Stuttering and Cluttering: Frameworks for Understanding and Treatment

Description

Stuttering and Cluttering provides a clear, accessible and wide-ranging overview of both the theoretical and clinical aspects of two disorders of fluency: stuttering and cluttering. This edition remains loyal to the idea that stuttering and cluttering can best be understood by first considering various overarching frameworks which can then be expanded upon, and provides a clear position from which to disentangle the often complex interrelationships of these frameworks. The book is divided into two parts, the first of which mainly deals with theory and aetiology, while the second focuses on clinical aspects of assessment, diagnosis and treatment. The book also provides frequent references across Parts I and II to help link the various areas of investigation together. This revised edition of Stuttering and Cluttering reflects the major changes in thinking regarding both theory and therapy that have taken place since the publication of the first edition. As well as those who stutter and clutter, the book will be invaluable for speech language therapy/speech language pathology students, practicing clinicians, psychologists and linguists around the world. Cover Half Title Title Page Copyright Page Dedication Table of contents List if figures List of tables Preface to the second edition Acknowledgements Part I The Aetiology of Stuttering and Cluttering 1 Definitions and epidemiology 1.1 Introduction 1.1.1 Developmental stuttering 1.1.2 Acquired stuttering 1.1.3 Cluttering 1.2 Normal disfluency and stuttering 1.3 Primary and secondary stuttering 1.4 Definitions of stuttering 1.4.1 The stuttering elephant 1.4.2 Psychologically based definitions 1.4.3 Symptom-led definitions 1.4.4 Wingate’s definition 1.5 Prevalence and incidence 1.6 Who is at risk of stuttering? 1.6.1 Age 1.6.2 Genetic predisposition 1.6.3 Male–female ratio 1.6.4 Children with co-occurring speech and language problems 1.6.5 Learning disorders 1.6.6 Children with poor motor control 1.6.7 Environmental factors 1.7 The development of stuttering 1.8 Fluency-enhancing phenomena 1.9 Causes of stuttering 1.10 Spontaneous recovery 1.11 Making sense of the data: stuttering as a balance between capacity and demand 1.12 Summary Key points Note Suggestions for further reading 2 Brain function and stuttering 2.1 Introduction 2.2 Cortical studies and cerebral dominance – some earlier studies 2.2.1 Introduction 2.2.2 Stuttering and handedness 2.2.3 Laterality of auditory function 2.2.4 Anaesthesia studies 2.2.5 Electrophysiological studies 2.3 Brain imaging studies 2.3.1 Methods 2.3.2 Findings at the cortical level Structural anatomy of speech/language centres White matter tract connectivity Brain structure studies – summary 2.3.3 The study of brain function in adults Brain function studies – summary Brain imaging of young children 2.4 CNS and motor control: two current perspectives 2.4.1 Stuttering as inhibited basal ganglia activation 2.4.2 DIVA/GODIVA model 2.5 Stuttering and metabolism 2.5.1 Extrapyramidal function and the role of dopamine 2.6 Drugs and stuttering 2.7 Brain stimulation 2.7.1 Transcranial magnetic stimulation 2.7.2 Transcranial direct current stimulation – implications for fluency therapy 2.8 Summary Key points Suggestions for further reading 3 Stuttering and auditory processing 3.1 Introduction 3.2 Stuttering and the hearing impaired 3.3 Stuttering and altered auditory feedback 3.3.1 Choral and unison speech 3.3.2 Shadowed speech 3.3.3 Delayed auditory feedback 3.3.4 Masking 3.3.5 Frequency-altered feedback 3.4 Auditory function and cerebral dominance 3.4.1 Dichotic listening 3.4.2 Time perception 3.5 Auditory processing and physiological factors 3.6 Stuttering as defective auditory processing 3.6.1 DIVA/GODIVA revisited 3.7 Summary Key points Notes Suggestions for further reading 4 Motor speech control and stuttering 4.1 Introduction 4.1.1 Motor speech and linguistics: a