Stuttering and Cluttering Stuttering and Cluttering provides a comprehensive overview of both theor- etical and treatment aspects of disorders of fluency: stuttering (also known as stammering) and the lesser known cluttering. The book demonstrates how treatment strategies relate to the various theories as to why stuttering and cluttering arise, and how they develop. Uniquely, it outlines the major approaches to treatment alongside alternative methods, including drug treatment and recent auditory feedback procedures. Part 1 looks at different perspectives on causation and development, emphasizing that in many cases these apparently different approaches are inextricably intertwined. Part 2 covers the assessment, diagnosis, treatment, and evaluation of stuttering and cluttering. In addition to chapters on estab- lished approaches, there are sections on alternative therapies, including drug therapy, and auditory feedback, together with a chapter on counselling. Ref- erence is made to a number of established treatment programs, but the focus is on the more detailed description of specific landmark approaches. These provide a framework from which the reader may not only understand others’ treatment procedures, but also a perspective from which they can develop their own. Offering a clear, accessible and comprehensive account of both the theo- retical underpinning of stammering therapy and its practical implications, the book will be of interest to speech language therapy students, as well as quali- fied therapists, psychologists, and to those who stutter and clutter. David Ward is Director of the Speech Research Laboratory at the University of Reading, and a specialist fluency clinician within the NHS. He qualified as a speech language therapist in 1987, and later received an MA in linguistics and phonetics and a PhD in motor control and stuttering. He has lectured extensively on disorders of fluency, and is involved in research into both theoretical and clinical aspects of stuttering and cluttering. Stuttering and Cluttering Frameworks for understanding and treatment David Ward First published 2006 by Psychology Press 27 Church Road, Hove, East Sussex BN3 2FA Simultaneously published in the USA and Canada by Psychology Press 270 Madison Avenue, New York, NY 10016 Psychology Press is an imprint of the Taylor & Francis Group, an informa business This edition published in the Taylor & Francis e-Library, 2008. “To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.” © 2006 Psychology Press All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. This publication has been produced with paper manufactured to strict environmental standards and with pulp derived from sustainable forests. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data Ward, David, 1956 Dec. 9– Stuttering and cluttering: frameworks for understanding and treatment / David Ward p.;cm Includes bibliographical references and index. ISBN-13: 978–1–84169–334–7 ISBN-10: 1–84169–334–0 1. Stuttering. 2. Cluttering (Speech pathology) 3. Speech Disorders. I. Title. [DNLM: 1. Stuttering. 2. Speech Disorders. WM 475 W257s 2006] RC424.W37 2006 616.85′5406—dc22 2006010954 ISBN 0-203-89280-1 Master e-book ISBN ISBN 13: 978–1–84169–334–7 ISBN 10: 1–84169–334–0 This book is dedicated to those who stutter and clutter Contents List of figures xiii List of tables xiv Preface xv Acknowledgements xviii PART I The aetiology of stuttering and cluttering 1 1Definitions and epidemiology 3 Introduction: What is stuttering? 3 Normal nonfluency and stuttering 5 Primary and secondary stuttering 6 Definitions of stuttering 7 Prevalence and incidence 10 Who is at risk of stuttering? 11 Development of stuttering 13 Phenomena associated with stuttering 13 Causes of stuttering 14 Spontanous recovery 16 Making sense of the data: Stuttering as a balance between capacity and demand 16 Summary 19 Key points 20 Further reading 21 2 Brain function and stuttering 22 Introduction 22 Cortical studies and cerebral dominance 22 Brain imaging studies 28 viii Contents CNS and motor speech control 35 Stuttering and metabolism 39 Drugs and stuttering 41 Summary 42 Key points 43 Further reading 44 3 Stuttering and auditory processing 46 Introduction 46 Stuttering and the hearing impaired 46 Stuttering and altered auditory feedback 47 Auditory function and cerebral dominance 51 Auditory processing and physiological factors 54 Stuttering as defective auditory processing 55 Summary 57 Key points 58 Further reading 58 4 Motor speech control and stuttering 60 Introduction 60 Respiratory control and stuttering 61 Laryngeal control and stuttering 62 Articulatory kinematics and neuromotor control 69 Acoustics 73 Motor control outside the speech domain 75 Stuttering and internal models 77 Summary 78 Key points 79 Further reading 79 5 Linguistic aspects of stuttering 81 Introduction 81 A linguistic basis for stuttering 81 Models of language processing 85 Linguistic or motor difficulties? 