Medication Therapy

“…the use of medication continues to demonstrate results that are not merely promising but that may prove to be outstanding, even revolutionary.” Without Hesitation: Speaking to the Silence and the Science of Stuttering by Gerald A. Maguire, MD with Lisa Gordon Wither ©2010, p. 8

I am always delighted when one of my students can attend the National Stuttering Association (NSA) annual convention. I have attended five conventions and found them to be of consistently high quality with a balance of fun, intimate sharing, and informative workshops. One of my teen students attended the 2010 convention and brought me back the new book, Without Hesitation. This book describes the use of medication to treat stuttering. All proceeds from the sale of the book benefit the NSA. I recommend it without hesitation.

This is a thin book and an easy read because Dr. Maguire wrote it for the layperson. It includes a very succinct history of treatments for stuttering, description of brain research, several case studies, a review of medications, and message of hope. Dr. Maguire invites anyone and everyone to contact him for speech therapy at The Kirkup Center for the Medical Treatment of Stuttering, http://www.kirkupcenter.uci.edu.

In an earlier post, I referred to a theory of developmental stuttering in which a child is repeatedly unsuccessful at repairing a speech problem and that this can results in increasing tension, both oral-motor and emotional. Without Hesitation wonders why such a speech difficulty occurs and makes a crucial statement: “We consider stuttering to be a multifactorial disorder; which means it’s a condition that has multiple causes” such as: (p. 12)
• Genetics
• PANDAS – Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strptococcal Infections
• Brain development during childhood

My understanding is that most brain research is done with adults who stutter, not children. So, there is an ongoing debate over whether brain research reflects what happens to a brain that has spent a lifetime stuttering, or, what a brain looks like in childhood as well as adulthood. Given the theory that the brain is “plastic” and changes continuously in response to learning and environment, fMRIs of adult brains may represent how stuttering impacts brain function over time.

Brain research has revealed at least three major discoveries.
1. “…the striatum performs as the brain’s natural timer and initiator of speech. People who stutter most often have trouble with the beginning of a phrase or word, but the speech flows more easily once they overcome this verbal block.” (p.28)
2. “…the left-hemispheric speech areas in individuals who stutter are low in functioning compared to…the right hemisphere…increased activity within the right hemisphere may represent overcompensation…” (p. 29)
3. Persons who stutter “often have too much dopamine in the brain, which may affect the brain’s ability to initiate and time speech. This surplus…is related…to striatal hypometabolism, a condition in which the striatum functions at an abnormally low rate.” (p.29)

If a neurological cause can be identified, then perhaps a medication can be designed to target that specific neurological issue. Studies suggest that lowering dopamine levels in the brain improves fluency. Several of the medications described in Without Hesitation, act to reduce brain levels of dopamine and showed both positive results and negative side-effects.

Another avenue for drug research is a neurotransmitter called GABA, gamma-aminobutyric acid. A medication called pagoclone “has shown particularly hopeful outcomes.” (p.42) A large scale study of pagoclone was underway as of March 2009 (p. 48).

Chapter 7 describes case studies of children trying medication therapy. My impression is that this is experimental in nature and there is no FDA drug currently approved for the treatment of stuttering. Nevertheless, parents wrestle with difficult decisions about their children’s educational, social, emotional, and medical health all the time. There are not many easy, clearly defined answers anywhere, IMHO. For some children, stuttering has a dramatic impact on quality of life and experimental therapies may make sense.

Parents are also making serious medication choices for their children for other chronic conditions. I want to highlight ADHD in particular:


“We know that chemical substances called dopamine agonists can make stuttering worse by enhancing the brain’s dopamine activity and diminishing the brain’s ability to time and initiate speech. Central nervous system stimulants, such as methylphenidate, and amphetamines that are used to treat attention deficit disorder and narcolepsy, are examples of dopamine agonists.” (p.34)

We remind our children that stuttering is not their fault while at the same time encouraging them to learn self-management. I wonder if the parents of children who have other chronic conditions such as juvenile diabetes, asthma, and learning disabilities also wonder how to encourage empowerment in the face of such circumstances. It’s my pleasure to watch parents do the best they can and children’s confident smiles in response!