proviso 4.2 Respiratory control and stuttering 4.2.1 Therapeutic relevance 4.3 Laryngeal control and stuttering 4.3.1 Voice onset 4.3.2 Voice initiation time Therapeutic ramifications 4.3.3 Vowel duration Therapeutic relevance Therapeutic relevance of a laryngeal component in stuttering 4.3.4 Electromyographic evidence 4.4 Articulatory kinematics and neuromotor control 4.4.1 Articulatory sequencing and single data-point studies 4.4.2 The analysis of phrase length data 4.5 Acoustics 4.6 Motor control outside the speech domain 4.6.1 Motor control in non-speech tasks 4.6.2 Motor control in non-speech oro-motor tasks 4.6.3 Coordinating motor speech and non-motor speech systems 4.7 Motor speech control – assimilating the data 4.8 Summary Key points Note Suggestions for further reading 5 Linguistic aspects of stuttering 5.1 Introduction 5.2 A linguistic basis for stuttering 5.2.1 The loci of stuttering 5.2.2 Word frequency/non word repetition 5.2.3 Lexical retrieval and stuttering 5.2.4 Lexical class and stuttering frequency 5.2.5 The development of linguistic skill and stuttering 5.3 Phonology and stuttering 5.3.1 Phonological encoding and stuttering 5.3.2 Phonological working memory 5.3.3 Phonological encoding and motor speech control 5.3.4 Rhyme judgement 5.3.5 Summary 5.4 Bilingualism 5.4.1 Prevalence 5.4.2 Distribution of stuttering across languages in multilingual populations 5.5 Models of language processing 5.6 Motoric and linguistic models of stuttering 5.6.1 Covert Repair Hypothesis 5.6.2 Vicious Circle Hypothesis 5.6.3 The EXPLAN model of fluency failure Phonological word Stalling The role of the phonological word and stalling in the EXPLAN model 5.7 Summary Key points Suggestions for further reading 6 The emergence and development of stuttering: Some organic perspectives 6.1 Introduction 6.2 Spontaneous recovery 6.2.1 Problems with research into spontaneous recovery 6.2.2 Implications for the treatment of stuttering 6.2.3 Predicting persistence of stuttering 6.3 Subgrouping stuttering 6.3.1 Some early theories 6.3.2 Van Riper’s four-track model of stuttering development Track I Track II Track III Track IV Summary of track development 6.3.3 Starkweather’s nine tracks of stuttering 6.3.4 Some further thoughts about subgrouping 6.4 A genetic component to stuttering 6.4.1 Twin studies 6.4.2 Adoption studies 6.4.3 Family studies 6.4.4 Genetic predisposition versus environmental factors 6.4.5 Gene studies 6.4.6 Some concluding thoughts 6.5 Summary Key points Note Suggestions for further reading 7 Some psychological perspectives on the development of stuttering 7.1 Introduction 7.2 Learning theory and stuttering 7.2.1 Stuttering – a bad habit? 7.2.2 Negative practice 7.2.3 Two-factor theory of stuttering 7.2.4 Diagnosogenic theory of stuttering Wendell Johnson and cerebral dominance The monster study The diagnosogenic theory Therapeutic perspectives 7.3 Stuttering as an operant behaviour 7.3.1 How does operant conditioning work? 7.3.2 Contingent punishment of stuttering 7.3.3 An operant perspective on the development of stuttering 7.3.4 Stuttering as an operant disorder – concluding thoughts on therapeutic implications 7.4 Stuttering and approach–avoidance conflict 7.4.1 Temperament 7.4.2 Stuttering and attention deficit 7.4.3 Emotional reactivity 7.4.4 The dual-diathesis model 7.4.5 Social anxiety 7.5 Stuttering as anticipatory struggle behaviour 7.6 Summary Key points Suggestions for further reading 8 The nature of cluttering 8.1 Introduction 8.2 Definitions 8.2.1 Some background 8.2.2 Lowest common denominator Overconstraint and underconstraint in definitions of cluttering 8.2.3 The cluttering spectrum 8.3 The features of cluttering 8.3.1 Factors within the LCD Overly rapid speech rate (tachylalia) 8.3.2 Features that have been associated with cluttering but now fall outside the LCD Phonological errors Grammar and syntax Lexical level Semantic/pragmatic level 8.4 The demographics of cluttering 8.4.1 Introduction 8.4.2 The development of cluttering 8.5 The aetiology of cluttering 8.5.1 Introduction 8.5.2 A motor speech perspective on cluttering 8.5.3 Non-motor speech control and cluttering 8.5.4 A genetic basis to cluttering? 