Articles

Ehud Yairi
by Alison Nicholas, The Michael Palin Centre for Stammering Children, London
Issue 20, Winter 2003

Professor Ehud Yairi is the Director of the Stuttering Research Program, Department of Speech and Hearing Science, University of Illinois. He has been a leading researcher in disorders of fluency for over 30 years. During the past two decades in particular, his research into the aetiology, epidemiology, and pathognomonic course of childhood stuttering has been highly influential. As a direct result of his work, researchers and clinicians have a far better understanding regarding the onset and diverse developmental paths of stuttering and the direct clinical implications. In 2002, Yairi was bestowed the Honors of the Association by the American Speech-Language-Hearing Association for his contribution to stuttering research.

Alison Nicholas from the Michael Palin Centre had the great honour of interviewing Professor Yairi over breakfast at the 4th World Congress on Fluency Disorders in Montreal, Canada in August 2003.

How did you first become interested in speech and language therapy?
Well, initially I wanted to study agriculture, but they wouldn't take me. They were concerned about my severe stuttering. At that time two new academic departments were starting up in Tel Aviv University in Psychology and African studies so I decided to major in both. Following an entrance interview by the Psychology faculty, I was asked to switch to Philosophy because they were concerned that I wouldn't get a job after I graduated because of the severity of my stutter. However, I fought my case and stayed. It wasn't until just before my graduation in 1965 that I became interested in switching to speech pathology. During my last year at college I took a child psychopathology course and chose to write an essay on stammering. It familiarised me with the writing of Wendell Johnson from the University of Iowa, and made me determined to study at the same university. Although I did communicate with Wendell Johnson, unfortunately he died about two months before my arrival. Anyway, I did study speech pathology at the University of Iowa where Dean Williams was my professor and mentor.

Your interest in stuttering is obviously linked to your own experience. Tell me a little bit about your own stuttering and how you have learnt to manage it?
Stuttering began at a very young age. I clearly recall an adult neighbour making fun of me at age four. Initially my speech did not stop me from taking part in class, but I do remember thinking about where to sit in the class not too near the front as then the teacher would choose me to speak and not too near the back as then, if I did contribute, everyone would look at me. When, in fourth grade, the school principal came into the classroom to listen to us read, I didn't want to do it and stutter. I remember getting upset and crying about it. From about the age of twelve things changed and my speech did stop me from taking part in class and this really continued through graduate studies at Iowa.
I have had all sorts of therapy, ranging from having to sit with my legs in cold water to having an injection in my bottom to help me be more relaxed! I also used a metronome, which in those days was too big to carry around, so the clinician told me to use my thumb to help me tap the rhythm. I also had some therapy with electrical stimulation around my mouth which was meant to help me relax. Although the sensation was great, it didn't really help! Later, psychoanalysis got a chance to cure my stuttering. For two years me lying on a couch talking in free associations. I was also given an injection sodium pentathol which was used to help patients reveal unconscious thoughts and feelings (during WWII it was used with prisoners of war to get them to reveal military information). Again this didn't work for me; I just fell sound asleep every time!
My speech was a problem throughout my years at university. As I mentioned before, the faculty at Tel Aviv wanted me to change course from psychology to philosophy because of my severe stuttering. Also, during my first year of graduate studies in speech pathology (Iowa), there was no scholarship or assistantship for me. Professor Williams said that the faculty decided that any financial support from the department for my second year was conditional on me improving my speech. This was quite convincing for a poor student and I became more serious about the speech therapy given to me by other graduate students in the department. Although my speech improved, it was not a whole lot better.
Stuttering continued to colour my life after receiving my doctoral degree and joining the faculty at Texas Tech University. At the first faculty meeting, each member had to introduce himself and that was always difficult for me. So for the next year's first meeting I showed up late! Also, during my first semester at Texas Tech, I was scared of possibly losing my job because of my stuttering to the point of refusing to buy a house. Instead we rented an apartment. The real reason was not revealed even to my wife. After one semester, however, realising that I was doing OK, and that my speech had improved considerably, we bought a home and stayed there for seven years. The first year of teaching was a turning point, probably due to a fast-developing self-confidence instated in me by the role of professor.
Since then I have overcome my fear of stuttering and I have lectured to large audiences all over the world without any real problems. Still, once in a while I have been surprised by adults who mock people who stutter, including me. There is also, apparently, some negative bias, even among professionals or professionals to be. For example, although I speak quite effectively, I have never been asked to address our departmental graduation ceremonies.

Has your speech and language therapy work always involved stuttering?
Whilst studying at the University of Iowa, I was interested in cleft palate, voice disorders and stuttering. Not being sure for a while about the right path for me, eventually I did my Masters and PhD in stuttering under Professor Dean Williams. My Masters thesis examined speech clinicians' stereotypes of school-aged children who stutter. Its publication encouraged other investigators to conduct more research on attitudes towards people who stutter. My doctoral research concerned children's perceptions of their parents. As you know, Wendell Johnson's research focused on parents' attitudes towards children who stutter and I wanted to see how children who stutter viewed their parents.
My strong interest in laryngectomy and glossectomy continued and for years I was involved in organising an annual national conference concerning medial and speech treatment for these conditions. But once I received the first major grant from the National Institutes of Health in 1989, the focus narrowed down to only stuttering.

