Fluency Disorders: Stuttering, Cluttering, and Related Fluency Problems

Second Edition

Kenneth J. Logan

Details: 609 pages, B&W, Softcover, 8.5"x11"

ISBN13: 978-1-63550-147-6

© 2022 | Available

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Fluency Disorders: Stuttering, Cluttering, and Related Fluency Problems, Second Edition is a vital resource for graduate courses on stuttering and related disorders of fluency. This thoroughly updated text features accessible and comprehensive coverage of fluency disorders across a range of clinical populations, including those with developmental and acquired stuttering, cluttering, and various types of developmental and acquired language impairment.

Information in the text is aligned with current standards for clinical certification specified by the American Speech-Language-Hearing Association's Council for Clinical Certification (CFCC). Readers will learn practical strategies and methods for how to assess and treat fluency disorders in preschool and school-aged children, teens, and adults.

The text is organized into five key sections: Foundational Concepts, Neurodevelopmental Stuttering, Other Types of Fluency Disorders, Clinical Assessment, and Intervention Approaches. Together, these topics make the comprehensive Fluency Disorders a truly distinguishable text in the field of speech-language pathology.

Key Features

  • Content that emphasizes clinical practice as well as client/patient experiences
  • Discussion of fluency disorders in the context of communicative functioning and quality of life
  • Chapter objectives begin each chapter and highlight key topics
  • "Questions to Consider" conclude each chapter to help readers apply their knowledge
  • Readers learn to organize information around clinical principles and frameworks

New to the Second Edition

  • New larger 8.5" x 11" trim size
  • Updated and expanded references throughout
  • Reorganized outline and increased coverage of treatment and counseling information 
  • Expanded use of text boxes to help readers relate chapter concepts to clinical practice 
  • Access to a PluralPlus companion website with PowerPoint lecture slides for instructors and clinical forms, skill-building activities, video demonstrations, and a list of suggested readings for students

Preface
Acknowledgments
Reviewers

 

Section I. Foundational Concepts

Chapter 1. An Introduction to Fluency Disorders

Chapter Objectives

Introduction

Speech Fluency Versus Language Fluency

Fluency as an Integral Component of Social and Communicative Functioning

Fluency in the Context of Speech-Language Pathology

Speech-Language Pathology as a Profession

Developing a Framework for Clinical Practice

Fluency in the Context of Service Delivery Domains

Fluency in the Context of Professional Practice

Viewing Fluency as a Component of an Individual’s Health Functioning

Functioning, Performance, and Capacity

Activities and Activity Limitations

Participation and Participation Restrictions

Impairment and Disability

Environmental and Personal Factors

Facilitators and Barriers

Fluency Disorders: A First Look

The Concept of Disorder

Stuttered Speech

Cluttered Speech

Providing Clinical Services to People Who Have Fluency Concerns

The Rewards of Being a Fluency Clinician

Developing the Necessary Knowledge

Developing the Necessary Skills

Developing Competencies for Interprofessional Practice

Engaging in Evidence-Based Practice

Establishing Effective and Valued Working Relationships With Clients

Summary

Questions to Consider

 

Chapter 2. Conceptualizing Fluency

Chapter Objectives

Context and Historical Perspective

Fluency: A Multidimensional Construct

The Dimensions of Fluency

Fluency Dimensions: Speech Continuity

Fluency Dimensions: Rate and Rhythm

Fluency Dimensions: Effort and Naturalness

Fluency Dimensions: Talkativeness

Fluency Dimensions: Stability

Organizing Fluency Dimensions Into a Clinical Model of Fluency

Fluency in the Content of a Speech Production Model

Modeling the Speech Production Process

Conceptualizing a Message

Transforming a Preverbal Concept Into a Corresponding Linguistic Form

Transforming Linguistic Representations to Articulatory Movements

Summary

Questions to Consider

 

