*NSSLHA members can download the full-text version of these articles in the "Members" section of our site.
- Advice to Students of Stuttering Treatment
- Best Practices for Preparing Students To Work With People Who Stutter
- Clinical Applications of a Multidimensional Approach for the Assessment and Treatment of Stuttering
- Documenting Individual Treatment Outcomes in Stuttering Therapy
- "How Can You Understand? You Don't Stutter!"
- Bullying in Adolescents Who Stutter: Communicative Competence and Self-Esteem
- Theoretical Perspectives on the Cause of Stuttering
- The Formative Years of Stuttering: A Changing Portrait
- Unstable or Insufficiently Activated Internal Models and Feedback-Biased Motor Control as Sources of Dysfluency: A Theoretical Model of Stuttering
- Assessment of Some Contemporary Theories of Stuttering That Apply to Spontaneous Speech
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1. Advice to Students of Stuttering Treatment
Mark Onslow
Abstract: This article proffers advice to students of stuttering treatment, with appropriate caveats attached. Students are advised to stay away from continua in clinical practice. It may well be the case that there is a continuum from normally developing speech in preschool children to the disorder of stuttering in preschool children. It may also well be the case that it can be difficult to decide whether a certain speech event is a normal disfluency or a stutter. However, students are advised not to be concerned about those issues because they impact on researchers only and do not affect day-to-day clinical practice. Students are also advised to be careful about their choice of treatments, and not to do any therapy that is based on a theory of stuttering, because that theory is likely to be wrong, and therefore the treatment is likely to be wrong. Instead of theories, students are advised to look to clinical trials evidence to establish "best practice" for their clients. Finally, students of stuttering treatment are advised to take the challenge of being accountable. This means being specific about treatment goals, using speech measures to determine outcomes, and benchmarking clinical performance. The benefits of accountability in clinical practice are argued. After closing discussion, some questions are posed for reflection.
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2. Best Practices for Preparing Students To Work With People Who Stutter
William P. Murphy
Robert W. Quesal
Abstract: This article discusses academic and clinical preparation for students in the disorder area of stuttering. Suggestions for improving both academic classes and clinical practicum are provided. A detailed group supervision model for a stuttering practicum is presented. The information is intended to assist academicians as they modify curriculum and practicum to meet the forthcoming (2005) changes to the standards for the Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP). Relevant information is provided for instructors, supervisors, and students.
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3. Clinical Applications of a Multidimensional Approach for the Assessment and Treatment of Stuttering
E. Charles Healey
Lisa Scott Trautman
Michel Susca
Abstract: This article describes a model and a process that involves a multidimensional assessment and treatment approach to persons who stutter. Because of the complexity of stuttering, the amount of information that needs to be considered when assessing and treating stuttering can be overwhelming. In this article, a model is proposed that focuses on five components believed to be central to the maintenance of stuttering. The model includes cognitive, affective, linguistic, motor, and social (CALMS) components, which form a basis for assessment and treatment planning. Specifically, the model accounts for individual differences in the performance each client has in the five components, and how changing demands influence a client's overall communicative abilities. Examples are given that demonstrate how ratings of performance in each component guide assessment. Specific applications of the information derived from the assessment for treatment are illustrated by a case study of a school-age child who stutters.
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4. Documenting Individual Treatment Outcomes in Stuttering Therapy
Scott Yaruss
Abstract: The documentation of treatment outcomes is one of the most important issues facing the field of fluency disorders. Unfortunately, there are several factors that complicate the process of evaluating the results of treatment for people who stutter. This article addresses three key factors that can affect treatment outcomes research in stuttering: (a) the variability of stuttering, both between and within individuals who stutter; (b) differences between individuals in terms of the specific goals they set for their treatment; and (c) the diverse experiences that people who stutter may have in their treatment and in their lives in general. Specific recommendations for overcoming these challenges are presented, based on the careful consideration of individual differences between people who stutter when designing treatment programs and evaluating stuttering treatment outcomes.
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5. "How Can You Understand? You Don't Stutter!"
Walt Manning
Abstract: A crucial factor in the process of therapeutic change is the competence of the clinician. A necessary characteristic of the effective clinician is the ability to understand the client's experience. This understanding is essential for making accurate and timely clinical decisions and for validating the effectiveness of our treatment. Can a nonstuttering clinician fully understand the stuttering client's experience? This article advocates for the importance of understanding the phenomenon of stuttering from each client's perspective and suggests ways that nonstuttering clinicians can inform themselves about the experience.
