Stuttering: Foundations and Clinical Applications

Stuttering: Foundations and Clinical Applications, Fourth Edition presents a comprehensive overview of the science and treatment of stuttering intended for both undergraduate and graduate level courses. It is the only text that incorporates general information on the nature of stuttering (e.g., incidence and development), a review of its theoretical and research perspectives, and a substantial clinical “how-to” guide for evaluating and managing the disorder at different ages. It guides 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 Fourth Edition

• A new third author, Cara M. Singer, PhD, CCC-SLP, brings a fresh perspective
• Reduced text where possible, enhancing reading and freeing space for new information
• Chapter reorganization in some sections
• An additional assessment-related chapter
• Integration of updated research 
• Updated and expanded clinical approaches 
• 100+ new, recent references

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

PluralPlus Online Ancillaries

For Instructors

• 300+ PowerPoint Slides
• 450+ Item Test Bank
• Assignments
• Links to Related Resources

For Students

• Videos
• Case Studies
• Exercises in Measuring Stuttering
• Links to Related Resources

Contents

Preface
About the Authors
Acknowledgments

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: Surface Speech Events or Complex Disorder?
Stuttering as Atypical Speech
   Dimensions of Speech Production
   Typical Disfluency or Instances of Stuttering?
   Speech-Oriented “Definitions”
   Perspectives on Stuttering as Speech Events
   Fluent Speech of People Who Stutter
Stuttering as a Complex Disorder
   Multidimensional Characteristics of the Stuttering Disorder
   Disorder-Oriented “Definitions”
   Perspectives of Stuttering as 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
Video Samples
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
   Predictive Factors
Study Questions and Discussion Topics
Video Samples
Suggested Readings

Chapter 4. Where Does Stuttering End? What Are Its Advanced Characteristics? 
Advanced Stuttering
Disfluency Types
   Dimensions and Severity 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
Video Samples
Study Questions and Discussion Topics
Suggested Readings

Part II. Explanations of Stuttering
 

Chapter 5. Theories and Evidence: Is Stuttering Psychological?
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?
Is Stuttering Psychological?
Psychoemotional Theories: Can Emotions Cause Stuttering?
   Psychoanalytic Theory
   Alternative Views of Psychoemotional Disturbance
   Personality Factors in Stuttering
   Summary of Psychoemotional Theories
Psychobehavioral Theories: Is Stuttering Learned?
   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: Does Stuttering Indicate Failed Word Assembly?
   Psycholinguistic Processes Resulting in Fluent Speech
   Psycholinguistic Factors in Stuttering
   A Theory of Covert Repair?
   The Fault Line Hypothesis
   Summary of Psycholinguistic Theories
Summary
Study Questions and Discussion Topics
Suggested Readings
 
Chapter 6. Theories and Evidence: Is Stuttering Biological? 
Introduction to Biological Theories
Genetic Perspectives
   Familial Incidence
   Twin Studies
   Family Aggregation
   Biological Genetics
Neurological Perspectives
   Cerebral Hemispheric Dominance
   The Modem 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 7. Observing and Examining Speech 
General Considerations
Speech Sample Context
   Monologues
   Reading Samples
   Play-Based Samples
   Recorded Home Samples
Speech Sample Size
Measures of Stuttering or Disfluency
Speech Recordings and Transcription
   Procedures for Speech Sample Analysis
Disfluency Reference Data
Severity of Stuttered Speech
   Disfluency Length
   Physical Concomitants
   Rating the Severity of Stuttering
Speaking Rates
   Rate Measurement Procedures
Voice and Other Communication Skills
Summary
Study Questions and Discussion Topics
Suggested Readings
Appendix 7–1. Frequency of Disfluency Types per 100 Words in Narrative Contexts for Younger and Older Adults Who Do Not Stutter
Appendix 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 Years
Appendix 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 Years
Appendix 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 Stutter

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
The Client-Clinician Relationship
   Empathy
   Self-Congruence
   Unconditional Positive Regard
Interview Process
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 
   Is It Stuttering? A Diagnostic Challenge
   Other Key Diagnostic Issues
   Objectives of the Initial Evaluation
   Setting and Preparations
The Case History
Case History Form: Preschool Children
   Part I: Client and Family Information
   Part II: Time and Circumstances of Onset
   Part III: Symptomatology at Onset and at Present
   Part IV: General Development and Health History
Collecting Clinical Data
   Obtaining Speech Samples
   Other Related Assessments
Analyzing Clinical Data
Interpreting Clinical Data
   Disfluency Status
   Borderline Cases
Making Prognosis
   The Illinois Prediction Criteria
Concluding Parent Conference
   Diagnosis, Prognosis, and Recommendations
   Parent Counseling
Summary
Study Questions and Discussion Topics
Websites
Suggested Readings

Chapter 10. Stuttering Therapy Overview: Issues and Directions
Introduction
Theoretical Considerations
The Objectives of Therapy
   Increased Fluency
   Reduced Stuttering Severity
   Improved Cognitive-Emotional-Social Adjustment
   General Therapeutic Approaches
The Client-Clinician Relationship
Clinical Applications
   Developing Appropriate Treatment Objectives
   Individual Versus Group Therapy Sessions
   Implementing Treatment
   Skill Maintenance, Fluctuations, and Prevention of Relapse
Evidence-Based Practice
   A Case Study to Illustrate the Steps in EBP
Clinical Research
   Group Studies
   Single-Subject Studies
   Issues Regarding Clinical Efficacy
Ethics
   Questions Concerning Ethics
Summary
Study Questions and Discussion Topics
Websites
Suggested Readings

Chapter 11. Therapy for Adults: Focus on Emotional Reactions
Adults Who Stutter
Treatments
Psychotherapy and Relaxation
   Psychoanalysis
   Rational-Emotive Therapy
   Mindfulness Therapy
   Acceptance and Commitment Therapy
   Relaxation
   Summary of Psychotherapy and Relaxation
Desensitization
   Systematic Desensitization
   Desensitization In Vivo
   Desensitization to Stuttered Speech
   Desensitization to Listeners
   Summary of Desensitization
Assertiveness Training, Communicative Competence, and Group Therapy
   Assertiveness Training
   Communication Competence Therapy
   Avoidance Reduction Therapy for Stuttering (ARTS)
   Group Therapy
   Summary of Assertiveness Training, Recent Approaches, 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: Cancellations (Post-Block Modification}
   Step II: Pullouts (In-Block Modification)
   Step III: Preparatory Sets (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
Integrated Approaches
Fluency-Inducing Instruments
   Metronome Pacing of Speech
   Auditory Masking
   Altered Auditory Feedback
   Biofeedback
   Summary of Fluency-Inducing Instruments
Internet Therapy, Mass Media–Based Therapy, and Teletherapy
Summary
Study Questions and Discussion Topics
Websites
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
   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 Interactions
   Focus on Speech/Motor Patterns
   Play Therapy
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 Trends 
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

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

The companion website is located at: https://www.pluralpublishing.com/publication/sfca4e

STUDENTS:

The student resources include Videos, Case Studies, Exercises in Measuring Stuttering, and Links to Related Resources.

To access the student resources, you must register on the companion website and log in using the access code located in the front of your textbook.

INSTRUCTORS:

The instructor resources include PowerPoint Slides, Test Bank, Assignments, and Links to Related Resources. You will also have access to all of the student resources listed above.

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

            Email: instructormaterials@pluralpublishing.com

            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.