Book review by Elaine Christie, Speech and Language Therapist, and at that time in our Primary Healthcare Workers Project.
This book landed on my desk long before Mark Onslow did his tour round Britain. I was interested to read it and compare its content to the information presented at one of Onslow's talks on the Lidcombe Programme. The text will be of interest and use to speech and language therapy students as well as therapists working with dysfluency, who want to gain a better understanding of a behavioural approach to intervention. Onslow raises many of the issues therapists have about stammering, including relapse, and the effectiveness of different therapeutic approaches.
The book is divided into eight parts which cover a number of topics relating to the behavioural management of stuttering. The evolution of this approach, and its application to treating early and advanced stuttering are discussed in detail (parts 2, 3 and 4). Therapists who attended one of Onslow's talks in Britain or want more in-depth information on his approach to early intervention will gain a better understanding of this by reading parts 2 and 3 (pp30-84). The Lidcombe method is reported along with a single case study illustration. Onslow's discussion of early intervention (part 7 - "Clinical issues in the Management of Early Stuttering" pp190-197) also provided a thought provoking read.
His approach by its very title "behavioural management" would appear to directly contradict the British approach to working with pre-school dysfluency. However, on examination of the text, Onslow does comment that ".. a range of nonbehavioural dimensions are critical in helping clients to eliminate stuttered speech .. and to accept the importance of behaviour in stuttering is not to reject the importance of those variables". He goes on to say that "it would be difficult to defend a treatment concerned only with the elimination of stuttered speech, and equally difficult to defend a treatment which paid no regard to the elimination of stuttered speech" (pp33).
Part 5 looks at various "perspectives on stuttering" which include speech motor control, stuttering and genetics, anticipatory struggle and anxiety. Throughout the book, Onslow puts forward his own thoughts about stuttering, whilst offering a summary of the current literature relating to differing aspects discussed. Much of this will be of familiar to the clinician working with dysfluency. However, it does serve as a reminder of the tentative conclusions which have been drawn from research into these areas. Onslow also suggests avenues for future research and some of the issues which, in his opinion require further exploration.
Onslow comments at the beginning of this book that its origins came from lectures written for an undergraduate course at the University of Sydney. The writer's main criticism of this book is in its organisation. Topics do not readily follow on from each other. Rather they are raised, left and then returned to intermittently, which was distracting and interrupted the reader's flow of thought. The author has attempted to cover a great deal in this one book. This has meant that some aspects of stammering are touched on only briefly.
In summary, this book provides a detailed insight into a therapeutic approach which Onslow claims can significantly help many dysfluent children. Therapists and students alike will find this book helpful as a basis from which to consider, compare and contrast treatment approaches when working with young dysfluent children.
From Speaking Out, Summer 1996