Stuttering

Ehud Yairi, PhD, CCC-SPL, F-ASHA, is an internationally renowned scholar and an expert on stuttering. A recipient of major grants from the National Institutes of Health, his research and clinical work on many aspects of the disorder throughout the age range, especially in children, had incorporated a wide range of its aspects, including environmental and genetic factors. Dr. Yairi was the first recipient of the Researcher Award of Distinction from the International Fluency Association, is a recipient of the Honors of the Association (the highest award of the American Speech-Language-Hearing Association), the Malcolm Fraser Award for excellence in the field of stuttering from the Stuttering Foundation of America, and many others. He is the author (with Nicoline Ambrose) of Early Childhood Stuttering (2005), as well as of numerous scientific articles.Carol Hubbard Seery, PhD, CCC-SLP, is an Emeritus Professor of the Department of Communication Sciences and Disorders at the University of Wisconsin-Milwaukee where she served as Graduate Program Coordinator for about 15 years and then Department Chair for 8 years. Her research primarily focused on areas of psycholinguistic factors in stuttering and fluency, and differential diagnosis of subtypes of stuttering. She has had extensive experiences with the disorder of stuttering in various clinical settings, such as public schools and university clinics, has taught undergraduate and graduate courses on stuttering, was a branch Principal Investigator of an NIH grant, and has published her research in various scientific journals.

• ContentsPrefaceAbout the AuthorsAcknowledgmentsPart I. Nature of Stuttering Chapter 1. What Is Stuttering?Defining Stuttering: Bases and AimsWhy Is the Definition Important? Practical ImplicationsPopulation IdentificationQuantification and MeasurementClinical DecisionsWhat to Define: Surface Speech Events or Complex Disorder?Stuttering as Atypical SpeechDimensions of Speech ProductionTypical Disfluency or Instances of Stuttering?Speech-Oriented “Definitions”Perspectives on Stuttering as Speech EventsFluent Speech of People Who StutterStuttering as a Complex DisorderMultidimensional Characteristics of the Stuttering DisorderDisorder-Oriented “Definitions”Perspectives of Stuttering as Complex DisorderOther ViewsOur Point of ViewSummaryStudy Questions and Discussion TopicsWebsitesSuggested Readings Chapter 2. Who and How Many Stutter? Incidence and PrevalenceInterpretation of Incidence and Prevalence DataThe Significance of Incidence and PrevalenceImplications for Research and TheoryImplications for Professional TrainingImplications for Clinical Service DeliveryImplications for Public Awareness and FundingResearch Methodology for Incidence and PrevalenceApproaches to Prevalence ResearchApproaches to Incidence ResearchDefining StutteringSelecting InformantsPrevalence: FindingsEarly InvestigationsLater ResearchIncidence: FindingsBiological Factors in Stuttering Incidence and PrevalenceFamilialityAgeGenderGeography, Race, and CultureGeographyRaceCultureBilingualismPrevalence in Clinical SubpopulationsHearing ImpairmentCleft PalateCognitive ImpairmentOther GroupsSummaryStudy Questions and Discussion TopicsVideo SamplesWebsitesSuggested ReadingsChapter 3. When and How Does Stuttering Begin? How Does It Develop? Theoretical and Clinical SignificanceOnsetGeneral Issues and Research MethodsStudies Concerning OnsetWhen Does Stuttering Begin?How Does Stuttering Begin?Features of Early StutteringEmotional and Physical HealthPhonology and LanguageDevelopmentHistorical Perspectives on Developmental ProgressionDifferential Developmental ProgressionsNatural RecoveryThe Statistical EvidenceRetrospective EvidenceIndirect Longitudinal EvidenceDirect Longitudinal EvidenceImplications of Developmental FindingsPredictive FactorsSummaryOnsetDevelopmentPredictive FactorsStudy Questions and Discussion TopicsVideo SamplesSuggested ReadingsChapter 4. Where Does Stuttering End? What Are Its Advanced Characteristics? Advanced StutteringDisfluency TypesDimensions and Severity of DisfluencyPhysical ConcomitantsOther Speech CharacteristicsVoiceSpeaking RateEmotional Characteristics and CognitionEmotional ReactionsCognitionConcomitant DisordersThe Dynamics of Advanced StutteringPatterns of OccurrenceLoci of StutteringConditions That Diminish StutteringConditions That Increase StutteringSummaryVideo