my going to come to that. Don't let me hold me to that. The two other things you said, I wanted actually just to punctuate and elevate for people who may have you speak. So it's just a fact. I could listen to you all day long. I'm on the edge of my seat. It's so eloquent and so grounded and no fluff. It's just a delight. So thank you. So I just want to punctuate this gentle message you, you talked about. I think we agree and so many people do, but I think it's not yet really realized out there. People who stutter are not a homogeneous group and it's an umbrella term. You use the word subgroup and I think we need to start really thinking about that. Which leads to where I'm going to go with it clinically. But if we think of people who stutter as not all being the same, they share a certain set of symptoms, a certain set of experiences that have a powerful both commonality in terms of how they present on the outside and also a relatively universal in different flavors internal and emotional experience for many. But. But they're very different one from the other. One might have a very bold physical stutter and a very strong inner sense and emotional strength and so on. And another person may appear there's no stuttering on the surface I didn't hear them stutter but in the inside it's eating them up from the insides. And so this inside, outside and the somewhat enigmatic nature of how both the variability but how it can present so differently. I often get phone calls from parents or people for themselves saying if they call from America they say I don't. It's not really a stutter, it's more of a stammer. And if they call from the UK they say oh no, no, it's not a stammer, more of a stutter. And anything it's. I don't think it's only the stigma of that word because they're the same word just different use different semantic usage in different parts of the world. So in England it's called a stammer. Us it's a stutter. They're the same thing. But I think people think of that movie they saw or that classmate they had that's a stutter. That out loud severe physical audible visual presentation of the biggest, loudest, boldest stutter and so people will say, well, I don't do that. And then as we continue the conversation, it's a difference of degree, not a difference in kind. But the composition of their experience suggests to me the subgrouping. So I just wanted to elevate, punctuate. You said subgroups, and I think thinking about those with ADHD and those with this temperament or that. Yeah. What did you want to say on that?

Param

Yes, I fully agree with you about this inside, outside thing, that it is a bit peculiar with stuttering, that often it seems like people who have quite mild stuttering and are able to hide it have the most psychological impact.

Uri Schneider

That's right. And that feeds into what I was going to say. There was a third thing that you said that was brilliant. I guess at the moment it's not necessary, but to respond to your question, temperament is relevant to me from the first phone call. I'm going to say this very practically for parents or for clinicians, anyone that wants to take this where they want to take it. I think usually the first question I ask a person who's calling, often it's a parent of a young child. Today it was the parent of a teenager. How do they feel about it? Are they bothered? And I'm not only asking, are they bothered and motivated and ready to do work, but I'm asking, like people around them, other stakeholders are concerned and raising concern or interest, how's the person's experience of it? And it doesn't mean it's accurate. But I ask them, you know, how do they react in the moment of the moment of a stutter, in the moment of the event, what type of reactivity do you see? And then I ask, you know, and overall, what is their overall temperament? Are they generally an easygoing, Are they somewhat, somewhat stiffer? Are they extraordinarily go with the flow? They almost don't have any anchor. And these things indicate to me, not predicting the trajectory of whether they will continue to stutter or not, as we usually see these conversations in the context of preschool children who are demonstrating stuttering. And the question often asked is, is this developmental stuttering, which the child will grow out of on his own, her own, or is this something that's going to be something that's going to persist, how we should treat it? My experience, based on the research that I've had access to and experience of my father, Dr. Philschneider, and my own, is that the indicator of whether to give support is informed by many inputs, and one of which is not just what we see in the stuttering behavior. But also if the child, for example, has super high standards, gets frustrated when they're building something and it falls down and they have oversized reactions and temper tantrums, they're disproportionate with the trigger or the frustration. So that child, I believe, tends to have a higher risk of being thrown off and rattled by a stutter and starting to go through a cycle of that vicious cycle you talked about more quickly and more, more fiercely, forcefully, fiercely stronger. And that's going to, that's a recipe for let's get in there and give some support and some guidance so that we don't create that reactive cycle that starts to reinforce itself, which hopefully we can unwind a bit. But why let that happen? That child is more susceptible to some event, some feedback from the environment, becoming a deeper, more impressionable experience, more lasting in, you know, impression. Whereas the child who's roly poly, who like spills milk on the floor, doesn't battle ash and you know, messes up their project and goes with the flow. I might have other questions about what might be most helpful there, but I'm, I'm more forgiving and I have a looser sense of they might be able to tolerate more experiences and not be as impressed or shaped by them. So that's how my question leads to my thinking about how soon, how strong I put intervention into place or support into place and what type of support. And it comes back to your comment at the beginning, more acceptance based or more, let's say, mechanical or behavioral. So for the child who is particularly high standards, let's say, I think acceptance is of the utmost importance to try to soften those standards to the degree we can. We can't be, we can't usually can't turn them around 180 degrees, nor do we have to. But we want to make sure that that high standards is something they can harness and use to their advantage as opposed to something that actually holds them back and gets in their own way. The flip side of the child who's roly poly and goes with the flow and so beautifully, delightfully easygoing, it might be a great opportunity to, to explore, experiment and play around with things that are more of a mechanical nature, more direct. Because there isn't as much of a concern in my mind that if we say the wrong thing in the wrong way, we're going to create some sort of harm that's, you know, can't be, can't be resolved, can't be worked with. So that's how that informs some of my.

