Fluency Disorders: Stuttering, Cluttering, and Related Fluency Problems

Preface
Acknowledgments
Reviewers
Section I. Foundational Concepts
	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
	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
	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
	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
	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
	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
	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
	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
	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
	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
	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
	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
	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
	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
	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
	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
	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
	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