8.5.5 A language component in cluttering 8.5.6 Neurological underpinnings 8.5.7 An auditory processing component 8.5.8 Cluttering and executive functioning 8.6 Cluttering and comorbidity 8.6.1 Introduction 8.6.2 Cluttering and attention deficit hyperactivity disorder (ADHD) 8.6.3 Specific learning disorders 8.6.4 Cluttering in Down’s syndrome 8.6.5 Cluttering and autism spectrum disorder (ASD) 8.6.6 Cluttering and stuttering 8.6.7 Acquired cluttering 8.7 Cluttering – assimilating the data 8.7.1 Point 1: definition 8.7.2 Point 2: a language component 8.7.3 Point 3: concomitants 8.8 Summary Key points Suggestions for further reading PART II The Treatment of Stuttering and Cluttering 9 Tools for the assessment of stuttering and people who stutter 9.1 Introduction 9.2 The measurement of speech fluency and speech rate 9.2.1 The fluency count – how do you do it? 9.2.2 What to count and what not to count Syllables or words? Stuttering versus normal disfluency Should nonstuttering disfluencies be included? Primary versus secondary stuttering Computerized fluency analysis 9.2.3 Speech rate Articulatory rate and speaking rate 9.2.4 Do frequency counts accurately reflect severity? 9.2.5 Reliability in calculating moments of stuttering and rate of speech 9.2.6 Interpretation of frequency counts 9.2.7 The Stuttering Severity Instrument (SSI) Administration of the SSI 9.3 Assessment of attitudes toward stuttering 9.3.1 Modified Erickson Scale of Communication Attitude (S-24) 9.3.2 Perceptions of Stuttering Inventory (PSI) 9.3.3 Overall Assessment of the Speaker’s Experience of Stuttering (OASES) 9.3.4 The Wright and Ayre Stuttering Self-Profile (WASSP) 9.3.5 Unhelpful Thoughts and Beliefs about Stuttering (UTBAS) 9.3.6 Sheehan’s Iceberg model 9.3.7 Attitudinal assessment of preschool- and primary school-age stuttering 9.4 Summary Key points Notes Suggestions for further reading 10 The assessment process 10.1 Introduction 10.2 Assessment of preschool stuttering 10.2.1 Goals of assessment Case history Clinician and child assessment Receptive and expressive language Phonology Motor control Assessment of speech fluency and speech rate Secondary stuttering The therapeutic decision-making process – determining potential treatment approach from assessment 10.3 Assessment of primary school-age stuttering 10.3.1 Case history 10.3.2 Child interview 10.4 Assessment of adolescent and adult stuttering 10.4.1 Case history 10.4.2 Adolescent and parent interview 10.4.3 Client interview (adolescent) 10.4.4 Client interview (adult) 10.4.5 Fluency count 10.4.6 Attitudinal assessments 10.4.7 Summation 10.5 Summary Key points Suggestions for further reading 11 Treating early stuttering 11.1 Introduction 11.2 The decision-making process for therapy 11.3 Indirect approaches to therapy 11.3.1 Parent–child interaction approach Rationale 11.3.2 Palin PCI assessment Initial screening Screening in the clinic Full assessment Synopsis Case history Formulation 11.3.3 PCI therapy Introduction Session scheduling Session 1 Session 2 Sessions 3–6 Consolidation period Review appointment RESTART–DCM programme 11.4 Direct approaches to therapy 11.4.1 The Lidcombe Program Introduction Stage 1: Establishment of fluency Assessment Home sessions Stage 2: Maintenance Telehealth service delivery Summary 11.4.2 Gradual Increase in Length and Complexity of Utterance 11.5 Integrated approaches to therapy 11.5.1 Van Riper’s approach Direct treatment strategy Desensitization Parent counselling 11.6 Summary Key points Suggestions for further reading 12 Treatment of stuttering in school-age children 12.1 Introduction 12.1.1 Stuttering and bullying 12.1.2 Stuttering and teacher reactions Summary 12.2 Group therapy 12.3 Treatment of primary school-age stuttering 12.3.1 Awareness of stuttering 12.3.2 Changing vocal tract dynamics – a modular approach to treatment 12.4 Fluency-shaping approaches 12.4.1 Introduction 12.4.2 Operant approaches to primary school-age stuttering 12.5 Speech modification approaches 12.5.1 Introduction 12.5.2 Rationale 12.5.3 Speech modification ‘fluency tools’ Smooth airflow Soft glottal onsets Soft consonant contact 12.5.4 Structuring the introduction of stuttering modification techniques 12.5.5 How are these techniques applied? 