Param

Yes, I think that you express it very well. So I, I have no problem about what you're saying. I think I would applause. Applause that clinical view, because what I said previously, it should not be interpreted as psychological aspects not being important because obviously it's important for how you, how your life is. And it's quite clear that many persons who start to develop secondary a problem of different kinds from the stuttering. So from a clinical perspective, I fully agree that, that these are important aspects. I think maybe we should write an article together about this.

Uri Schneider

I just got chills. Yeah, that would be the greatest honor the, to me, the bridge. The bridge and the beauty of who you are. And many of the great researchers right now in the space are people who stutter. So whether they do it with explicit intention or not, they are a greater bridge and they bring more humanity to their research just by virtue of their lived experience. But at the same time, there's more work to be done to inform clinical practice with data and science and research and vice versa. So some of the research could be further informed by a greater connection with frontline clinicians.

Param

Yes. So in summary, I think that, that, that these aspects that you are highlighting here are important in the clinic, but it's important to. Not to so to over interpret that as the fundamental cause of stuttering.

Uri Schneider

Absolutely. Let's. With the time that we have, we'll never get to everything because I don't know if I showed on video here, but I shared a video with all my friends. These are the articles that Per sent me to prepare. There's at least 300 pages here. And that's not even everything. But let's, let's talk about one of the other enigmatic things about stuttering, which is the variability. So another thing I hear from people reaching out for help, whether it's a parent, whether it's a person, you know, in this situation, I can no longer go on like this. But at the same time, like yesterday was fine. And talking to my mom yesterday, like, I just want you to know, like it doesn't happen there and then in this other place, I, I can't, I can't go on like this. And so that in and of itself creates another layer of this frustration. It's been said by people who are blind and stutter that the stutter is far more disturbing to them. The blindness is something that is steady and consistent in its presentation, whereas the stutter has this theragan and then it's not. And I think as Chris Constantino and I think Eric Jackson had this conversation. It's. It's the thing that doesn't cooperate the way you want it to. So when you don't care, it doesn't happen. And when the stakes are high and you actually wish it wouldn't show up, that's when it shows up. So what would you say about the variability? And I think the multiple. I think the multifactorial thing. I'm thinking of it like an hourglass. It's almost like there are many reasons that a person might have started stuttering. The cause might have multiple inputs that resulted in what we see today, both biological, environmental, and the mix in between. And then there's like, the bottom side of it is like the variability of how it presents, which is a function of many other interactions and dynamic models which you talked about in that last presentation. So what would you say to crack open this black box of variability for people to start understanding for themselves and for others?

Param

Yeah. Yeah. Thank you. I, I think that when it comes to the basic view, the basic course of stuttering, I agree that it is multifactorial, but I think that my view of this multifactorial differs somewhat because, um, I think current research points primarily to various types of biological factors, but different.

Uri Schneider

I just, I just want to go on the record and pull that back. I did not mean for, for my own sake, not because of what you said. I wasn't suggesting that stuttering is, is, should not be considered unless it's an extenuating circumstance of a very unusual sort to be caused by an environmental factor or an environmental experience. Yeah, those are far and few between. They exist, but they are the very, very extreme experiences and they're very few in terms of what proportion of people who stutter. The cause is based on that. So you could have a trauma of the greatest capital T, and you didn't stutter until the age of 40 and you went through something which I don't even want to articulate, and you acquire a stutter or you could have a brain injury. Those are the kinds of things for children who stutter. Different biological contributors. And then how they go through the reactivity of that or the response to that.

