Stuttering: Foundations and Clinical Applications

Cover
Title
Copyright
Preface
Contents
Part I: Nature of Stuttering
	1 What Is Stuttering?
		Defining Stuttering: Bases and Aims
		Why is the Definition Important? Practical Implications
			Population Identification
			Quantification and Measurement
			Evaluation of Clinical Progress
		What to Define: Atypical (Abnormal) Speech or Complex Disorder?
		Stuttering as Atypical Speech
			Normally Fluent Speech Production
			Normal Disfluency or Instances of Stuttering?
			Defining Stuttering as Speech Events
			Examples of Definitions of Stuttered Speech
			Fluent Speech of People Who Stutter
		Stuttering as a Complex Disorder
			Multidimensional Characteristics of the Stuttering Disorder
			Diversity of Disorder-Oriented Definitions
			Examples of Definitions of Stuttering as a Complex Disorder
			Other Views
			Our Point of View
		Summary
		Study Questions and Discussion Topics
		Websites
		Suggested Readings
	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
			Current Research
		Incidence: Findings
		Biological Factors in Stuttering Prevalence and Incidence
			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
	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
			Traditional Models of Developmental Progression
			Differential Developmental Models
		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
	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
	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
	6 Is Stuttering Psychological? Theories and Investigations
		Is Stuttering Psychological?
		Psychoemotional Theories
			Psychoanalytic Theory
			Stuttering as a Psychoemotional Disturbance
			Personality Factors in Stuttering
			Summary of Psychoemotional Theories
		Psychobehavioral Theories
			Stuttering as a Reactive Avoidance Behavior
			Stuttering as a Conditioned Anxiety Response
			The Conflict Theory of Stuttering
			Stuttering as an Operant Behavior
			Two-Factor Theory of Stuttering
			The Anticipatory-Struggle Hypothesis
			The Demands-Capacities Model
			Summary of Psychobehavioral Theories
		Psycholinguistic Theories
			Psycholinguistic Processes Resulting in Fluent Speech
			Psycholinguistic Factors in Stuttering
			The Covert-Repair Hypothesis
			The Fault Line Hypothesis
			The Neuropsycholinguistic Theory
			Related Areas of Research
			Summary of Psycholinguistic Theories
		Summary
		Study Questions and Discussion Topics
		Suggested Readings
	7 Is Stuttering Biological? Theories and Investigations
		Introduction
		Genetic Perspectives
			Familial Incidence
			Twin Studies
			Family Aggregation
			Biological Genetics
			Summary of Genetic Perspectives
		Neurological Perspectives
			Cerebral Hemispheric Dominance
			The Modern Era of Brain Research
			Summary of Neurological Perspectives
		Auditory Perspectives
			The Role of Audition
			Summary of Auditory Perspectives
		Motor Perspectives
			Motor Learning Theories of Stuttering
			Brainstem Reflexes: A Disorder of Movement
			Sensorimotor Dysfunction
			Evidence of Motor Differences
			Multifactorial Theory from a Motor Perspective
			Summary of Motor Perspectives
		Summary
		Study Questions and Discussion Topics
		Suggested Readings
Part II: Clinical Management of Stuttering
	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
			Stuttering Severity
			Physical Concomitants
			Speaking Rates
			Voice and Other Communication Skills
		Observations and Examinations: Other 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
	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 Preparations
		The Case History
			Comments on Part I
			Comments on Part II
			Comments on Part III
			Comments on Part IV
		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
			Past Prediction Guidelines
			Recent Developments: The Illinois Prediction Criteria
		Concluding Parent Conference
			Diagnosis, Prognosis, and Recommendations
			Parent Counseling
		Summary
		Study Questions and Discussion Topics
		Suggested Readings
	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
		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
		The Client-Clinician Relationship
			Empathy
			Self-Congruence
			Unconditional Positive Regard
		Clinical Research
			Evaluating Efficacy
			Group Studies
			Single-Subject Studies
			Issues Regarding Efficacy Research
		Ethics
			Questions Concerning Ethics
		Summary
		Study Questions and Discussion Topics
		Suggested Readings
	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
		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
		Suggested Readings
	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-Focused Therapies
			Fluency-Shaping Basics
			Rhythmic Speech
			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
			Computer and Mass Media-Based Therapy
		Summary
		Study Questions and Discussion Topics
		Suggested Readings
	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
			Teasing and Assertiveness
			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
	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 Speech/Motor Patterns
			Focus on Operant Conditioning
			Focus on Parent-Child Interaction
			Focus on Emotionality
		Clinical Research
			Past and Current Research
			Weaknesses and Other Issues in Research
		General Reflections
		Summary
		Study Questions and Discussion Topics
		Suggested Readings
	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