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.

Part I. Nature of Stuttering

Chapter 1. What Is Stuttering?

Defining Stuttering: Bases and Aims
Why is the Definition Important? Practical Implications

Population Identification

Quantification and Measurement

Clinical Decisions

What to Define: Atypical (Abnormal) Speech or Complex Disorder?
Stuttering as Atypical Speech

Normally Fluent Speech Production

Normal Disfluency or Instances of Stuttering?

Speech-Oriented "Definitions"

Examples of Stuttering Denoting Speech Events

Fluent Speech of People Who Stutter

Stuttering as a Complex Disorder

Multidimensional Characteristics of the Stuttering Disorder

Disorder-Oriented "Definitions"

Examples of Stuttering Denoting Complex Disorder

Other Views

Our Point of View

Summary
Study Questions and Discussion Topics
Websites
Suggested Readings

Chapter 2. Who and How Many Stutter?

Incidence and Prevalence

Interpretation of Incidence and Prevalence Data

The Significance of Incidence and Prevalence

Implications for Research and Theory

Implications for Professional Training

Implications for Clinical Service Delivery

Implications for Public Awareness and Funding

Research Methodology for Incidence and Prevalence

Approaches to Prevalence Research

Approaches to Incidence Research

Defining Stuttering

Selecting Informants

Prevalence: Findings

Early Investigations

Later Research

Incidence: Findings
Biological Factors in Stuttering Incidence and Prevalence

Familiality

Age

Gender

Geography, Race, and Culture

Geography

Race

Culture

Bilingualism

Prevalence in Clinical Subpopulations

Hearing Impairment

Cleft Palate

Cognitive Impairment

Other Groups

Summary
Study Questions and Discussion Topics
Websites
Suggested Readings

Chapter 3. When and How Does Stuttering Begin? How Does It Develop?

Theoretical and Clinical Significance
Onset

General Issues and Research Methods

Studies Concerning Onset

When Does Stuttering Begin?

How Does Stuttering Begin?

Features of Early Stuttering

Emotional and Physical Health

Phonology and Language

Development

Historical Perspectives on Developmental Progression

Differential Developmental Progressions

Natural Recovery

The Statistical Evidence

Retrospective Evidence

Indirect Longitudinal Evidence

Direct Longitudinal Evidence

Implications of Developmental Findings

Predictive Factors

Summary

Onset

Development

Study Questions and Discussion Topics
Suggested Readings

Chapter 4. Where Does Stuttering End? What Are Its Advanced Characteristics?

Advanced Stuttering
Speech Disfluency

Types of Disfluency

Major Disfluency Classes

Dimensions of Disfluency

Physical Concomitants
Other Speech Characteristics

Voice

Speaking Rate

Emotional Characteristics and Cognition

Emotional Reactions

Cognition

Concomitant Disorders
The Dynamics of Advanced Stuttering

Patterns of Occurrence

Loci of Stuttering

Conditions That Diminish Stuttering

Conditions That Increase Stuttering

Summary
Study Questions and Discussion Topics
Suggested Readings

Part II. Explanations of Stuttering

Chapter 5. Why Do People Stutter? Evaluating Theories and Models

Theories and Models

How to Analyze a Stuttering Theory

Science, Superstition, and Stories About Stuttering

The Need for an Integrated Framework

Criteria for Strong Theories and Models
Testing Theories and Models
Are There Stuttering Subtypes?
Summary
Study Questions and Discussion Topics
Suggested Readings

Chapter 6. Is Stuttering Psychological? Theories and Investigations

Is Stuttering Psychological?
Psychoemotional Theories

Psychoanalytic Theory

Alternative Views of Psychoemotional Disturbance

Personality Factors in Stuttering

Summary of Psychoemotional Theories

Psychobehavioral Theories

Stuttering as a Reactive Avoidance Behavior

Stuttering as a Conditioned Anxiety Response

Stuttering as an Operant Behavior

Two-Factor Theory of Stuttering

The Demands-Capacities Model

Summary of Psychobehavioral Theories

Psycholinguistic Theories

Psycholinguistic Processes Resulting in Fluent Speech

Psycholinguistic Factors in Stuttering

A Theory of Covert-Repair?