87 Summary 95 Key points 95 Further reading 96 Contents ix 6 Some psychological perspectives on stuttering 98 Introduction 98 Learning theory and stuttering 98 Stuttering as an operant behaviour 103 Stuttering and approach-avoidance conflict 108 Stuttering as anticipatory struggle behaviour 109 Summary 110 Key points 111 Further reading 111 7 The development of stuttering 113 Introduction 113 Track development of stuttering 114 Spontaneous recovery 125 A genetic component to stuttering 128 Summary 136 Key points 137 Further reading 138 8 The nature of cluttering 139 Introduction 139 Definitions 139 Aetiology of cluttering 140 Characteristics 141 Development of cluttering 147 Cluttering and attention deficit hyperactivity disorder 148 Cluttering and stuttering 149 Cluttering spectrum behaviour 150 Summary 151 Key points 152 Further reading 153 PART II The treatment of stuttering and cluttering 155 9 The measurement and assessment of stuttering 157 Introduction 157 Measurement of speech rate and speech fluency 158 Assessment of attitudes toward stuttering 171 x Contents Assessment of preschool stuttering 180 Assessment of primary school age stuttering 185 Assessment of adolescent and adult stuttering 187 Summary 191 Key points 192 Further reading 192 10 Treating early stuttering 194 Introduction 194 The decision-making process for therapy 194 An indirect approach to therapy 196 Direct approaches 204 Integrated approaches 212 Summary 214 Key points 215 Further reading 215 11 The treatment of stuttering in school age children 217 Introduction 217 Group therapy 218 Treatment of primary school age stuttering 220 Treatment of secondary school age stuttering 234 Is one treatment approach better than another? 240 Summary 241 Key points 242 Further reading 242 12 The treatment of stuttering in adults 244 Introduction 244 Modifying stuttering 245 Modifying behavioural, cognitive and affective responses to stuttering 253 Modifying speech: Fluency shaping approaches 257 Integrated approaches to the treatment of stuttering 267 Covert stuttering 271 Summary 274 Key points 275 Further reading 275 Contents xi 13 Counselling approaches 277 Introduction 277 Cognitive therapy 278 Personal construct therapy 279 Transactional analysis 282 Rational emotive therapy 284 Neurolinguistic programming 286 Brief therapy 288 Summary 289 Key points 290 Further reading 291 14 Alternative approaches to the treatment of stuttering 292 Introduction 292 Altered feedback therapies 293 Computerized feedback devices 300 Drug therapy 301 Botox treatment of stuttering 304 Stutterer-led therapy 306 Summary 313 Key points 314 Further reading 315 15 The efficacy of stuttering therapy 316 Introduction 316 Problems in demonstrating treatment efficacy 317 Efficacy in adult therapy: What constitutes successful treatment? 319 Efficacy of early treatment programs for children 322 What constitutes good efficacy study design? 325 Summary 328 Key points 330 Further reading 330 16 Acquired stuttering 332 Introduction 332 Occult stuttering 332 Neurogenic stuttering 333 Psychogenic stuttering 335 xii Contents Treatment of neurogenic stuttering 339 Treatment of psychogenic stuttering 343 Summary 348 Key points 349 Further reading 349 17 Assessment, diagnosis and treatment of cluttering 351 Introduction 351 Assessment of cluttering 351 Differential diagnosis 359 Treatment of cluttering 363 Treating cluttering and stuttering 374 Summary 376 Key points 376 Further reading 377 References 379 Author index 423 Subject index 433 Figures 1.1 Example of some possible demands and capacities 18 2.1 Schematic illustration of three models of hemispheric interaction and stuttering 36 2.2 Schematic representation of the interaction of the D2 system with speech motor planning function of the medial system 38 3.1 Schematic example of Harrington’s model of stuttering as the misperception of linguistic rhythm 57 7.1 Developmental characteristics of the four tracks of stuttering development 121 9.1 Formulas for calculating frequency of stuttering and rate of speech 159 9.2 Identical length phrases with similar degree of stuttering and identical communicative content, but showing