This book is written by three well respected specialist speech and language therapists who, at the time of writing, were working at the Michael Palin Centre in London.

The book states in the first sentence that it aims to provide a comprehensive but essentially practical approach to the treatment of early childhood dysfluency. There is no doubt that the aim is well achieved.

The first chapter of the book consists of a through look at the research into the various factors involved in childhood nonfluency. These include: onset and development, spontaneous recovery, variability, and physiological, linguistic, environmental and psychological factors. This gives a comprehensive picture and shows how this approach fits into the current "state of the art".

The following four chapters describe the extensive assessment procedures used by these therapists which form the bases of any therapy that follows. There are four components to this assessment procedure:
1. The child assessment, including linguistic and psychological factors
2. The interactive assessment, concerning the environment and sociocultural factors
3. The parent interview, which encompasses physiological and/or genetic factors, linguistic factors, sociocultural and emotional aspects
4. The formulation. This is a summary of all the findings which is shared with the parents and upon which therapy proceeds.

The remainder of the book concentrates on therapy. One chapter describes the work carried out on developing parental interaction with their child, including establishing a "special time" task, reducing directiveness, gaining attention and working on linguistic factors that improve or develop fluency. Another chapter looks at family issues which may affect fluency. Specific difficulties covered here are reactions to stammering, routines (such as eating or sleeping), bilingualism, English as a second language, behaviour problems, illness and change (including bereavement, moving house, divorce). In the final chapter there is a briefer account of some direct therapy approaches with case studies to illustrate the ideas.

Much of this book is quite technical and obviously written to instruct other professionals (for example, when discussing the child assessment the authors include lists of standardised language tests used by speech and language therapists, ideas on how to test the child's comprehension of language at different level of difficulty, how to transcribe the child's speech, how to measure dysfluency and so on).

Parents and carers may be interested in aspects of the book, rather than attempting to take the in whole text. In my opinion, these readers may find some chapters worthy of greater attention than others; in particular sections relating to parental-child interaction, the parental interview and therapy. The case studies may also be of interest and these are generally less technical.

I would certainly recommend this text to speech and language therapists working with young children and others wishing to develop specialist skills in dysfluency. I am sure aspects would also be of interest to parents of a child embarking on and/or currently receiving speech and language therapy. The authors are to be congratulated on a through, but useful text in an area that can be a difficult one in which to work.

Reviewed by Dr Trudy Stewart, Specialist Speech and Language Therapist, Leeds in the Autumn 1996 issue of 'Speaking Out'.

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