The Fault Line Hypothesis

Related Areas of Research

Summary of Psycholinguistic Theories

Summary

Study Questions and Discussion Topics

Suggested Readings

Chapter 7. Is Stuttering Biological? Theories and Investigations

Introduction
Genetic Perspectives

Familial Incidence

Twin Studies

Family Aggregation

Biological Genetics

Neurological Perspectives

Cerebral Hemispheric Dominance

The Modern Era of Brain and Other Neurological Research

Summary of Neurological Perspectives

Auditory Perspectives

The Role of Audition

Summary of Auditory Perspectives

Physiological and Motor Perspectives

Motor Learning Theories of Stuttering

Brainstem Reflexes: A Disorder of Movement

Sensorimotor Dysfunction

Multifactorial Theory from a Motor Perspective

Evidence of Motor Differences

Summary of Physiological and Motor Perspectives

Summary
Study Questions and Discussion Topics
Suggested Readings

Part III. Clinical Management of Stuttering

Chapter 8. Assessment of Adults and School-Age Children

General Considerations

Assessment of Stuttering

Special Considerations for School-Age Children

Assessment Objectives

Background and Case History
Observations and Examinations: Speech

Speech Sample Context

Speech Sample Size

Measures of Stuttering or Disfluency

Speech Recordings and Transcription

Procedures for Speech Sample Analysis

Disfluency Reference Data

Severity of Stuttered Speech

Physical Concomitant

Speaking Rates

Voice and Other Communication Skills

Affective and Cognitive Domains

Situational Rating Protocols

Attitude Rating Scales

Interpretations and Treatment Recommendations

Diagnosis

Treatment Recommendations

The Diagnostic Report

Summary
Study Questions and Discussion Topics
Suggested Readings

Chapter 9. Assessment of Preschool-Age Children

Challenges, Objectives, and Settings for the Initial Evaluation

Stuttering versus Normal Disfluency: A Diagnostic Challenge

Other Key Diagnostic Issues

Objectives of the Initial Evaluation

Setting and Preparation

The Case History
Case History Form: Preschool Children

Collecting Clinical Data

Obtaining Speech Samples

Other Related Assessments

Analyzing Clinical Data

Disfluency Frequency and Types

Disfluency Length

Speech Rate

Interpreting Clinical Data

Disfluency Status

Stuttering Severity

Borderline Cases

Making Prognosis

The Illinois Prediction Criteria

Concluding Parent Conference

Diagnosis, Prognosis, and Recommendations

Parent Counseling

Summary
Study Questions and Discussion Topics
Suggested Readings

Chapter 10. Stuttering Therapy Overview: Issues and Directions

Introduction
Theoretical Considerations
The Objectives of Therapy

Increased Fluency

Managed Stuttering

Improved Cognitive-Emotional Adjustment

General Therapeutic Approaches

The Client-Clinician Relationship

Empathy

Self-Congruence

Unconditional Positive Regard

Clinical Applications

Developing Appropriate Treatment Objectives

Individual Versus Group Therapy Sessions

Implementing Treatment

Skill Maintenance and Prevention of Relapse

Evidence-Based Practice

A Case Study to Illustrate the Steps in EBP

Clinical Research

Evaluating Efficacy

Group Studies

Single-Subject Studies

Issues Regarding Clinical Efficacy

Ethics

Questions Concerning Ethics

Summary
Study Questions and Discussion Topics
Suggested Readings

Chapter 11. Therapy for Adults: Focus on Emotional Reactions

Adults Who Stutter
Treatments
Psychotherapy and Relaxation

Psychoanalysis

Rational-Emotive Therapy

Relaxation

Summary of Psychotherapy and Relaxation

Desensitization

Systematic Desensitization

Desensitization in Vivo

Desensitization to Stuttered Speech

Desensitization to Listeners

Summary of Desensitization

Mindfulness Therapy; Acceptance and Commitment Therapy

Assertiveness Training and Group Therapy

Assertiveness Training

Group Therapy

Summary of Assertiveness Training and Group Therapy

Antianxiety Drugs

Why Drugs?

Drugs for What?

Studies of Pharmaceutical Treatments for Stuttering

Summary of Antianxiety Drugs

Summary
Study Questions and Discussion Topics
Websites
Suggested Readings

Chapter 12. Therapy for Adults: Focus on Stuttering and Fluency

Introduction
Identification

Rationale

Phase I: Awareness

Phase II: Analysis

Summary of Identification

Modification

Step I: Post-Block Modification

Step II: In-Block Modification

Step III: Pre-Block Modification

Summary of Modification

Fluency Oriented Therapies

Fluency-Focused Therapy Basics

Rhythmic Speech

Slow Stretched Speech

Behavioral Reinforcement

Summary of Fluency-Focused Therapies

Fluency-Inducing Instruments

Metronome Pacing of Speech

Auditory Masking

Altered Auditory Feedback

Biofeedback

Summary of Fluency-Inducing Instruments

Integrated Approaches

Internet, Mass Media-Based and Teletherapy

Summary
Study Questions and Discussion Topics
Suggested Readings

Chapter 13. Therapy for School-Age Children

School-Age Children Who Stutter

Awareness and Emotional Reactions

Overt Stuttering

Academic Performance

The School and Home Factors

The Age Factor

Prognosis and Objectives for Therapy

Why Is Stuttering in School-Age Children Difficult to Treat?
Therapy Alternatives and Objectives

Home and School Environments

Counseling Parents

Teachers and Peers

Therapy: Explaining Stuttering

The Speech System

What Can Go Wrong with the Speech System?

Experimentation

Therapy: Focus on Emotional Reactions

Adapted Desensitization Activities

Assertiveness, Resilience, Teasing

Bullying

Therapy: Focus on Stuttering and Fluency

Identification and Analysis

Changing Speech

Stuttering Modification

Fluency Facilitating Speaking Skills

Generalization

Other Therapy Programs

Conditioning Fluent Speech

Family Stuttering Programs

Group Therapy

Clinical Research
Summary
Study Questions and Discussion Topics
Websites
Suggested Readings

Chapter 14. Therapy for Preschool-Age Children

General Considerations
A Brief Historical Review

Direct Treatments

Indirect Treatments

Winds of Change

Current Issues Concerning Early Intervention

Factors Pertaining to Stuttering

Factors Pertaining to Age

Who Should Be Treated? When?

Current Therapies

Focus on Learning Principles

Focus on Parent-Child Interaction

Focus on Speech/Motor Patterns

Focus on Emotionality

Clinical Research

Past and Current Research

Weaknesses and Other Issues in Research

General Reflections
Summary
Study Questions and Discussion Topics
Websites
Suggested Readings

Chapter 15. Other Fluency Disorders; Cultural and Bilingual Issues

Introduction
Childhood Disorders

Unusual Breathing Patterns

Word-Final Disfluency

Language Disorders

Cluttering

Acquired Stuttering

Neurogenic Stuttering

Psychogenic Stuttering

Malingering

Stuttering in Bilingual and Multicultural Populations

Incidence

Diagnosis

Treatment

Summary
Study Questions and Discussion Topics
Websites
Suggested Readings

References
Index