Stuttering: Foundations and Clinical Applications

Third Edition

Ehud Yairi, Carol H. Seery

Details: 465 pages, B&W, Softcover, 8.5" x 11"

ISBN13: 978-1-63550-355-5

© 2023 | Available

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Stuttering: Foundations and Clinical Applications, Third Edition presents a comprehensive overview of the science and treatment of stuttering in a single text. The book offers a unique level of coverage of the stuttering population, the disorder’s features, and the therapies offered for different ages. Written for both undergraduate and graduate level audiences, the authors guide students to critically appraise different viewpoints about the nature of stuttering, understand the disorder’s complexities, and learn about the major clinical approaches and therapies appropriate for different age groups.

This evidence-based textbook is divided into three distinct sections. Part I, Nature of Stuttering, offers descriptive information about stuttering, including its demographics and developmental pathways. Part II explores the various explanations of stuttering, giving students an understanding of why people stutter. Part III focuses on clinical management, delving into the assessment of both adults and children, as well as various age-appropriate intervention approaches. In the final chapter, the authors explore other fluency disorders, as well as cultural and bilingual issues.

New to the Third Edition

  • Significantly updated scientific information and references
  • Content has been edited, shortened, and simplified to be more concise and reader-friendly
  • A PluralPlus companion website with ancillary materials for instructors and students

Key Features

  • Each chapter begins with a list of learner objectives to frame the chapter before new material is presented
  • Boxes throughout the text and bolded words are used to highlight important points
  • End-of-chapter summaries and study questions allow readers to review and test their understanding
  • Infused with suggested further readings and websites
  • Included visuals, tables, diagrams, photos, and drawings help clarify and expand on key concepts
  • Numerous case studies and testimonies from parents in the text with additional cases on the book’s companion website
  • Bolded key terms throughout with a comprehensive glossary to improve retention of the material


“…The purpose of the third edition is to provide an all-encompassing textbook that covers the nature of stuttering, a review of the theories and explanations of the disorder, and a practical guide for clinicians in evaluating and treating stuttering at various ages. The book is a comprehensive representation of the complexities of the disorder and includes clear explanations of how to provide supportive services, depending on the needs of the person who stutters (PWS). Stuttering modification, fluency shaping, and instrumentation are described to guide therapy. Clinicians in the field, as well as students preparing their skills, will appreciate the well-described steps in implementing therapy tasks.
This updated edition remains targeted to undergraduate and graduate students, as well as speech-language pathologists working with children and adults. The comprehensive nature of the discussions allow this to be a stand-alone, required text for a fluency course at either the undergraduate or graduate level… Extensive investigations are presented throughout the chapters, covering historical studies and current research…
One feature that is valued when reading through the various psychological and neurophysiological theories is the discussion of clinical implications and strengths and weaknesses of the theories presented. Readers gain a reflective understanding that drives application of therapy intervention. The authors present case studies along with descriptions of cluttering, neurogenic, and psychogenic stuttering, which help provide guidance for differential diagnosis and treatment of related disorders. Throughout the book, the authors refer back to previous discussions, helping the readers understand the continuity of learning between topics. Each chapter ends with thought-provoking discussion questions and suggested readings that can be used for self-reflection, class assignments, or group interaction. Website links are provided in print for many of the chapters. These same websites are available on the companion website, which is granted to students and instructors for supplementary material.  
This book is a detailed representation of stuttering that considers scientific evidence, ethical considerations, and age-related evaluation and treatment considerations. The authors thoughtfully discuss foundational topics such as the complexities of stuttering when defining the disorder, as well as deep examinations of theories and models that drive therapeutic intervention… this outstanding textbook is invaluable. Research in the area of stuttering is continually being updated, thus, there is validation for the authors to provide a relevant resource. Beyond current research that is presented, they identify aspects within the topic of stuttering that have been inconclusive and need to be more fully researched for speech pathologists to gain a fuller understanding of the disorder and its impact on intervention. Overall, this book is a phenomenal resource for professors, students, and speech pathologists wanting to gain a complete understanding of stuttering, impacting those from preschool through adulthood.”  

–Darcie Beth Hultberg, BA, MS, Biola University, from Doody’s Reviews (August 2022)