Param

Yeah, great with. Perfect. So the variability. Yes. How can we view this variability? First, I want to say that we don't fully understand this. We can have. What I have is some speculations. I would say, I think that I liked what Constantino and Eric Jackson said about. I don't remember the exact wording, but.

Uri Schneider

Stuttering is the thing that doesn't cooperate or behave the way you want it to. Something of that sort.

Param

Yes, exactly. Because I think the stuttering is basically from my view, a problem of moving the speech articulators or larynx or so in the right way. And normally when we plan a movement for something moving our hand, we just think about moving your hand and the hand moves. It's no issue. Starting to me is an intermittent disconnection between will and a motor action. Sometimes we are thinking about saying something, but this does not happen. And of course that's frustrating. And it's also surprising. It can be shocking. And if it's in a social situation, it's of course quite stressing because no one understand why and the person who, who experience it don't understand what's happening. It's just a sudden disconnection between the will and motor action. And that is I think, the central stuttering, why this is happening. And that is something we are exploring right now in different ways. There are indications that it parts of the brain called the basal ganglia in the center of the brain. And Eric Jackson's team and others have done very important study, I think about what's called the beta waves, the brain waves which should be in. They should be suppressed when we do a movement. But it seems like when we get stuck, they are not sufficiently suppressed. And then it's. As you mentioned before we started recording the. The comparison that stuttering might be like not releasing the parking brake when starting the car, like the parking brake in the brain would be the beta waves. When the beta waves are strong, all movements stop. When the beta waves are suppressed, the movements can go on. But it seems like when we are in moments of suffering, we don't suppress the beta wave sufficiently. How can this come about? Well, I think that I've been thinking about this the last weeks for different reasons. It's getting a bit complicated, so I have to and planning to write more about this. But one aspect I think is that the brain basically have two main systems in Science Terminal. One is called the default network. Basically you could say that we have one network that is inward directed and one is outward directed. And the inward directed is very active when we are focusing on memories, emotions, making plans, so to say the outward directive is active when we are actually doing something, when focusing on movement, focusing on sensory information, hearing and so on. And what's interesting is that these two systems are like a seesaw. When one is strong, the other is weak. So they suppress one another. And one thing is that if you ever have an advanced stuttering. You are beginning to expecting problems in speech situations. You starting to think about what will happen if I get stuck and what will be the consequences? Will I lose my job, will they hate me and whatever. So basically this default system, the inward system starts to become very active while you at the same time should focus on the outward system to be able to talk. So I think that in struggling person it's not that the inward system is abnormal, I think it's perfectly normal. But because the outward system of speech is a bit, a bit unstable, so to say, when the inward focus becomes very strong, it suppresses the outward system and the risk of stuttering increases. So my views actually that maybe it's not so much the, than the sort of emotions of anxiety and so on that trigger stuttering in this situation, I think it may be more the thoughts we have, the catastrophic thoughts which compete with the actually wordings and formulations that we are trying to express in speech.

Uri Schneider

So to layer that in, again, super profound. I'm fascinated. And just to unpack what you were saying, because I think some people get on the pop science of neuroscience and they start going down the dopamine brain, dopamine train is what I meant. But it's the dopamine brain as well. And it's, it's not so simple. It's not just looking at dopamine. So you're talking about the beta waves and the gamma waves. You're also talking about the dopamine. Right. And so, and then there's questions of the signals and how strong the signaling is to tell the neurotransmitters how and what to do. But what I was thinking about, you had a quote in something you shared with me where you said there's a quote from Burke that the dopamine system is sort of estimates whether it's worth expending a limited internal resource like energy, attention or time. It's this anticipatory decision that's made kind of at a subconscious level of whether the outcome is something that we want. Well, then we're going to invest in it. And if it's something that we don't want, we're going to hit the brakes. And so are you talking about that, that that's where kind of the inside outside experience starts to get into the neuroscience understanding of what's happening?