12.6 An integrated approach to primary school-age stuttering 12.6.1 Introduction 12.6.2 An example speech modification programme – the Apple House approach Goals of the programme Parental involvement Assessment Identification – explaining stuttering Desensitization Stuttering modification Transfer Post-clinic assessment Maintenance 12.7 Treatment of secondary school-age stuttering 12.7.1 Introduction 12.7.2 Stuttering and social anxiety Assessment and therapy planning 12.7.3 Stuttering modification approaches for teenagers Three further integrated approaches to the treatment of adolescent stuttering 12.7.4 The Apple House speech modification approach to adolescent stuttering 12.7.5 The Michael Palin Centre intensive group approach for teenagers who stutter 12.7.6 The Fluency Trust intensive group programmes 12.7.7 Fluency-shaping approaches to the treatment of adolescent stuttering 12.7.8 Ryan’s delayed auditory feedback approach 12.8 Is one approach better than another? 12.9 Summary Key points Notes Suggestions for further reading 13 Treatment of stuttering in adults 13.1 Introduction 13.1.1 Stutter more fluently and speak more fluently approaches 13.2 Modifying stuttering 13.2.1 Van Riper’s stuttering modification approach Aims 13.2.2 Schedule 13.2.3 Therapy Identification Desensitization Open stuttering Pseudostuttering Freezing Modification Increasing proprioceptive awareness Summary of modification phase 13.2.4 Stabilization 13.2.5 The legacy of Van Riper’s approach 13.3 Modifying cognitive and affective responses to stuttering 13.3.1 Sheehan’s approach-avoidance conflict therapy Self-acceptance Monitoring Initiative Modification The safety margin 13.4 Modifying speech: fluency-shaping approaches 13.4.1 Prolonged speech Theoretical underpinnings 13.4.2 Main features of prolonged speech programmes 13.4.3 The Camperdown Program Stage 1 Stage 2 Stage 3 Stage 4 Efficacy of the Camperdown Program 13.4.4 Fluency-shaping programmes and speech naturalness – some final comments 13.5 Integrated approaches to the treatment of stuttering 13.5.1 The case for integration Integrated approaches 13.5.2 Covert stuttering 13.5.3 An integrated approach to the treatment of covert stuttering Identification/desensitization Modification Transfer and maintenance 13.6 Summary Key points Note Suggestions for further reading 14 Counselling approaches 14.1 Introduction 14.2 Cognitive behavioural therapy 14.2.1 Concepts and overview Escape behaviours Negative thoughts 14.2.2 Evidence base 14.3 Mindfulness therapy 14.3.1 Concepts and overview ‘Doing mode’ and ‘being mode’. Acceptance 14.3.2 Evidence base 14.4 Acceptance and Commitment Therapy (ACT) 14.4.1 Concepts and overview 14.4.2 Evidence base 14.5 Neurolinguistic programming 14.5.1 Concepts and overview 14.5.2 NLP as part of an integrated approach to stuttering 14.5.3 Evidence base 14.6 Brief therapy 14.7 Other approaches 14.7.1 Personal Construct Therapy 14.7.2 Transactional analysis 14.7.3 Rational–emotive therapy The ABC model 14.8 Summary Key points Suggestions for further reading 15 Alternative approaches to the treatment of stuttering 15.1 Introduction 15.2 Altered feedback therapy 15.2.1 Introduction 15.2.2 Choral speech and shadowed speech 15.2.3 Delayed auditory feedback therapy 15.2.4 Frequency-altered feedback therapy and combined frequency and delayed feedback The efficacy of altered feedback devices 15.2.5 Masked auditory feedback therapy 15.3 Computerized biofeedback devices 15.3.1 Computer Aided