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'Stuttering and Cluttering' by David Ward

Rachel Everard, Robin Lickley | 28.08.2018

Reviews of the 2017 and 2006 editions of ‘Stuttering and Cluttering: Frameworks for Understanding and Treatment’.

Review by Rachel Everard – 2nd edition 2017

'Stuttering and cluttering' by David WardThis is the second edition of a textbook, popular with researchers, clinicians and speech and language therapy students alike. Like the first edition published in 2006, this revised version follows a similar structure: Part I covers the aetiology of stuttering and cluttering and Part II covers the treatment of stuttering and cluttering. (‘Stuttering’ means the same as ‘stammering’, whereas ‘cluttering’ is another fluency disorder).

The author, David Ward, a highly respected researcher and clinician who happens to have a clutter himself, has rigorously updated each chapter to reflect the latest research. The two chapters on cluttering have been completely rewritten as cluttering is the area where most significant changes have taken place over the last 11 years. Likewise the chapter on counselling approaches has been thoroughly revised to take into account the different ways of working on the psychological side of stuttering.

The book has much to recommend it, including its highly accessible style, the interweaving of anecdote with peer-reviewed research, the highly comprehensive nature of the contents and Dr Ward’s ability to carefully and respectfully summarise what research is telling us and how this applies to current clinical practice.

The book has much to recommend it, including its highly accessible style, and the interweaving of anecdote with peer-reviewed research

The contents description might appear daunting at first because of its level of detail but in fact orientates the reader on the overall structure of the book and helps with the decision on what particular chapters to focus on. In my view, the book can either be read in its entirety, with the advantage of learning about the theory underlying the description, possible causes and management of stuttering and cluttering, before moving onto the practical issues around therapy. Alternatively, the reader can pick and choose which chapters will be of more interest to him/her.

Another helpful aspect included at the end of every chapter is a summary of key points and suggestions for further reading, with a brief description of each article or book.

With regards to describing therapy approaches for adults who stammer, Dr Ward wisely chooses to include those offered by speech and language therapists as well as those offered by people who stammer themselves. This section is therefore all-encompassing and would enable people who stammer to make an informed choice as to what type of therapy would be best suited to their needs. Similarly I would recommend anyone who clutters read the two chapters on cluttering, to help them understand what cluttering is and what therapy might involve.

In this way, Stuttering and Cluttering lives up to its promise of being relevant to people who stammer and to people who clutter - although its length and at times its focus on historical and current research might deter some from reading it cover to cover.

One disappointment is the consistently medical approach taken throughout the book, as highlighted by the use of the word ‘treatment’ in the title, and in the way descriptions of therapy focus solely on what the ‘client’ has to do to change, rather than what others can do. No mention is made of the relatively recent and increasing interest in the application of the social model of disability to stuttering amongst people who stammer and speech and language therapists. The social model suggests that disability is created by barriers in society, which may be physical but can include negative attitudes and stereotypes. Similarly, only fleeting mention is made of the widely reported stigma people who stutter experience. On a rather pedantic note, the sloppy editing at times is annoying and at odds with the meticulous care and attention the author has clearly given to revising this comprehensive and clearly written book.

In my opinion, the book’s largest audience would be first and foremost student speech and language therapists, followed closely by qualified speech and language therapists wanting to develop and/or refresh their knowledge of current research and practice, as well as people who stammer and who clutter. Overall, I would highly recommend this book.

Rachel Everard, Highly specialist speech and language therapist, City Lit

'Stuttering and Cluttering: Frameworks for understanding and treatment', by David Ward, Psychology Press, 2nd edition, 512pp

Review by Robin Lickley, 1st edition 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.

Robin Lickley, Research fellow, Queen Margaret University College, Edinburgh. From the Winter 2006 issue of 'Speaking Out', page 18