Evidence-Based Treatment of Stuttering: empirical bases and clinical applications
Bothe, A.K. (Ed)
Lawrence Erlbaum Associates, 2004

Review: Sharon Millard, Specialist clinical and research therapist, Michael Palin Centre for Stammering Children

This book is the result of a 'state of the art conference' held in 2002 at the University of Georgia and is intended to provide 'state of the art' information to researchers, clinicians and students (p.xi).

The book begins with a chapter by Bothe, who provides a useful description of evidence-based practice and points out that evidence-based practice is more complex than simply accepting empirical evidence. This research must be sourced, evaluated and applied according to the specific needs of the individual client, which is dependent on the clinician's skills and expertise. The impact of therapy must then be evaluated by the clinician. Following the Introduction, the book is divided into three further sections:

In Part II, chapters relating to the nature and theory of stuttering and the implications for evidence-based treatment are presented. The second chapter by Webster reports his theory of stuttering, based on hemispheric lateralisation and his hypotheses of the neurophysiological impact of therapy. In chapter three Ingham discusses the methodological issues within the neuroimaging literature. This is a helpful chapter for those who are unfamiliar with the procedures employed in such studies and would be useful to a reader who is familiar with the literature but who wishes to improve their ability to critically appraise such studies.

The only chapter that appears to be dedicated to indirect therapy methods is chapter four, written by Packman and colleagues, who describe the weaknesses of the demands and capacities model (DCM). This chapter ends with a description of the Lidcombe Programme, which seems strangely placed within a chapter exploring the DCM. The argument that the Lidcombe program is evidence against the DCM since it 'increases demands for fluency' is not adequately argued. From a DCM perspective, it might be argued that the therapy process is instead increasing the child's 'capacity' for fluency, through the manipulation of linguistic complexity that takes place as part of therapy.

In two very clinically relevant chapters, Shenker discusses therapy in the context of bilingualism (chapter 5), while Nippold considers therapy in the context of co-existing phonological disorders (chapter 6). In chapter 7, Finn reports on recovery in adolescents and the ability of the client to achieve change without therapy.

Part III of the book contains two chapters on measuring outcome, which emphasise the need to develop and broaden current methods.

Part IV, contains three chapters that reflect on the literature relating to direct therapy programmes. Overall, they demonstrate that further evaluations are needed, to incorporate greater subject numbers, long term follow up and beyond clinic measures in order that practice may become more evidence based.

The format of the conference required the papers to be presented, with substantial time to allow discussion and consideration. This would be a useful way in which to approach this book. The authors of this book are, without exception, behaviourists whose clinical and research work focuses on direct therapy management strategies. Not surprisingly, the theoretical perspective of stuttering as a multifactorial disorder and the value of indirect therapy management approaches with young children is not adequately represented in the text and is negated within a number of chapters. This is an unfortunate bias, which could have been avoided by including reviews from researchers with a broader range of perspectives.

This is not an introductory book, nor a book to 'dip into'. The concepts presented and the issues raised are at times complex and require thought and consideration. Approaching this book with the 'healthy scepticism' that Bothe suggests should be applied to all research literature (p.5) would result in a useful text for researchers and clinicians to use for discussion, to develop critical appraisal skills and to reflect on the value and issues inherent in evidence-based practice.

From the Summer 2007 issue of 'Speaking Out', page 17

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