Fluency Establishment Trainer (CAFET) and Dr. Fluency 15.4 Drug therapy 15.4.1 Dopamine blocking drugs 15.4.2 Serotonin-specific reuptake inhibitors 15.4.3 Pagaclone study 15.4.4 Beta-adrenoreceptor blocking drugs 15.4.5 Other drugs 15.4.6 Summary of drug treatments 15.5 Botox and the treatment of stuttering 15.6 PWS-led therapy 15.6.1 The McGuire Programme Introduction Theory Schedule and structure of programme Procedures and techniques Costal breathing Hit and hold Deep breathy tone Others Practice Summary 15.6.2 Harrison’s Hexagon 15.6.3 The Valsalva hypothesis 15.6.4 The Starfish Project 15.7 Summary Key points Notes Suggestions for further reading 16 The efficacy of stuttering therapy 16.1 Introduction 16.2 Problems with demonstrating treatment efficacy 16.2.1 Different outcome measures for different approaches 16.3 What constitutes successful treatment? 16.3.1 The client as a consumer 16.3.2 How long should therapy effects last to be considered ‘successful’? 16.4 Research design: two approaches 16.4.1 Randomized controlled trials 16.4.2 Single case study design 16.4.3 Documenting clinical outcomes: a five-step process for clinicians 1. Describe the nature of the treatment programme 2. Define success clearly 3. Operationalize the clinical decision-making process 4. Measure the outcomes of treatment 5. Report all changes (both positive and negative) objectively 16.5 Summary Key points Suggestions for further reading 17 Acquired stuttering 17.1 Introduction 17.2 Occult stuttering 17.3 Neurogenic stuttering 17.3.1 Stuttering subsequent to stroke 17.3.2 Site of lesion 17.3.3 Characteristics of neurogenic stuttering 17.4 Psychogenic stuttering 17.4.1 Characteristics of psychogenic stuttering 17.4.2 Late onset stuttering in children 17.4.3 Stuttering as post-traumatic stress disorder? 17.5 Treatment of neurogenic stuttering 17.5.1 Assessment and diagnosis 17.5.2 Treatment 17.6 Treatment of psychogenic stuttering 17.6.1 Some case examples 17.6.2 Psychogenic stuttering and experiencing pain 17.6.3 Anaesthesia treatment Lidocaine injection 17.6.4 Recovery period in the treatment of PS 17.7 Summary Key points Suggestions for further reading 18 Assessment and treatment of cluttering 18.1 Introduction 18.2 Assessment of cluttering 18.2.1 Case history 18.2.2 Cluttering checklists 18.2.3 Predictive cluttering inventory – revised 18.2.4 Ward checklist – revised 18.2.5 Assessment procedures Conversation (5 minutes) Oral reading (around 2 minutes) Story retelling 18.2.6 Data analysis Speech rate Abnormal pausing and speech rhythm Over-coarticulation Excessive number of nonstuttering-like disfluencies Summary Language Articulation Attention and cognition Memory Self-perception 18.2.7 Cluttering assessment program (CLASP) 18.2.8 Further assessments 18.2.9 Data interpretation 18.3 Treatment of cluttering 18.3.1 Introduction 18.3.2 Recovery from cluttering and therapeutic goals 18.3.3 Treating preschool-age children who clutter 18.3.4 Cluttering therapy for primary school-age children Scaler Scott and Ward’s method Back door approach Underlying concepts 18.3.5 Therapy approaches for children and adults Myers’ approach Van Zaalen’s approach Cognitive component Emotional components Verbal-motor components Communicative component Therapy 18.3.6 Delayed auditory feedback 18.3.7 Hearing aids 18.3.8 Summary of treatment methods 18.4 Treatment of cluttering and stuttering 18.4.1 Introduction 18.4.2 Therapy approaches 18.4.3 Mindfulness 18.5 Treatment of cluttering and other concomitant disorders 18.5.1 Autism spectrum disorder 18.5.2 Cluttering and other concomitant disorders 18.6 Maintenance of cluttering therapy 18.7 Evidence base for clinical research in cluttering: some ongoing problems 18.7.1 Objectively measurable criteria 18.7.2 Isolating ‘pure’ cluttering from possible contamination of co-morbidities 18.7.3 Group size/funding for studies 18.8 Summary Key points Note Suggestions for further reading References Author index Subject index