SamplesStudy Questions and Discussion TopicsSuggested ReadingsPart II. Explanations of Stuttering Chapter 5. Theories and Evidence: Is Stuttering Psychological?Theories and ModelsHow to Analyze a Stuttering TheoryScience, Superstition, and Stories About StutteringThe Need for an Integrated FrameworkCriteria for Strong Theories and ModelsTesting Theories and ModelsAre There Stuttering Subtypes?Is Stuttering Psychological?Psychoemotional Theories: Can Emotions Cause Stuttering?Psychoanalytic TheoryAlternative Views of Psychoemotional DisturbancePersonality Factors in StutteringSummary of Psychoemotional TheoriesPsychobehavioral Theories: Is Stuttering Learned?Stuttering as a Reactive Avoidance BehaviorStuttering as a Conditioned Anxiety ResponseStuttering as an Operant BehaviorTwo-Factor Theory of StutteringThe Demands-Capacities ModelSummary of Psychobehavioral TheoriesPsycholinguistic Theories: Does Stuttering Indicate Failed Word Assembly?Psycholinguistic Processes Resulting in Fluent SpeechPsycholinguistic Factors in StutteringA Theory of Covert Repair?The Fault Line HypothesisSummary of Psycholinguistic TheoriesSummaryStudy Questions and Discussion TopicsSuggested Readings Chapter 6. Theories and Evidence: Is Stuttering Biological? Introduction to Biological TheoriesGenetic PerspectivesFamilial IncidenceTwin StudiesFamily AggregationBiological GeneticsNeurological PerspectivesCerebral Hemispheric DominanceThe Modem Era of Brain and Other Neurological ResearchSummary of Neurological PerspectivesAuditory PerspectivesThe Role of AuditionSummary of Auditory PerspectivesPhysiological and Motor PerspectivesMotor Learning Theories of StutteringBrainstem Reflexes: A Disorder of MovementSensorimotor DysfunctionMultifactorial Theory from a Motor PerspectiveEvidence of Motor DifferencesSummary of Physiological and Motor PerspectivesSummaryStudy Questions and Discussion TopicsSuggested ReadingsPart III. Clinical Management of Stuttering Chapter 7. Observing and Examining Speech General ConsiderationsSpeech Sample ContextMonologuesReading SamplesPlay-Based SamplesRecorded Home SamplesSpeech Sample SizeMeasures of Stuttering or DisfluencySpeech Recordings and TranscriptionProcedures for Speech Sample AnalysisDisfluency Reference DataSeverity of Stuttered SpeechDisfluency LengthPhysical ConcomitantsRating the Severity of StutteringSpeaking RatesRate Measurement ProceduresVoice and Other Communication SkillsSummaryStudy Questions and Discussion TopicsSuggested ReadingsAppendix 7–1. Frequency of Disfluency Types per 100 Words in Narrative Contexts for Younger and Older Adults Who Do Not StutterAppendix 7–2. Frequency of Disfluency Types per 100 Words in an Oral Reading Context for 15 Male and 15 Female Adults Who Do Not Stutter, Age 20 to 22 YearsAppendix 7–3. Mean Frequency of Disfluency Types per 100 Syllables for Adults: In Monologue (Job Task) for People Who Do Not Stutter (PWNS) and in Oral Reading for People Who Stutter (PWS)Appendix 7–4. Frequency of Disfluency Types per 100 Words in Spontaneous Speech for 10 Male and 10 Female Adults Who Stutter, Ages 19 to 48 YearsAppendix 7–5. Frequency of Disfluency and Types per 100 Words in Story Narratives for 56 Male Children Who Stutter and 56 Male Children Who Do Not StutterChapter 8. Assessment of Adults and School-Age Children General ConsiderationsAssessment of StutteringSpecial Considerations for School-Age ChildrenAssessment ObjectivesBackground and Case HistoryThe Client-Clinician RelationshipEmpathySelf-CongruenceUnconditional Positive RegardInterview ProcessAffective and Cognitive DomainsSituational Rating ProtocolsAttitude Rating ScalesInterpretations and Treatment RecommendationsDiagnosisTreatment RecommendationsThe Diagnostic ReportSummaryStudy Questions and Discussion TopicsSuggested ReadingsChapter 9. Assessment of Preschool-Age Children Challenges, Objectives, and Settings for the Initial Evaluation Is It Stuttering? A Diagnostic ChallengeOther Key Diagnostic IssuesObjectives of the Initial EvaluationSetting and PreparationsThe Case HistoryCase History Form: Preschool ChildrenPart I: Client and Family InformationPart II: Time and Circumstances of OnsetPart III: Symptomatology at Onset and at PresentPart IV: General Development and Health HistoryCollecting Clinical DataObtaining Speech SamplesOther Related AssessmentsAnalyzing Clinical DataInterpreting Clinical DataDisfluency StatusBorderline