articleThis content is more than 5 years old.

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

Charmaine Burrow, Margaret Evesham | 01.03.2008

Book reviews by Charmaine Burrow and Margaret Evesham.

Review by Charmaine Burrow of revised 2007 edition

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

This comprehensive, practical manual is written for speech & language therapists, and includes useful checklists, therapy plans and presentation outlines. The authors relate theory with their tried and tested practical experiences.

The authors start by acknowledging shared concerns; those of the child and those of the clinician. They emphasise valuing the contributions of dysfluent children and their families, and use these to illustrate and confirm theory. The reader is given an insight into the complex world of dysfluency and its management. Because the authors modestly acknowledge the limitations of what they know, we as readers are empowered to keep searching and questioning our own practice.

They start by setting the scene. The child is quite clearly placed centrally, but equally, as well as looking at the dysfluency and concerns of the child we are told to consider the context, family dynamics, and the impact the dysfluency is having on the child. We the therapists are to see ourselves very much as partners in the whole process.

The authors consider the development of stammering and theoretical models, giving personal accounts to illustrate and support Starkweather`s Demands & Capacities Model. There is a very strong focus on Personal Construct Psychology (PCP), with activities for clinicians to use when trying to understand how children construe themselves. Recent research findings are detailed and discussed.

Yairi's 4 developmental dimensions - Quantitative (frequency/duration of dysfluencies, number of repetitions), Qualitative, (the different types of dysfluencies), Physical (rate of repetitions/prolongations linked to tension) and Physiological (e.g. tension, loss of eye contact) - are explained, leading to a proposed 5th dimension = Psychological which the authors feel is equally important. They propose that by using this 5th dimension we are able to explore the transition from 'stammering' when the child is still at the early dysfluency stage to 'stammerer' when the child is beginning to realise that there is something 'not right' with his/her speech and tries to do something about it.

The authors give key risk factors and encourage us to be consistent in our assessment technique. They also offer a useful format for analysing transcriptions in determining if the dysfluency is developmental or acquired. The 5 dimensions are then used to help illustrate the transition from early dysfluency to 'borderline' and 'confirmed' stammering. Throughout these stages we are given practical suggestions on how to work in a sensitive and positive way with the child, the parents and school staff. The authors share group programmes with us - giving outlines to follow and use with parents of young dysfluent children, and with children and parents at the borderline and confirmed stages. Also included is a detailed section on the school environment, offering the clinician practical suggestions to follow when liaising with and advising school staff.

After reading this book clinicians will have a comprehensive battery of assessment and intervention methods to equip them to assess and treat covert and overt features in the child, and to gain an important understanding of parental concerns and attitudes.

I would recommend this book to any clinician working with dysfluency. It's written in a very supportive, encouraging style, which is not surprising when you know the authors.

From the Spring 2008 issue of 'Speaking Out' page 17. Charmaine Burrow is a Specialist Speech & Language Therapist, Clinical Lead for Fluency East Lancashire Primary Care Trust.

Review by Margaret Evesham of 2003 edition

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'.