“…As was the case in previous versions, the book is intended for students in the field of speech-language pathology and related fields as a single main text for a general course on stuttering… Stylistically, the book is more reader friendly and has been edited to abbreviate certain sections while maintaining the key content. It also contains new visuals, pictures, diagrams, and tables, and overall has a better flow than previous editions. It contains features such as learner objects at the start of each chapter, boxes that highlight key points, end-of-chapter summaries and study questions, suggestions for further reading and websites, case studies and parent testimonials, and a comprehensive glossary.
Another nice feature for instructors is the PluralPus companion website that contains a lot of useful content and is a big improvement from previous editions… I was particularly happy to see the addition of videos of people stuttering in different languages and severity levels, as well as videos of ameliorating factors. This content will be a great help for students and instructors and this alone is reason enough to strongly consider adopting the book for a class.
Part I of the book focuses on the “Nature of Stuttering” and includes four chapters that discuss topics like terminology, definitions, symptoms, incidence and prevalence data, research on onset and development, and other factors related to the epidemiology of stuttering…
Part II of the book discusses “Explanations of Stuttering” including three chapters discussing theories and models of stuttering. I particularly enjoyed Chapter 5 which deals with how to evaluate theories and models. I believe that chapter helps set the stage for the critical thinking students need for evaluating the assertions contained in the various theories described later. This chapter is another example of what sets this book from some others. The authors discuss the need for an integrated framework of stuttering and, very importantly, distinguish between different levels of causation including predisposing, precipitating, and perpetuating causes… I enjoyed how the authors discuss weaknesses and potential clinical implications of the theories they describe to make it clear how one’s theory for what causes stuttering influences how it is managed clinically. 
Part III of the book focuses on “Clinical Management of Stuttering.” This section starts with two chapters on assessment (one focusing on adults and school-age children, the other on pre-school children). The content in these chapters is thorough and the authors do a nice job linking the epidemiological research reviewed earlier in the book to assessment factors relevant for pre-school children… I also appreciate how the authors describe methods and procedures for assessment of physical speech disruption as well as assessment of social, emotional, and cognitive factors. In doing this, they clinically operationalize their view that stuttering is a multidimensional condition in the context of carrying out an assessment.
…The book closes with Chapter 15, which focuses on a variety of topics including other types of fluency disorders and cultural and bilingual issues. This is another strong chapter that presents a variety of helpful information on topics that have perplexed many speech-language pathologists including neurogenic stuttering, psychogenic stuttering, and cluttering… Overall, the third edition of “Stuttering: Foundations and Clinical Applications” by Ehud Yairi and Carol H. Seery is a textbook packed with valuable information about stuttering and other fluency disorders. It balances information on research, theory, and clinical management, has been updated with new and important research findings since the last edition, and includes a more reader friendly style and flow. A large quantity of helpful supplemental instructor and student resources are available as well. Ultimately, I highly recommend that instructors of classes covering fluency disorders consider adopting this book as a primary text for their students. The book is certainly appropriate as a main textbook for graduate students learning about fluency disorders, perhaps with the addition of supplemental readings on topics such as those I have recommended in this review. Certain portions of the book would also be useful for undergraduates in courses focused on stuttering, although the book strikes me as more appropriate for graduate study. I have enjoyed reading the previous editions of this book, and this newest edition is the strongest yet. I appreciate the authors’ efforts and their hard work in writing, revising, and updating this book for the important purpose of better educating our students, and professionals (current and future) on the disorder of stuttering and its clinical management.”

–Michael P. Boyle, PhD, CCC-SLP, Montclair State University, from the Journal of Fluency Disorders (2022)

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

Study Questions and Discussion Topics
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




Geography, Race, and Culture





Prevalence in Clinical Subpopulations

Hearing Impairment

Cleft Palate

Cognitive Impairment

Other Groups

Study Questions and Discussion Topics
Suggested Readings

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

Theoretical and Clinical Significance

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


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




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


Speaking Rate

Emotional Characteristics and Cognition

Emotional Reactions


Concomitant Disorders
The Dynamics of Advanced Stuttering

Patterns of Occurrence

Loci of Stuttering

Conditions That Diminish Stuttering

Conditions That Increase Stuttering

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?
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


Study Questions and Discussion Topics

Suggested Readings

Chapter 7. Is Stuttering Biological? Theories and Investigations

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

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


Treatment Recommendations

The Diagnostic Report

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

Study Questions and Discussion Topics
Suggested Readings

Chapter 10. Stuttering Therapy Overview: Issues and Directions 

Theoretical Considerations
The Objectives of Therapy

Increased Fluency

Managed Stuttering

Improved Cognitive-Emotional Adjustment

General Therapeutic Approaches

The Client-Clinician Relationship



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


Questions Concerning Ethics

Study Questions and Discussion Topics
Suggested Readings

Chapter 11. Therapy for Adults: Focus on Emotional Reactions 

Adults Who Stutter
Psychotherapy and Relaxation


Rational-Emotive Therapy


Summary of Psychotherapy and Relaxation


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

        Study Questions and Discussion Topics
        Suggested Readings

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



Phase I: Awareness

Phase II: Analysis

Summary of Identification


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


Summary of Fluency-Inducing Instruments

Integrated Approaches

Internet, Mass Media-Based and Teletherapy

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?


Therapy: Focus on Emotional Reactions

Adapted Desensitization Activities

Assertiveness, Resilience, Teasing


Therapy: Focus on Stuttering and Fluency

Identification and Analysis

Changing Speech

Stuttering Modification

Fluency Facilitating Speaking Skills


Other Therapy Programs

Conditioning Fluent Speech

Family Stuttering Programs

Group Therapy

Clinical Research
Study Questions and Discussion Topics
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
Study Questions and Discussion Topics
Suggested Readings

Chapter 15. Other Fluency Disorders; Cultural and Bilingual Issues

Childhood Disorders

Unusual Breathing Patterns

Word-Final Disfluency

Language Disorders


Acquired Stuttering

Neurogenic Stuttering

Psychogenic Stuttering


Stuttering in Bilingual and Multicultural Populations




Study Questions and Discussion Topics
Suggested Readings


Ehud Yairi

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.

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Carol H. Seery

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.

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Stuttering: Foundations and Clinical Applications, Third Edition comes with access to supplementary student and instructor materials on a PluralPlus companion website.


To access the student materials, you must register on the companion website and log in using the access code printed on the inside front cover of your book.


To access the instructor materials, you must contact Plural Publishing, Inc. to be verified as an instructor and receive your access code.

    Tel: 866-758-7251 (toll free) or 858-492-1555

*Note for students: If you have purchased this textbook used or have rented it, your access code will not work if it was already redeemed by the original buyer of the book. Plural Publishing does not offer replacement access codes for used or rented textbooks. 

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