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Valuable information is available to clinicians both from research articles, and reports from clinicians. Both sources have limitations. Research, with the exception of longitudinal studies, tends to isolate a variable or two from the whole, limiting its usefulness. Clinical techniques reported are sometimes biased, and perform well for certain therapists in certain settings, and not so well for others. Interrelationships are important among variables such as dentition, anatomy, physiology, oral muscle functions, oral rest postures, eating, and speech. Each affects the others. Equally important are interrelationships among all the specialists who treat patients with orofacial myofunctional disorders. A wholistic approach to the evaluation and treatment of orofacial disorders is advocated.

Stuttering is a broad behavioral phenotype with an adult prevalence of 0.7-1.0%. Family, twin, and segregation studies all indicate that stuttering has a large genetic component to its etiology. The relatively simple phenotype, the early onset, and the apparent rarity of phenocopies of adult stuttering all make stuttering a promising model for the study of the genetics of broad behavioral phenotypes.

Introduction: The scope, nature, and focus of clinicians who treat oral myofunctional disorders are continuously changing. Healthy disagreements exist among practitioners on a number of important issues and procedures. Certain concepts and practices, however, are not objects of disagreement; they simply persist in spite of a lack of theoretical foundation. or in spite of the potential harm they offer to the client and to the profession. Purpose: The purpose of this article is to review four areas that deal with some of these issues. They are: I. Terminology. Some terms used by orofacial myologists are outdated. Others are controversial and arouse unnecessary hostility in the professional and/or lay listener. Certain terms should be avoided, and others used in a much more restricted manner than is often the custom. II. Treatment considerations. Philosophical considerations will be presented, along with rationale for specific groups of exercises, such as those carried out for the purpose of strengthening lips, and assignments designed to alter sleep habits. III. Relationships between orofacial muscle activity and dental malocclusions. IV. Informed consent: an important protective document.

We have ascertained a five generational 1,200-member family residing in the Utah-Idaho area that has a prevalence of a stuttering phenotype at rates several times that of the general population. This family is an ideal resource for further studies into the genetic transmission of the stuttering phenotype because its large size eliminates genetic heterogeneity as a confounding factor. Using data from one branch of this family we can report preliminary evidence supporting the sex-modified trait hypothesis of genetic transmission in stuttering.

The collaboration of an orthodontist, speech-language pathologists, and orofacial myologists in the compilation of this special issue of the IJOM is a significant happening. It is symbolic of the recent history of multidisciplinary assessment and treatment of a group of disorders known collectively as "tongue thrust." Such collaborations may be surprising and possibly disappointing to a group of dentists and speech pathologists who met over a decade ago and developed a statement questioning the validity of the concept that the tongue affects the teeth. Despite the subsequent endorsements of that skepticism by three powerful professional organizations (the American Speech-Language-Hearing Association, the American Dental Association, and the American Association of Orthodontists) all of which published position papers upholding the "Joint Statement" of that 1974 committee, therapy for what came to be known as abnormal orofacial patterns of behavior persisted in most parts of the country under the rubric "myofunctional therapy." A major purpose of this publication is to evaluate the legitimacy of the field of myofunctional therapy in light of research before and after 1974. A second purpose is to describe the scope of present evaluative and therapeutic procedures. A third is to make recommen­dations concerning future directions for research and clinical activities.

A philosophy of the treatment of tongue thrusting has been presented, along with a description of a therapy program. In geographic areas where such therapy has been provided over a number of years, it has been well accepted. Patients who do poorly in therapy coincide with those who have orthondtic relapse. Although tongue thrust may occasionally disappear spontaneously in patients receiving orthodontic treatment, the unpredictability of this outcome makes treatment a wise preventive procedure. Oral myotherapy may be administered by anyone who has the proper knowledge, training, and experience. Most therapists prefer to wait until the child is about 9 years old to begin treatment. Poor risks for treatment include patients with (1) long-standing nearnormal occlusions: (2) negative attitudes; (3) predominantly normal habit patterns; (4) mental or psychological disorders; and (5) uncooperative parents. A thorough orthodontic evaluation should precede treatment, and any conditions which mitigate against successful therapy should be remediated medically, surgically, or orthodontically before therapy begins. Usually, however, it is preferable to complete habit training before banding is begun. Eighty to 90 per cent of patients should complete treatment successfully and retain proper oral habits. The orthodontist should be wary of abbreviated training programs and should readily send the patient back to the therapist throughout treatment if any signs of relapse are detected. The role of the dentist in motivating the patient cannot be overemphasized. Whereas some patients are self-motivated, others need immediate reinforcement throughout therapy, such as behavioral-modification procedures offer. My approach to treatment entails a structured, yet flexible, program which uses learning theory principles. It requires a thorough diagnostic session plus at least nine weekly sessions, followed by recheck visits spaced gradually farther apart. Patients are seen periodically throughout orthodontic treatment. Follow-up studies have proved this to be an effective approach to the remediation of tongue thrust.

The closing phase of this longitudinal study of tongue thrust, started in I 967 by Hanson and associates, is reported. Data were gathered over a period of 13½ years, starting with a ,group of 225 children with a mean age of 4 years, 9 months. Of this group, 61 were located and examined at or near age 18. The findings from this final evaluation are analyzed.

This study investigated the assumption that oral myofunctional services might facilitate remediation of articulation disorders. Subjects were ten 6-year-old elementary school children who exhibited both tongue-thrust behavior and articulation errors. All subjects had equal service time for a 14-week period, half receiving articulation services only and the other half receiving oral myofunctional services prior to and in conjunction with articulation services. Results showed that children in both programs made essentially equal progress in correcting placement of tongue-tip-sounds, remediating /s/ and /z/ misarticulation, and remediating general articulation errors. Only children who received oral myofunctional services remediated tongue-thrust behaviors.

