Working With Dysfluent Children:
practical approaches to assessment and therapy
by Trudy Stewart and Jackie Turnbull

This book is intended for speech and language therapists (SLTs). Information about current theories and the principles upon which intervention is based is well presented. The authors describe techniques for therapy which they have found useful. They give clear examples along with helpful and interesting case studies.

The overall approach is based firmly on Personal Construct Psychology (PCP). The authors say they do not wish to look upon themselves as experts but rather to be open to new ideas and new evidence, rejecting ideas which no longer make sense. To my mind this should be the definition of a good therapist and of any expert and these ladies certainly qualify for the title.

The early chapters describe what is known about stammering, the attitude of parents and children to it and how it can develop from early dysfluency. Though not written for them many parents of young dysfluent children would find these chapters readable and helpful.

The authors clearly describe their approach to children with early dysfluency. From their base of PCP they accept that the child behaves in a particular way because it has meaning for him and it is important to find the individual meaning for each child. Environmental influences are discussed with emphasis on the increasingly acceptable 'Demands and Capacities' model and on the way parents and children 'construe' the stammer. Work in partnership with parents shows how they can be enabled to modify the child's speaking environment where necessary.

Only occasionally do these authors work directly with children at this stage. They do not offer specific fluency techniques and indeed appear to be very biased against them. Some small description of such techniques is confined to the Appendix. British SLTs are often uneasy with very structured programmes even when they have been shown to be successful and enjoyable for the children. I have no doubt that such programmes are insufficient of themselves but they can be beneficial for some children.

There are practical ideas for helping parents to help the child to make the best out of any potential for fluency. Later chapters concentrate on therapy for 'borderline' and 'confirmed' stammerers. The school and peer group are seen to be important. The authors show considerable insight when discussing the child's attitude and feelings. They believe that the way a 'borderline' stammer construes herself is crucial to her either becoming fluent or developing into a 'confirmed' stammerer.

Optimism is expressed about the 'confirmed' stammerer, following Kelly's view that 'no-one needs to be a victim of his own biography': change is always possible. Intervention at this stage relies much upon PCP. Techniques are described to help children to express themselves and to help the therapist to understand their viewpoint. Children are helped to reconstrue their world as they are given help to produce fluent speech. There are some sensible ideas presented for dealing with teasing and bullying. Work with parents of adolescents is mentioned, for after all these youngsters are still part of the family unit.

Group therapy is given much attention and is obviously in favour with these authors. There are detailed guidelines for organising groups. Roles within the group are discussed including those of therapists, family and teachers. One chapter is devoted to programmes for children at different stages of non-fluency and for groups of parents of early dysfluent children. Practical suggestions abound here and should be invaluable to therapists who may be a little diffident about setting up therapy groups for children and young people. There are even guidelines for organising training sessions on stammering for teachers. After twenty years experience of working with groups I found much in this section to stimulate me and provide food for thought.

I enjoyed reading this book. It presents a very comprehensive view of dysfluency in children and provide some very practical ideas for SLTs working with them whether they are inexperienced or 'experts'.

Reviewed in the Winter 1995 issue of 'Speaking Out' by Margaret Evesham

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