Chapter 3. Conceptualizing Disfluency

Chapter Objectives

Defining Disfluency

Identifying Disfluent Segments

The Structure of Disfluency

The Moment of Interruption

The Reparandum

The Original Utterance

The Editing Phase

The Repair Phase

Labeling Disfluency

Characteristics of Common Disfluency Types

Revisions

Pauses

Interjections

Repetitions

Prolonging and Blocking

Variations in Disfluency Form

Variations in the Editing Phase

Variations in the Repair Phase

Nested Errors

Repetition of Final Segments in Words and Utterances

Limitations of Disfluency Labeling Systems

Limitation 1: Lack of Standard Terminology

Limitation 2: Lack of Comprehensive Terminology

Limitation 3: Inconsistent Relationship Between Labels and Structure

Limitation 4: Continued Dependence on Listener-Based Judgments

Summary

Questions to Consider

 

Chapter 4. Speech Fluency in Typical Speakers

Chapter Objectives

Characteristics of Typical Fluency

Quantitative and Qualitative Perspectives on Fluency

Speech Continuity in Typical Speakers

Disfluency Frequency in Children With Typical Fluency

Disfluency Frequency During Adulthood

Types of Disfluency

Context Effects: Where Does Disfluency Occur?

Utterance Locations That Are Prone to Disfluency

Syntactic Forms That Are Prone to Disfluency

Speaking Tasks That Elicit Disfluency

Is It Typical for Young Children to Be Highly Disfluent?

Rate in Typical Speakers

Articulation Rate

Speech Rate

Rhythm in Typical Speakers

Disfluency Duration

Effort in Typical Speakers

Perspectives on Effort

Naturalness in Typical Speakers

Talkativeness in Typical Speakers

Talkativeness in Relation to Conversational Participation

Talkativeness in Relationship to Communicative Functions

Stability of Fluency in Typical Speakers

Summary

Questions to Consider

 

Section II. Neurodevelopmental Stuttering

Chapter 5. Stuttering: Characteristics and Etiology

Chapter Objectives

Terminology

Historical Perspective

Defining Stuttering

Early Attempts to Define Stuttering

Contemporary Definitions

Characteristics of Stuttered Speech

Continuity Characteristics of Stuttered Speech

Rate and Rhythm Characteristics

Effort and Awareness

Compensation and Concealment Strategies

Performance Variability

Effects of Speaking Task, Setting, and Conversational Partners on Speech Fluency

Effects of Linguistic Complexity on Speech Fluency

Summary

Questions to Consider

 

Chapter 6. Stuttering: Correlates and Consequences

Chapter Objectives

Historical Perspective

Correlates of Stuttering

Genetic Correlates of Stuttering

Approaches to Researching Genetic Factors

Neuroanatomical Correlates of Stuttering

Gray Matter Volume and Hemispheric Asymmetry

White Matter Integrity

Neurophysiological Correlates

Early Studies of Brain Activation and Hemispheric Dominance for Language

Electroencephalography (EEG) Findings

Neuroimaging Findings

Motor Correlates of Stuttering

Manual Movements

Reaction Time and Speech Initiation

Speech Motor Coordination and Movement Control

Motor Learning

Linguistic and Cognitive Correlates

Syllable, Word, and Utterance Properties That Precipitate Stuttering-Related Disfluency

Effects of Syntactic and Phonologic Complexity

Assessments of Language Functioning in Speakers Who Stutter

Developmental Disorders that Co-Occur with Stuttering

Studies of Phonological Encoding

Cognitive Functions and Stuttering-Related Disfluency

Psychological and Social-Emotional Correlates

Life Experiences of People Who Stutter

Anxiety and Related Disorders

Personality Characteristics

Temperament Characteristics

Emotions and Autonomic Nervous System Functioning

Environmental Correlates

Listener Behavior

Summary

Questions to Consider

 

Chapter 7. Stuttering: Epidemiology, Development, and Etiology

Chapter Objectives

Epidemiology

Age of Onset

Fluency Characteristics Near the Time of Onset

Incidence and Prevalence

Lifetime and Cumulative Incidence

Prevalence

Stuttering Prevalence in Males Versus Females

The Developmental Course of Stuttering

Persistent Versus Transient Stuttering

Patterns of Recovery From Stuttering During Childhood

Predictors of Recovery From Stuttering

Recovering From Stuttering After Childhood

Age- and Stage-Based Approaches to Describing Persistent Stuttering

Primary Versus Secondary Stuttering

Progressing From Repeating to Prolonging/Blocking as a Primary Symptom

Relationships Between Age and Stuttering Frequency

Relationship Between Age and Stuttering-Related Disability

Age, Disability, and Quality of Life

Attempts to Explain Stuttering: Theories and Models of the Disorder

Early Explanations: Psychological and Learning-Based Explanations

The Move Toward Viewing Stuttering as a Symptom of Speech Production “Breakdown”

