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Stuttering prevention: A clinical method
BOOK
137
REVIEWS
significant portion is devoted to a very important, but much neglected, area-normal fluency and its development. Starkweather has presented a very convmcmg argument for, and explanation of, the Demand/Capacity model. For those who are looking for a treatment of other models, or for an historical view of stuttering research, this text would be somewhat disappointing. On the other hand, those who wish to concentrate on what appears to be a promising approach to the understanding of fluency and the cause and development of stuttering will find this text to be a welcome addition to their libraries.
REFERENCES Adams, M. (1990) The demand and capacities model I: Theoretical tions. Journal of Fluenc_y Disorders, 15, 135-141. Bloodstein, 0. (1987) A Handbook Seal Society.
of Stuttering.
Chicago:
National
evaluaEaster
Starkweather, C.W., and Gottwald, S.R. (1990) The demand and capacities model II: Clinical applications. Journal of Fluency Disorders, 15. 143157.
Stuttering Prevention: A Clinical Method Starkweather, C.W., and Ridener, S. (1990). Englewood Cliffs, NJ: Prentice-Hall, 134 pages, $27.00. Reviewed by GARY R. LABLANCE,
PH.D.
Associate Professor Department of Communication Disorders School of Medicine St. Louis, Missouri
This book discusses an early intervention program for preschool children who are at risk for stuttering. That is, children who “. . . show unusually high levels of nonstruggled disfluency and whose parents are concerned that stuttering might develop” (p. 4). The principles and methods presented are based on a lo-year project initiated by the authors at Temple University. Various aspects of the program have been presented at national and intemational meetings as well as in the ASHA Manual on the Prevention of Disorders of Speech, Language, and Hearing (Cole, 1986).
138
BOOK
REVIEWS
Chapters 1 and 2 describe the rationale behind early intervention, whereas Chapters 3-5 discuss the principles and practices of assessment and intervention with young children who stutter. Chapter 1 presents solid arguments to refute the claims of practitioners who believe that early direct intervention of stuttering should be avoided. The principles of early intervention are discussed in Chapter 2. The program is based on the belief that stuttering is a multidimensional disorder resulting from an interaction of the child’s capacities (cognition, emotion, language, motor skill) with the environmental demands for fluency (those conditions that require a rapid rate of speech or speech continuity). The Demands and Capacities model is presented as a framework for clinicians to organize relevant data about a child’s fluency development. Practical examples are provided on how to use this information to design and implement an effective treatment program based on the child’s personal circumstances. Chapter 3 presents strategies to evaluate fluency capacities and environmental demands that might stress these capacities. Assessment of the child’s and the parents’ speech, and the nature of family interactions are involved. Specific measures include judgments of the parents’ and child’s awareness of and reactions to disfluency, as well as assessments of the child’s and parents’ speech continuity, speech rate, and language level. The authors stress that absolute values in continuity, rate, and language level may not be as significant as the relative differences in values between the parents’ and child’s speech. The demand for fluency may increase as these relative differences increase. Chapter 4 discusses the intervention process. The focus of the program is to reduce the demands and to enhance the child’s capacity for fluency. To this end, the program consists of individual and group parent education and counseling, as well as individual and group direct therapies for the child. Topics such as changing parents’ speech rate, language level, and negative reactions to stuttering are discussed, as are suggestions for establishing family rules for conversational turn-taking, ways to reduce demand speech, and direct-therapy techniques that can be used successfully by parents. Chapter 5 is concerned with the criteria for dismissal from treatment. Two variables are described: parental change and the child’s fluency. Specific criteria are given for each variable. The book provides useful information in an area that has largely been ignored by the profession. The text is well-organized and clearly written. The case histories presented in Chapters 34 provide effective illustrations of how to implement their program. Anecdotal reports of the success of this approach provide evidence of the program’s efficacy. Intervention strategies are pragmatic and may be incorporated easily into a hospital- or clinic-based practice. Direct involvement of parents makes the program more difficult for school professionals to utilize. Various aspects of the program, however, can
BOOK
139
REVIEWS
be easily incorporated into the classroom-collaborate model. There is a paucity of references, many of which are dated. However, given the nature of the text, this does not present a major obstacle. The text should prove useful to graduate students and speech-language pathologists interested in the prevention of stuttering in young children.