CasesMaking PrognosisThe Illinois Prediction CriteriaConcluding Parent ConferenceDiagnosis, Prognosis, and RecommendationsParent CounselingSummaryStudy Questions and Discussion TopicsWebsitesSuggested ReadingsChapter 10. Stuttering Therapy Overview: Issues and DirectionsIntroductionTheoretical ConsiderationsThe Objectives of TherapyIncreased FluencyReduced Stuttering SeverityImproved Cognitive-Emotional-Social AdjustmentGeneral Therapeutic ApproachesThe Client-Clinician RelationshipClinical ApplicationsDeveloping Appropriate Treatment ObjectivesIndividual Versus Group Therapy SessionsImplementing TreatmentSkill Maintenance, Fluctuations, and Prevention of RelapseEvidence-Based PracticeA Case Study to Illustrate the Steps in EBPClinical ResearchGroup StudiesSingle-Subject StudiesIssues Regarding Clinical EfficacyEthicsQuestions Concerning EthicsSummaryStudy Questions and Discussion TopicsWebsitesSuggested ReadingsChapter 11. Therapy for Adults: Focus on Emotional ReactionsAdults Who StutterTreatmentsPsychotherapy and RelaxationPsychoanalysisRational-Emotive TherapyMindfulness TherapyAcceptance and Commitment TherapyRelaxationSummary of Psychotherapy and RelaxationDesensitizationSystematic DesensitizationDesensitization In VivoDesensitization to Stuttered SpeechDesensitization to ListenersSummary of DesensitizationAssertiveness Training, Communicative Competence, and Group TherapyAssertiveness TrainingCommunication Competence TherapyAvoidance Reduction Therapy for Stuttering (ARTS)Group TherapySummary of Assertiveness Training, Recent Approaches, and Group TherapyAntianxiety DrugsWhy Drugs?Drugs for What?Studies of Pharmaceutical Treatments for StutteringSummary of Antianxiety DrugsSummaryStudy Questions and Discussion TopicsWebsitesSuggested ReadingsChapter 12. Therapy for Adults: Focus on Stuttering and FluencyIntroductionIdentificationRationalePhase I: AwarenessPhase II: AnalysisSummary of IdentificationModificationStep I: Cancellations (Post-Block Modification}Step II: Pullouts (In-Block Modification)Step III: Preparatory Sets (Pre-Block Modification)Summary of ModificationFluency-Oriented TherapiesFluency-Focused Therapy BasicsRhythmic SpeechSlow-Stretched SpeechBehavioral ReinforcementSummary of Fluency-Focused TherapiesIntegrated ApproachesFluency-Inducing InstrumentsMetronome Pacing of SpeechAuditory MaskingAltered Auditory FeedbackBiofeedbackSummary of Fluency-Inducing InstrumentsInternet Therapy, Mass Media–Based Therapy, and TeletherapySummaryStudy Questions and Discussion TopicsWebsitesSuggested ReadingsChapter 13. Therapy for School-Age Children  School-Age Children Who StutterAwareness and Emotional ReactionsOvert StutteringAcademic PerformanceThe School and Home FactorsThe Age FactorPrognosis and Objectives for TherapyWhy Is Stuttering in School-Age Children Difficult to Treat?Therapy Alternatives and ObjectivesHome and School EnvironmentsCounseling ParentsTeachers and PeersTherapy: Explaining StutteringThe Speech SystemWhat Can Go Wrong With the Speech System?ExperimentationTherapy: Focus on Emotional ReactionsAdapted Desensitization ActivitiesAssertiveness, Resilience TeasingBullyingTherapy: Focus on Stuttering and FluencyIdentification and AnalysisChanging SpeechStuttering ModificationFluency Facilitating Speaking SkillsGeneralizationOther Therapy ProgramsFamily Stuttering ProgramsGroup TherapyClinical ResearchSummaryStudy Questions and Discussion TopicsWebsitesSuggested ReadingsChapter 14. Therapy for Preschool-Age ChildrenGeneral ConsiderationsA Brief Historical ReviewDirect TreatmentsIndirect TreatmentsWinds of ChangeCurrent Issues Concerning Early InterventionFactors Pertaining to StutteringFactors Pertaining to AgeWho Should Be Treated? When?Current TherapiesFocus on Learning PrinciplesFocus on Parent-Child InteractionsFocus on Speech/Motor PatternsPlay TherapyClinical ResearchPast and Current ResearchWeaknesses and Other Issues in ResearchGeneral ReflectionsSummaryStudy Questions and Discussion TopicsWebsitesSuggested ReadingsChapter 15. Other Fluency Disorders; Cultural and Bilingual Trends IntroductionChildhood DisordersUnusual Breathing PatternsWord-Final DisfluencyLanguage DisordersClutteringAcquired StutteringNeurogenic StutteringPsychogenic StutteringMalingeringStuttering in Bilingual and Multicultural PopulationsIncidenceDiagnosisTreatmentSummaryStudy Questions and Discussion TopicsWebsitesSuggested ReadingsReferencesIndex