The purpose of the present paper is to present evidence to support the following hypotheses: (1) there is a relationship between tongue thrust and malocclusion, and it is probably a reciprocal one; (2) tongue thrust may yield spontaneously to nonthrusting patterns; (3) if tongue thrust does not yield spontaneously to nonthrusting patterns, some form of treatment should be considered; (4) if myofunctional therapy is the treatment of choice, its timing with respect to patient age, developmental factors, and orthodontic treatment should be an individual matter. The need for more definitive research is described. In order for such research to be meaningful, a standard definition of tongue thrust is required. Such a definition is proposed.

Summary: The approach to assessment and treatment advocated in this article stresses individualization and completeness. The field of orofacial myology provides many oppor­tunities for budding clinicians to latch onto a particular program of treatment and apply it wholesale to patients of all types and ages. The temptation to do so should be resisted vigorously. The purpose of all procedures should be to help the patient eliminate postural or move­ment patterns that create undesirable pressures against teeth or unfortunate cosmetic results. Since tongue and lip-resting postures have the greatest potential of all patterns for interfering with proper dental development and orthodontic treatment, they should receive early and pervasive attention during treatment. Conceptually, therapy may be divided into three phases: Learning new patterns, incorporating those patterns into everyday activities until they become automatic, and maintaining them. Patients should be seen for rechecks for at least two years, or until all orthodontic work is completed. Treatment for orofacial myofunctional disorders is most successful, when the clinician, child, parents and dental specialist work in close cooperation.

SummaryInefficient performance on auditory-visual tests of intersensory integration is thought to be a sensitive indicator of certain specific types of cerebral dysfunction which cannot be detected by standard neurological examination. The present study was designed to assess the proficiency of fluent speakers and stutterers at matching auditory-temporal (tapping) patterns with visual-spatial (dot) displays. A modification of the Birch and Belmont test of auditory-visual integration was administered to twenty pairs of matched stutterers and fluent speakers. Results indicated that the stutterers' performance on this particular intersensory integration task was significantly lower than that of their fluent peers. This finding was interpreted as supporting the theory that the cortical organisation of stutterers might somehow be different from and less efficient than that of fluent speakers. Stutterers would seem to possess some type of specific neurological dysfunction which prevents or interferes with their...

1. 1. Eighty-four (39 per cent) of the 214 preschool children in this study had a tongue-thrust pattern for saliva swallowing; 117 (55 per cent) for liquid swallowing; and 146 (68 per cent) for swallowing solids, according to the conservative definition of tongue-thrust. 2. 2. One hundred sixty-four (77 per cent) had a thrust for saliva swallowing; 181 (85 per cent) for liquid swallowing; and 190 (89 per cent) for solid swallowing, according to the liberal definition. 3. 3. With the liberal definition of tongue-thrust, a significant χ 2 was obtained comparing large tonsils and small tonsils for liquid and solid swallows, lack of mentalis contraction, or some degree of contraction for saliva swallows. 4. 4. With the conservative definition of tongue-thrust, a significant χ 2 result was obtained comparing large tonsils with small tonsils for solid and liquid swallows, comparing nasal breathing with mouth breathing, and comparing high, narrow palate arches with normal arches. 5. 5. Among these subjects there was a considerable variability of swallowing patterns. This variability was noted in terms of the medium being swallowed. 6. 6. Most of the variables which have been reported in the literature as being causally related to tongue-thrust (feeding patterns, masseter muscle activity, thumb-sucking habits, rugae roughness, and, to a certain degree, mentalis muscle contraction) were not found to be significantly related in these subjects.

Our results, added to those found in the literature, prompt us to consider the possibility that structure and function act reciprocally upon one another. Many of our findings suggest that any crowding of the tongue, whether it be from a narrow maxillary arch, enlarged tonsils, or the presence of an intruding thumb, might well promote a tongue-thrust habit. Conversely, after reviewing research concerning the lingual pressures required to move teeth and comparing that information with measurements of tongue pressure during tongue thrust, it is difficult to avoid the conclusion that the tongue does have the strength and the persistence required to bring about malocclusion. That the bone encasing the teeth responds to pressures of relatively little magnitude seems to be the basis of orthodontic treatment. Much research has verified the presence of lingual pressures against the teeth during speech, at rest, and during swallowing. The aggregate of these pressures is significantly greater than the amounts which Weinstein41 reports are sufficient to move teeth. It would seem that more progress in research might be made if investigators paid less attention to perpetuating a dichotomy and structured their research to allow for the possible reciprocation between form and function. Clinical application. The only consistent identifying characteristic of tongue thrust appears to be the anterior positioning or movement of the tongue against or between the teeth. This phenomenon seems to be present, following a conservative definition, in approximately one half of all 4- and 5-year-old children. Ideally, a dentist could examine a child of this age, observe signs indicative of future malocclusion, and take steps to prevent its occurrence. Although the results of the present research do not provide that kind of information, certain diagnostic criteria do emerge as having prognostic importance pertaining to the retention of a thrusting pattern. The presence of any one of the following factors to a marked degree, or of any combination of them, is a potential predictor of a tongue-thrust pattern likely to persist throughout the mixed dentition: 1. 1. Mouth breathing. 2. 2. Digit-sucking. 3. 3. Enlarged tonsils. 4. 4. A high and/or narrow anterior palatal arch. 5. 5. Marked lip movement during swallowing. 6. 6. Any anterior malocclusion in the deciduous dentition. 7. 7. Dentalization of linguo-alveolar consonants (/s/, /z/, /d/, /t/, /l/, /n/).