Multifactorial Models of Stuttering

Summary

Questions to Consider

 

Section III. Other Types of Fluency Disorders

Chapter 8. Acquired Stuttering

Chapter Objectives

Introduction and Background

Characteristics of Acquired Stuttering

Terminology and Subtypes

Disfluency Characteristics

Epidemiological Data

Disfluency Profiles

Rate Characteristics

Facilitative Contexts and Response to Treatment

Associated Behaviors and Emotional Reactions

Summary

Questions to Consider

 

Chapter 9. Cluttering

Chapter Objectives

Background and Historical Perspective

Defining Cluttering

Approaches to Defining Cluttering

The Evolution of Cluttering Definitions

Fluency Characteristics of Cluttered Speech

Speech Continuity in Cluttered Speech

Effort and Naturalness Characteristics of Cluttered Speech

Talkativeness Characteristics of Cluttered Speech

Performance Consistency/Stability in Cluttered Speech

Speech Articulation Characteristics of Speakers Who Clutter

Coarticulatory Characteristics of Cluttered Speech

Speech Sound Accuracy in Cluttered Speech

Syntax and Discourse Characteristics of Cluttered Speech

Epidemiological Characteristics of Cluttering

Incidence and Prevalence of Cluttering

Onset and Developmental Course of Cluttering

Gender and Familial Patterns of Cluttering

Disorders That Co-Occur With Cluttering

Etiology of Cluttering

Early Views on Etiology 

Contemporary Views on Etiology

Public and Professional Views Toward Cluttering

Summary

Questions to Consider

 

Chapter 10 Disfluency Patterns in Other Clinical Populations

Chapter Objectives

Fluency in Children With Specific Language Impairment

Frequency and Types of Disfluency in Children With Language Impairment

Language Development, Language Demands, and Fluency Performance

Disfluency Variability in Children With Language Impairment

Fluency in Individuals With Intellectual Disability

Fluency in Individuals With Genetic Syndromes

Fluency in Individuals With Down Syndrome

Fluency in Individuals With Fragile X Syndrome

Fluency in Individuals With Prader-Willi Syndrome

Fluency in Individuals With Tourette Syndrome

Fluency in Individuals With Neurofibromatosis Type 1

Fluency in Individuals With Autism Spectrum Disorder

Other Cases of Atypical Disfluency

Word-Final Repetition in the Context of Ostensibly Typical Development

Atypical Disfluency in the Context of Other Communication Disorders

Palilalia: Repetition of Utterance Final Words

Summary

Questions to Consider

 

Section IV. Clinical Practice: Assessing Fluency Disorders

Chapter 11. Assessment Protocols and Data Collection

Chapter Objectives

Assessment Goals and a Framework for Assessment

Assessment Goals

A Framework for Fluency Assessment

Eliciting Background Information: Case Histories and Client Interviews

Administering a Case History Form

Interviewing the Client and/or Caregiver

Eliciting Speech Samples

Clinician-Designed Tasks: Conversation

Clinician-Designed Tasks: Narration

Clinician-Designed Tasks: Oral Reading

Clinician-Designed Tasks: Sentence Production Tasks

Other Sampling Conditions

Norm-Referenced Tests for Assessing Stuttering

The Stuttering Severity Instrument–Fourth Edition (SSI-4)

The Test of Childhood Stuttering (TOCS)

Tests for Assessment of Language Fluency

The Controlled Oral Word Association Test (COWAT)

Tests of Speech-Language Functioning in Adults With Neurological Impairment

Rating Scales and Questionnaires for Assessment of Stuttering and Related Disorders

Rating Scales for Stuttering

Scales for Assessing Temperament, Anxiety, and Self-Concept

Rating Scales for Cluttering

Open-Ended, Written Responses

Designing Assessment Protocols

Summary

Questions to Consider

 