Disorders of Fluency 2nd ed. Dalton, P., and Hardcastle, W.J. (1989). London: Cole and Whurr, 195 pages Reviewed
by ALF PREUS, M.A., and CAND. POLIT.
Speech
Clitticim
(retired).
Skjelsbo.
When
the first edition
Vesteroy.
Norwn?
of this book was published in 1977, in the series and Rernediation, it appeared to differ from existing books on stuttering and other fluency disorders. The authors attempted to define speech fluency in linguistic terms, and to describe variables related to fluent speech. These variables included aspects such as transition smoothness, pausing, rhythmic patterning, and regulation of tempo. The book also presented a neurologically based speech model, although the authors stipulated that it was a speculative approach. In the original edition, the first three chapters dealt with aspects of a preliminary model of speech production, and certain speech variables involved in fluency assessment. The second portion of the book described fluency disorders-stuttering, cluttering, and distluencies of organic origin. Useful information, in capsule form, was presented on the nature and treatment of the foregoing disorders, with the authors displaying a critical and well-balanced view. The material on organic-based fluency disorders seemed especially valuable. Also, the section contrasting the phonetic features of stuttering and cluttering was original and thought-provoking. As a result of the foregoing, this reviewer approached the second edition with great expectations, but was deeply disappointed. The eight chapters from the 1977 edition had been reprinted, unaltered, and the book added only two new chapters. These new chapters comprise about 20% of the total pages and the reference list contains about 15% new titles since 1977. Sheehan’s Stuttering: Research and Therapy, a 1970 publication, is referred to as “recent” in this 1989 edition. Of the two new chapters in the 1989 edition, one describes a procedure for structuring a linguistic profile of a stuttered speech sample. Repetitions, prolongations, and pauses are to be noted not only in relation to phonemes Studies
in Lmgunge
Disabilig
137
REVIEWS
significant portion is devoted to a very important, but much neglected, area-normal fluency and its development. Starkweather has presented a very convmcmg argument for, and explanation of, the Demand/Capacity model. For those who are looking for a treatment of other models, or for an historical view of stuttering research, this text would be somewhat disappointing. On the other hand, those who wish to concentrate on what appears to be a promising approach to the understanding of fluency and the cause and development of stuttering will find this text to be a welcome addition to their libraries.
REFERENCES Adams, M. (1990) The demand and capacities model I: Theoretical tions. Journal of Fluenc_y Disorders, 15, 135-141. Bloodstein, 0. (1987) A Handbook Seal Society.
of Stuttering.
Chicago:
National
evaluaEaster
Starkweather, C.W., and Gottwald, S.R. (1990) The demand and capacities model II: Clinical applications. Journal of Fluency Disorders, 15. 143157.
Stuttering Prevention: A Clinical Method Starkweather, C.W., and Ridener, S. (1990). Englewood Cliffs, NJ: Prentice-Hall, 134 pages, $27.00. Reviewed by GARY R. LABLANCE,
PH.D.
Associate Professor Department of Communication Disorders School of Medicine St. Louis, Missouri
This book discusses an early intervention program for preschool children who are at risk for stuttering. That is, children who “. . . show unusually high levels of nonstruggled disfluency and whose parents are concerned that stuttering might develop” (p. 4). The principles and methods presented are based on a lo-year project initiated by the authors at Temple University. Various aspects of the program have been presented at national and intemational meetings as well as in the ASHA Manual on the Prevention of Disorders of Speech, Language, and Hearing (Cole, 1986).