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6. Bullying in Adolescents Who Stutter: Communicative Competence and Self-Esteem
Gordon W. Blood
Ingrid M. Blood
Abstract: This study examined the perceived communicative competence, self-esteem, and vulnerability to bullying of 53 adolescents who stutter and 53 adolescents who do not stutter. Adolescents who stutter were at a significantly higher risk of experiencing bullying behavior (43%) than were adolescents who do not stutter (11%). The majority of adolescents who stutter (57%) rated themselves as having poor communicative competence. In contrast, only 13% of the adolescents who do not stutter rated themselves as having poor communicative competence. Seventy-two percent of adolescents who stutter scored within 1 SD from the mean on a standardized measure of self-esteem, which is indicative of positive self-esteem. Students with low self-esteem and poor confidence in their communicative competence were more likely to be victimized by bullies. The importance of perceived communication skills, especially in establishing and maintaining positive social interactions, and their relationship to potential victimization by bullies is discussed. Social and communication skills training programs may be an important part of treatment programs for some adolescents who stutter to manage potential bullying behavior.
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7. Theoretical Perspectives on the Cause of Stuttering
Nicoline Grinager Ambrose
Abstract: The many theories of the cause of stuttering are too numerous to mention. Instead, this article presents a brief background of theories in the realms of psychology, learning theory, and biology. A representative sampling of older literature is discussed, followed by a more detailed consideration of a few state-of-the-art studies. The article concludes that previously presented general models can provide a basis for testable hypotheses. Current research appears to indicate that there is a genetic basis for stuttering, affecting both motor and sensory systems in the brain in subtle ways, and that deficits are exacerbated by a host of both other genetic as well as environmental factors. Genetic, physiologic, psychologic, and environmental influences guide the developmental pathway of stuttering.
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8. The Formative Years of Stuttering:A Changing Portrait
Ehud Yairi
Abstract: Conceptions and information regarding the onset and development of stuttering in early childhood have undergone large changes during the past three decades. In general, the notions that stuttering begins with normal disfluency and that, once it exists, the disorder typically develops in an ascending manner following a stage-like progression, have been greatly challenged, if not discarded. A review of highlights of the findings of the Illinois Stuttering Research Program reveals strong genetic components to stuttering. Considerable variability is seen in the event of onset. Early symptomatology is complex, often containing characteristics seen in advanced stuttering, and tends to be moderate or even higher in severity. Generally, the developmental course of stuttering is characterized by diverse pathways, with the great majority of children exhibiting natural recovery within 3 years after onset. The findings have significant clinical implications.
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9. Unstable or Insufficiently Activated Internal Models and Feedback-Biased Motor Control as Sources of Dysfluency: A Theoretical Model of Stuttering
Ludo Max
Frank H. Guenther
Vincent L. Gracco
Satrajt S. Ghosh
Marie E. Wallace
Abstract: This article presents a theoretical perspective on stuttering based on numerous findings regarding speech and nonspeech neuromotor control in individuals who stutter in combination with recent empirical data and theoretical models from the literature on the neuroscience of motor control. Specifically, this perspective on stuttering relies heavily on recent work regarding feedforward and feedback control schemes; the formation, consolidation, and updating of inverse and forward internal models of the motor systems; and cortical, subcortical, and cerebellar activation patterns during speech and nonspeech motor tasks. Against this background, we propose that stuttering may result when producing speech (a) with unstable or insufficiently activated internal models or (b) with a motor strategy that is weighted too much toward afferent feedback control. We discuss how these two hypotheses can account for the specific dysfluencies that form the primary characteristics of stuttering, and we suggest that the hypotheses are compatible with several of the phenomena associated with the disorder (e.g., age of onset, fluency-enhancing conditions, treatment effects). For one of the hypotheses, we also describe a computer simulation implemented in the DIVA (directions into velocities of articulators) model-a neural network model of the central control of speech movements.
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10. Assessment of Some Contemporary Theories of Stuttering That Apply to Spontaneous Speech
Peter Howell
Abstract: In this article, a selection of theoretical approaches about stuttering is examined. One way of characterizing theories is in terms of whether the problem of stuttering arises at the linguistic or motor levels or in the interaction between the two. A second contrast between theories is in terms of whether they link production together with perception (linked theories, e.g., the covert repair hypothesis) or they consider that the production system works independent of perception (autonomous theories, e.g., EXPLAN). It is argued that many features of stuttering can be explained in an autonomous production model in which the problem arises at the point where linguistic and motor processes interact.
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