Chapter 12. Describing Client Performance

Chapter Objectives

Historical Context

Obtaining Rich Descriptions of Client Performance

Describing the Client’s Perspective on Fluency Impairment

General Considerations

Perspectives on Fluency Impairment

Describing Speech Continuity

Measurement Options

Formats for Analyzing Continuity Data

Reporting Summary Statistics

Disfluency Measures Versus Stuttering Measures

Describing Speaking Rate

Articulation Rate

Speech Rate

Rate Deviations

Describing Rhythm

Time-Based Measures of Disfluency Duration

Restart Attempts During Repetition

Evaluating the Rhythmic Structure of Repetitions

Describing Effort

Objective Measures of Effort

Subjective Ratings of Effort

Acoustic and Visual Correlates of Effortful Speech

Describing Naturalness

Describing Compensatory and Concealment Strategies

Motor-Based Compensations for Fluency Impairment

Other Strategies for Circumventing, Postponing, or Concealing Fluency Difficulty

Describing Performance Variability

Describing Emotions, Feelings, Thoughts, and Beliefs

Describing Participation and Participation Restrictions

Verbal Output Within Tasks

Situational Involvement

Analyzing Communicative Flexibility

Summary

Questions to Consider

 

Chapter 13. Linking Assessment Data to Intervention

Chapter Objectives

Assigning Diagnostic Classifications

Normal Fluency Functioning

Developmental Fluency Disorders and Atypical Fluency Patterns

Acquired Fluency Disorders

Rating Disorder Severity

Formulating and Presenting General Recommendations

Recommending Dismissal

Recommending Reevaluation

Recommending Intervention

Making Referrals

Other Considerations When Making Recommendations

Making Intervention Recommendations for Preschoolers Who Stutter

Making Recommendations When Parents and Children Disagree on the Need for Intervention

Developing Comprehensive Intervention Plans

Working From Assessment Results

Clarifying the Purpose of Intervention

Taking a Collaborative Approach to Goal Development

Developing Goals Within a Comprehensive Framework of Functioning

Designing Intervention Plans That Encompass Multiple Service Delivery Domains

Planning for Incremental Evaluation of Progress

Other Planning Considerations

Summary

Questions to Consider

 

Section V. Clinical Practice: Intervention Approaches

Chapter 14. The Clinician’s Roles and Responsibilities in Intervention

Chapter Objectives

Background

Clinical Practice and the Code of Ethics

Ethical Principles

Fluency Intervention: Clinician Roles and Responsibilities

Roles That Fluency Clinicians Are Likely to Assume During Intervention

Fluency Intervention: Independent and Evidence-Based Clinical Judgment

Using External Scientific Evidence

Locating Scientific Evidence and Implementing It in Practice

Using Clinician-Generated Data and Clinician Expertise

Incorporating the Perspectives of Clients and Their Caregivers

Clinical Expertise Revisited: Understanding the Intervention Landscape

An Overview of Intervention

Behavioral Treatments

Other Approaches to Treatment

Counseling as an Intervention Component

Prevention as an Intervention Component

Direct Versus Indirect Interventions

Summary

Questions to Consider

 

Chapter 15. Intervention Principles and Strategies for Helping People Who Stutter

Chapter Objectives

Historical Perspective

A Principle-Based Approach to Improving Communication Functioning

Intervention Principle 1: Develop the Client’s and Others’ Knowledge of Stuttering, Speech Production, and the Treatment Process

Overview and Rationale

Implementation

Intervention Principle 2: Build an Environment That Is Supportive and Accepting of Stuttering

Overview and Rationale

Implementation

Intervention Principle 3: Build a Communication Environment That Facilitates Speech Fluency

Overview and Rationale

Implementation

Intervention Principle 4: Provide Systematic Feedback About Fluency Performance

Overview and Rationale

Implementation

Intervention Principle 5: Help the Client Discover and Build on Existing, Productive Responses to Stuttering

Overview and Rationale

Implementation

Intervention Principle 6: Help the Client Develop Skills That Reduce Stuttering Frequency

Overview and Rationale

Implementation

The Speaker’s Experience of Speech Regulation

Intervention Principle 7: Help the Client Develop Skills That Modify Unproductive Responses to Stuttering