Param

Yes, I think that can be part of it also because that's the other aspect I would say. And, and here I feel we are on a bit uncertain ground. So to say, I think the dopamine hypothesis on stuttering are very interesting and very important. My personal view at the moment is that I think that in most persons who stutter the dopamine system in itself is not really any different, basically, but I feel it, I think it can still play an important role in stuttering. Related to the quote you just read, because I've used the term that the dopamine system is the master of action. It's the very old system and it's basically researchers have been looking at very ancient types of fishes and they have the same dopamine system as we have. So it's have been preserved during, during the millions of years. And what the dopamine system basic function is that when it is released it, it says yes, go do this. And it, when it's not released, it's such an inhibiting movement that it should not be. So when Parkinson's deceived, they have a, have a shortage of dopamine and they have difficulties moving. So when we are getting into a speech situation, I think the brain automatically makes an estimation. What will be the outcome of this? If I say something, what will be the outcome? Will it be catastrophic or will people be happy? And depending on my view of the outcome, that will influence the release of dopamine. So if I think the consequence will be catastrophic, then there will be very little dopamine release. But because the brain is not stupid, they don't want to do something that will hurt me. While on the other hand, if they think this will be great, then more dopamine is released and then the movement gets easier. So that I think is sort of the other side of, of this, of this variability in my current thinking.

Uri Schneider

Fascinating. It's like sometimes these episodes are similar to stuttering. If we just had a little bit extra time, we could say everything we want to say. But we're going to start to bring this episode to a close. But clearly we're, we're laying the seeds for much more. Hopefully a master class with you in another episode. But I would just say about that for people that are listening, you could tell me if this is a fair or if you want to tighten it. I think the idea of the variability being so concerning, people often call and think there's something wrong, that if their child stutters or they stutter, but it's not all the time, that must mean it's psychological, that must mean there's something wrong with them. Because if it was stuttering, shouldn't it happen all the time? You know, someone who's blind doesn't wake up one day with vision and one day not. So the, the coming and going of it I think is quite imagining and so understanding that the thing that's driving the supercomputer, that's driving speech motor coordination, speech motor movement is an extremely dynamic system and the bio neurochemical shifts of that brain have an impact in how different parts of the body function. And speech motor is one of, if not the most complex of them all.

Param

Very, very well expressed. Thank you. Yes, I. Yes, I would like to add one thing, one piece of research I read quite recently. It was a study of temperament. So many children. I think it was by the, by the country team. I think it was quite interesting because it seems like in these children that in some children stuttering seems to be especially triggered by positive emotion when they became positively excited. And that would imply more release of dopamine. And that makes me think about is it subgroups or what is it? Actually, I think that there's a lot of things we don't really know here. But I think it's a good, important message to parents that if the child started more at home than in school, it does not mean by itself that the child don't like it at home. It could be the opposite, that he just relaxes at home with Tamora.

Uri Schneider

There you go. Now you're talking clinical language. It's a, it's a huge confusion because people think, well, if he stutters at grandpa's house, there must be something inappropriate happening or I've got to start digging to figure out what's happening over there. And sometimes it's a signal. The person is actually very comfortable and at ease and so they're just letting their hair down is what my dad says. Or not putting on the tuxedo. They're just wearing a pajamas.

Param

Perfect.

Uri Schneider

Let's close on this. I'm going to ask you this question and I'm going to move my space. If you could take the billboard in the New York Times or in Stockholm equivalent, what message would you like to share with the world on that billboard at no cost? What would that message be?

Param

Well, if it's going to become real, I have to think about it again. But I was thinking that maybe one thing I will say core, is that stuttering is about speech movements and not about personality.

Uri Schneider

Would you say that one more time? I got moved over there.

Param

Yes. Okay. Yes, I think that one. I think that one of the key aspects I would like to highlight from my point of view is that stuttering is about speech movements and not about personality.

Uri Schneider

Amazing. And so we have to think of the other side of that, which is don't judge a book by its cover. We all from a neurodiversity or speech diversity point of view, we might have motor movements that are different one from the other, but it doesn't have an indication of the person's value or intellect or personality or interest in being part of that conversation. And so it's these conversations we need to have and really just open up and learn how to have conversations that are sometimes uncomfortable because we can get to much more comfortable places on the other side. So this was certainly uncomfortable. When you sent me all those articles, I didn't feel like you were going to test me, but I didn't know where I'd have the time or the headspace. And I can just tell you it was a chain reaction of questions that it brought up for me and probably about another 50 questions that I had lined up for our conversation. So we're going to need another five episodes at least, but we'll take it. Yeah. Well, thank you so much.

Param

Thank you for having me. It has been a pleasure talking to you here.

Uri Schneider

Thank you. This episode is just the beginning. You can listen to more episodes, join us for events, masterclasses, workshops and trainings. You can join our private community, check it all out@transcendingx.com and you can sign up to get our emails and see what works for.