Tell me more about your research history.
Well, obviously it started at the University of Iowa and continued for the seven years when I worked at Texas State University. My work at that time mainly involved investigating the dysfluent speech of normally fluent children and children who stutter and then also older children and adults, including aged people. I was also doing and publishing research in voice and oral sensation.
Moving to the University of Illinois, I arrived there in 1977 as the second youngest faculty member; now I am the oldest! There, I began to pursue more comprehensive research projects, with much more emphasis on early childhood stuttering, which, at the time, was not common. Most research was conducted with adults who stutter. We looked at the dysfluent speech of various groups and did a longitudinal study of the dysfluent speech of normally developing children, two to three years old.
But it wasn't until 1989 that I received my first good-sized grant from the National Institute of Health, which allowed us to conduct our large-scale longitudinal studies. It enabled us to see many more kids and to examine them frequently over longer periods of time. Originally we didn't have any intention to do research on natural recovery. The goal was simply to describe the symptomatology and the characteristics of stuttering over time. It was only after some data was collected that we realised that the stuttering of many children was declining, and that after three years most of them had stopped stuttering without treatment. It was only then that we began to focus more on factors that influence recovery and persistency and directed our research towards possible identification of risk predictors (eg, gender, phonology, language, acoustic characteristics and dysfluency patterns). Next we focused on genetics (familial patterns of stuttering), which has proved to be, so far, one of the most important predictors.

Tell me a little bit more about your genetic studies
For years our genetic findings resulted from studies where the distributions of stuttering in families were compared against several possible genetic models to see which one provides the best fit. This led us to our first important finding that there appears to be a major gene factor in the transmission of stuttering. A few years later we had another important finding in that we showed that recovery and persistence are related to differences in the type of familial history of stuttering.
Because our initial genetic findings were so convincing, we felt justified in pursuing biological genetics in stuttering to look for, and find, the genes that underlie stuttering. What we are in the midst of doing at the moment is trying to identify the general location of the possible genes. This project involves international co-operation. We are responsible for finding specific families with multiple cases of stuttering and getting the blood samples. In this, we are fortunate to have the co-operation of colleagues in Sweden, Israel, and the USA. The blood samples are then sent to the genetic labs at the University of Chicago School of Medicine. Right now they are carrying out the genotyping of the first batch of the blood samples, so in a few weeks we may have something to say. If we get some encouraging results about where the genes of stuttering may be, then the next stage will be to try to identify the specific genes. We know that genetics has a strong etiological role in stuttering but genetics of what? That is, we do not yet know what is being transmitted large tongue, blue eyes, temperament, brain structure and/or processes etc. We just don't know.

What other research are you involved in at the moment and what do you see as being important for the future?
In addition to genetics, I think that the brain imaging research, done in several centres including ours, is very promising, but much more work is needed. Current results are already showing some clues in the brain functioning, perhaps also structure, of adults who stutter. More specific information, particularly from studies involving young children who stutter is needed. I am also interested in the subtyping of stuttering. Although for many years different ideas have been put forward about the different types of stuttering and types of stutterers, there hasn't been enough data to support any classification. So far, for all practical purposes, stuttering has been dealt with in research and treatment as a single disorder. Our new grant from the National Institute of Health is aimed at obtaining data from a large set of children and adults who stutter, looking at several different domains: epidemiology, speech, language, motor, and personality/temperament. Hopefully, integrating such a wealth of data, will bring us closer to the isolation of stuttering subtypes.

Who have or do you admire in the field of stuttering?
I don't admire, just appreciate and get interested in. I don't like to use the word admire in this respect, and I don't like to give names either.The contributions of many colleagues in different countries, and concerning different aspects of the disorder all add to the progress being achieved. Stuttering is a complex disorder that requires attention to its many facets. Some of us do the work in the laboratory, others in the clinical setting. You never know what may prove to be really useful or critical. I think, however, what is important, is that there has been a substantial shift in the attention of research to very young children who stutter. This is where the problem begins the formative years. It was a mistake in the past to make too many strong assumptions about the nature of stuttering' based primarily on adults. I think another important development in the field has been a shift from great emphasis on the motor perspectives of stuttering to also investigating difficulties in central processing involved in language and speech planning that may contribute to stuttering, rather than just the motor execution. Brain imaging is very promising in this respect. Finally, we are also beginning to see better research in the treatment of young children and in documenting the effectiveness of each therapy. This is very challenging in that one must control for the very high percent of natural recovery.

What do you want to be remembered for?
I am proud of my contributions to the shift in research to early childhood stuttering and for enhancing research and co-operation between colleagues in a good number of countries. Although recognising and correcting errors are the stepping stones of progress in science, hopefully, I have not done and published too many stupid things. These are not easy to avoid. As Albert Einstein observed, stupidity, unlike genius, has no limits. As we grow old, we must encourage and make room for new people, as well as new and better ideas for the next step.