Overview and Rationale

Implementation

Intervention Principle 8: Develop the Client’s Ability to Apply Stuttering Management Skills in Natural Settings

Overview and Rationale

Implementation

Intervention Principle 9: Develop the Client’s Ability to Maintain Stuttering-Related Improvements after Intervention Ends

Overview and Rationale

Implementation

Summary

Questions to Consider

 

Chapter 16. Counseling People Who Stutter

Chapter Objectives

Historical Perspective and Overview

An Overview of Counseling Approaches

Counseling and the Scope of Practice in Speech-Language Pathology

Counseling in Speech-Language Pathology: Overview 

Emotions That May Accompany Stuttering

Emotions That Parents May Experience

Ways of Interacting With Clients During Therapy Activities

Engaging in Active Listening

Using Empathic Highlights

Using Probes and Summaries

Presenting Challenges and Disputations

Application of Counseling Practices in Stuttering Intervention

Targeting Self-Limiting Beliefs and Self-Talk: Research Outcomes

Applying Counseling Practices in the Broader Context of Stuttering Treatment

Summary

Questions to Consider

 

Chapter 17. Sample Intervention Programs for Children Who Stutter

Chapter Objectives

Introduction

A Recap of Intervention Concepts Discussed Thus Far

Individualized Intervention: Introductory Comments and Preliminary Considerations

Case 1: Preschooler With Mildly Disfluent, but Typical Fluency Performance

Background Information

Summary of Speech-Language Assessment Protocol and Results

Relationship Between Recommendations and Intervention Principles

Measuring Outcomes

Contingency Plans

Case 2: Preschooler With Moderately Severe Stuttering

Background Information

Summary of Speech-Language Assessment Protocol and Results

Relationship Between Recommendations and Intervention Principles

Measuring Outcomes

Contingency Plans

Case 3: Early Elementary Grade Student With Moderate Stuttering

Background Information

Summary of Speech-Language Assessment Protocol and Results

Relationship Between Recommendations and Intervention Principles

Case 4: Intervention With Children Who Have Concomitant Disorders

Summary

Questions to Consider

 

Chapter 18. Intervention With Older Children, Teens, and Adults

Chapter Objectives

Initial Considerations: Clinical Outcomes Research for Stuttering

A Framework for Organizing Intervention Approaches

Applying Intervention Research to Clinical Practice

Intervention With Older Versus Younger Clients: What Are the Main Differences?

Behavior Modification Approaches to Treating Stuttering

Use of Time-Out as a Primary Intervention Strategy

Speech Motor Approaches for Treating Stuttering

Using Regulated Articulation Rate and Syllable-Timed Speech as Primary Intervention Strategies

Explanatory Mechanisms

Developing the Client’s Ability to Use a Motor-Based Strategy

Examples of Intervention Protocols

Other Strategies That Involve Alteration of Speech Motor Behavior

Speech Motor Strategies in the Context of General Intervention Principles

Structure of a Typical Clinical Session

Feedback and Technology Interventions

The Basics of Delayed Auditory Feedback

The Basics of Frequency Altered Feedback

Explanatory Mechanisms

Intervention Protocols When AAF Is the Primary Intervention Strategy

AAF in the Context of General Intervention Principles

AAF Research Outcomes

Combined/Multiple-Component Interventions

Van Riper’s Stuttering Modification Therapy

A Framework for Designing Combined or Multicomponent Interventions

Evaluating Client Progress and Intervention Outcomes

Intervention for Cluttering

Summary

Questions to Consider

 

References

Index

Kenneth J. Logan

Kenneth J. Logan, PhD, CCC-SLP, is an associate professor at the University of Florida. Dr. Logan completed his bachelor’s and master’s degrees at Colorado State University, and his doctorate degree at Syracuse University. He has over 30 years of experience with teaching college courses on stuttering and over that time, he also has provided clinical services to children, teens, and adults who stutter. His research has examined a variety of issues, including the speaking contexts in which stuttered speech occurs, listeners’ reactions to stuttered speech, and the development of methods for improving the quality and efficiency of fluency assessment. Dr. Logan is a former associate editor of the Journal of Fluency Disorders, and he has given numerous conference presentations and published dozens of research papers on stuttering.

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