138
BOOK
REVIEWS
Chapters 1 and 2 describe the rationale behind early intervention, whereas Chapters 3-5 discuss the principles and practices of assessment and intervention with young children who stutter. Chapter 1 presents solid arguments to refute the claims of practitioners who believe that early direct intervention of stuttering should be avoided. The principles of early intervention are discussed in Chapter 2. The program is based on the belief that stuttering is a multidimensional disorder resulting from an interaction of the child’s capacities (cognition, emotion, language, motor skill) with the environmental demands for fluency (those conditions that require a rapid rate of speech or speech continuity). The Demands and Capacities model is presented as a framework for clinicians to organize relevant data about a child’s fluency development. Practical examples are provided on how to use this information to design and implement an effective treatment program based on the child’s personal circumstances. Chapter 3 presents strategies to evaluate fluency capacities and environmental demands that might stress these capacities. Assessment of the child’s and the parents’ speech, and the nature of family interactions are involved. Specific measures include judgments of the parents’ and child’s awareness of and reactions to disfluency, as well as assessments of the child’s and parents’ speech continuity, speech rate, and language level. The authors stress that absolute values in continuity, rate, and language level may not be as significant as the relative differences in values between the parents’ and child’s speech. The demand for fluency may increase as these relative differences increase. Chapter 4 discusses the intervention process. The focus of the program is to reduce the demands and to enhance the child’s capacity for fluency. To this end, the program consists of individual and group parent education and counseling, as well as individual and group direct therapies for the child. Topics such as changing parents’ speech rate, language level, and negative reactions to stuttering are discussed, as are suggestions for establishing family rules for conversational turn-taking, ways to reduce demand speech, and direct-therapy techniques that can be used successfully by parents. Chapter 5 is concerned with the criteria for dismissal from treatment. Two variables are described: parental change and the child’s fluency. Specific criteria are given for each variable. The book provides useful information in an area that has largely been ignored by the profession. The text is well-organized and clearly written. The case histories presented in Chapters 34 provide effective illustrations of how to implement their program. Anecdotal reports of the success of this approach provide evidence of the program’s efficacy. Intervention strategies are pragmatic and may be incorporated easily into a hospital- or clinic-based practice. Direct involvement of parents makes the program more difficult for school professionals to utilize. Various aspects of the program, however, can
BOOK
139
REVIEWS
be easily incorporated into the classroom-collaborate model. There is a paucity of references, many of which are dated. However, given the nature of the text, this does not present a major obstacle. The text should prove useful to graduate students and speech-language pathologists interested in the prevention of stuttering in young children.
Disorders of Fluency 2nd ed. Dalton, P., and Hardcastle, W.J. (1989). London: Cole and Whurr, 195 pages Reviewed
by ALF PREUS, M.A., and CAND. POLIT.
Speech
Clitticim
(retired).
Skjelsbo.
When
the first edition
Vesteroy.
Norwn?
of this book was published in 1977, in the series and Rernediation, it appeared to differ from existing books on stuttering and other fluency disorders. The authors attempted to define speech fluency in linguistic terms, and to describe variables related to fluent speech. These variables included aspects such as transition smoothness, pausing, rhythmic patterning, and regulation of tempo. The book also presented a neurologically based speech model, although the authors stipulated that it was a speculative approach. In the original edition, the first three chapters dealt with aspects of a preliminary model of speech production, and certain speech variables involved in fluency assessment. The second portion of the book described fluency disorders-stuttering, cluttering, and distluencies of organic origin. Useful information, in capsule form, was presented on the nature and treatment of the foregoing disorders, with the authors displaying a critical and well-balanced view. The material on organic-based fluency disorders seemed especially valuable. Also, the section contrasting the phonetic features of stuttering and cluttering was original and thought-provoking. As a result of the foregoing, this reviewer approached the second edition with great expectations, but was deeply disappointed. The eight chapters from the 1977 edition had been reprinted, unaltered, and the book added only two new chapters. These new chapters comprise about 20% of the total pages and the reference list contains about 15% new titles since 1977. Sheehan’s Stuttering: Research and Therapy, a 1970 publication, is referred to as “recent” in this 1989 edition. Of the two new chapters in the 1989 edition, one describes a procedure for structuring a linguistic profile of a stuttered speech sample. Repetitions, prolongations, and pauses are to be noted not only in relation to phonemes Studies
in Lmgunge
Disabilig