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'Stuttering and Cluttering' by David Ward

Robin Lickley | 01.12.2006

Review by Robin Lickley, Research fellow, Queen Margaret University College, Edinburgh.

David Ward's new book Stuttering and Cluttering describes the phenomena, theories and treatments for these two disorders of fluency.

Part one - Aetiology of stuttering and cluttering - covers these aspects of stuttering in some depth: definitions and epidemiology; brain function; auditory processing; speech motor control; linguistic aspects; some psychological perspectives; development. It ends with a summary of the nature of cluttering.

Part two - Treatment of stuttering and cluttering - comprises stuttering-directed chapters on measurement and assessment, on treatment of preschool, school-aged and adult stuttering on counselling approaches and on alternative approaches. These are followed by a chapter on stuttering treatment efficacy. There follows a chapter on acquired stuttering, and the book ends with a discussion of assessment, diagnosis and treatment of cluttering.

I was looking forward to this book, mainly because I wanted to learn more about cluttering. I was slightly disappointed by the relatively small proportion of the book dedicated to the subject (2 out of 17 chapters), but given the state of knowledge, it is not surprising. It does provide a useful introduction to cluttering, with chapter 8 summing up what there is in the literature, not much of it being less than 10 years old. It makes the points that it is hard to pin down a definition for cluttering, that it is different from stuttering, though there may be some stutter-like behaviour, and that there is not enough research on the topic and no consensus on what it actually is.

The author suggests that there may be a case for the use of the term 'cluttering spectrum behaviour', though, rather confusingly, he intends that this be used to not describe people with a diagnosis of cluttering, but those who have clutter-like behaviours who do not merit the definite diagnosis. Having said that, the claim is still made that cluttering lies on a continuum with normal disfluency. The second chapter on cluttering (assessment and treatment) lists ideas for the speech and language therapist.

In the more extensive coverage of stuttering, the author takes a strongly multi-factorial position, with much reference to the demands and capacities model. It is worth noting that this is a UK-based book, and there are several references to UK clinics including the author's own clinical base, as well as discussion of some non-SLT treatments within the UK.

The book helpfully gives an overview of a wide range of different treatments, but I found that while descriptions are given of treatment approaches, with mention of clinicians' preferences, there is little in the way of structured argument for why one treatment may be better than another.

The time lag from final draft to publication must be a frustrating period for any author, so this one did well to manage to insert at least one reference from 2006 ' Daly and Cantrell's IFA talk. However, the omission of the Lidcombe Programme's RCT publication in the BMJ (Jones et al., 2005) from the chapter on efficacy of stuttering therapy is unfortunate. But it is also bizarre, as this paper is actually cited earlier in the book. Given the Demands and Capacities bent of the book, Franken et al.'s (2005) study was also worth a mention here.

Parts of the book would have benefited from careful reading by an editor to improve the structure and flow at several points. As suggested by the contents listing above, a lot of ground is covered in 377 pages. As such, the book will serve as a helpful resource for speech and language therapists and students to dip into.

'Stuttering and Cluttering: Frameworks for understanding and treatment', by David Ward, Psychology Press 377 pp

From the Winter 2006 issue of 'Speaking Out', page 18