For the 2007 edition, Bloodstein asked Nan Bernstein Ratner to bring the

book up to date. The result is over 500 pages covering 2800 studies!

However, the book needed an overhaul, not just an update.

The book’s structure reflects stuttering research circa fifty years ago.

Then, research was 80% about adults and 20% about children; and 90% about

etiology and 10% about treatment. The first eleven chapters present research

on adult stutterers, searching for stuttering’s etiology in adult

stutterers’ physiology, personalities, and other areas. The twelfth chapter

is about early childhood stuttering, and the last chapter is about

treatment.

But, beginning in the 1980s, stuttering research moved to focus on children,

as about 80% of stutterers are children, and almost all stutterers started

stuttering as children. Chapter 12 starts by saying, “To try to glimpse

something of its etiology in the mass of information we have accumulated on

adults and school-aged children is a little like viewing it through a dense

screen.” Yes, and this is why the book should have started with early

childhood stuttering. One’s beliefs about how stuttering starts colors how

one interprets data about every other area of stuttering. Too much of the

book is devoted to obsolete ideas about stuttering etiology that make no

sense in the light of what we now know about early childhood stuttering (for

example, most of chapter 2).

I liked the chapter about early childhood stuttering. The chapter begins

with Wendell Johnson’s diagnosogenic theory. The author(s) then presents

three studies conducted by Johnson and his associates to test different

aspects of the diagnosogenic theory–and the results of all three studies

didn’t support the diagnosogenic theory! The author(s) take a clear stand

here: “the central premise of the diagnosogenic theory would not appear to

have been borne out by the group data.” (page 308) Then Johnson’s “Iowa

Study” is compared to Yairi and Ambrose’s “Illinois Study,” published in

2005. This is where the book shines: a clear-eyed look at the old studies,

side by side with recent research. However, the chapter has some flaws, for

example, in the middle of the section about Johnson’s work is a four-page

digression about whether listeners can accurately count the number of

stuttering disfluencies in adult stutterers’ speech.

I especially liked the the six-page section about recent brain scan studies.

This is the best overview I’ve seen on the subject, leaving the reader with

clear ideas of what’s abnormal in the brains of adult stutterers during

speech. However, the chapter begins with 23 pages about lateral dominance.

Compared to the brain scan studies, the lateral dominance studies were

crude–e.g., forcing left-handed children to become right-handed, or the

“Wada Test,” which injected sodium amytal into left and right carotid

arteries, at substantial risk of death. And the results of most of these

lateral dominance studies were “inconclusive.” I’m not sure what I learned

from those 23 pages, other than that neuroscience research wasn’t much until

the 1990s.

The section about “Language Ability” is good. It begins with studies about

preschool children, and then later paragraphs cover older children and

adults. But the section lacks subheads so I kept having to go back and look

whether I was reading a paragraph about what age group.

The chapter about treatment covers the history of stuttering therapies well.

Then in the section about “Current Behavioral Therapies” we get Suzybelle,

the scary puppet that punished small children when they stuttered (1972); a

hospital in Australia where stutterers lived for three weeks trading tokens

when they stuttered or spoke fluently, and they needed the tokens for food

and cigarettes (1972); and some “innovative” programs using a new technology

called “delayed auditory feedback” (1974, 1980)!

The description of Hollins is clear, especially on the question of whether

the program is effective: “Very little published data have emerged from the

Hollins program over the years” (page 360). I was also impressed that the

section on Van Riper stuttering modification therapy included the few

effectiveness studies, such as a 2005 study of the Successful Stuttering

Management Program (SSMP, a.k.a. the Breitenfeldt program), which found that

“the program did not produce statistically significant changes in fluency.”

I like that the author(s) aren’t afraid to step on the toes of some of the

biggest names in our field.

The section about “Pharmaceutical Treatments” starts out well, covering the

published studies of various drugs that either did or didn’t reduce

stuttering. But the section doesn’t mention that some medications prescribed

to children cause stuttering, especially Ritalin and SSRIs (e.g., Prozac).

No studies have been published about this, raising a question: if an

important topic has only anecdotal reports, should it be included?

I didn’t read some chapters, such as the chapter about personality tests. I

read everything in the fifth edition carefully and that chapter could be

summarized with “Stutterers have, on average, completely normal

personalities, except for speech-related fears and anxieties.”

Smaller quibbles: The first chapter goes on for six pages trying to develop

a definition of stuttering, and leaves out silent blocks.

The section about measuring stuttering (page doesn’t discuss

time-interval measures of stuttering, used by Roger Ingham and others in

some studies.

The section on genetics missed Comings’ 1996 study linking stuttering to the

genes that control dopamine levels (Comings, D., et al., “Polygenic

Inheritance of Tourette Syndrome, Stuttering, Attention Deficit

Hyperactivity, Conduct, and Oppositional Defiant Disorder,” American Journal

of Medical Genetics 67:264-288, 1996).

I couldn’t find anything in the book about illnesses and stuttering onset.

Yairi and Ambrose reported that 14% of children started stuttering after an

illness or extreme fatigue (Yairi, E., Ambrose, N.G. Early Childhood

Stuttering, 2005, ISBN 89079-985-7, page 62-63). Tourette’s is linked to

childhood streptococcal infection that causes the child’s immune system to

attack brain cells in the putamen area (ADVANCE For Speech-Language

Pathologists, July 6, 1998, page 22).

Saving the worst for last, I come to the section about “Assistive Devices.”

This is my area of expertise, as owner of Casa Futura Technologies. The

first mistake: “delayed auditory feedback (DAF)…forces [stutterers] to

speak more slowly.” That myth was dispelled by Joseph Kalinowski, Andrew

Stuart, and colleagues, in a series of studies first published in 1993. But

Kalinowski and Stuart’s research isn’t mentioned, except in a mistaken

summary saying that their 1993 study investigated “frequency filtering,”

when it in fact compared DAF, FAF, and white noise. Rather, we get a nice

history of Israel Goldiamond using DAF as punishment in an operant

conditioning therapy in 1965, and discovering that stutterers liked this

form of punishment; followed by studies of DAF use in therapy from the

1970s.

The information about the Edinburgh Masker mistakenly suggests that it

produced white noise, when in fact it produced a sine wave matching the

frequency of the user’s phonation.

Next we learn, regarding frequency-altered auditory feedback (FAF), “Data to

support the effectiveness of FAF in treating stuttering while the speaker

wears the device is currently scanty.” That statement was true in the 1995

edition, but many studies have since been published.

A question is raised on page 299 as to “Whether or not [DAF] can be

successfully exploited to create durable therapeutic improvements in fluency

in spontaneous speech outside the speech clinic is still under

investigation.” Actually, that question was answered by Ryan and Van Kirk in

1974, Ryan and Ryan in 1995, and Van Borsel in 2003.

There’s a wealth of information in A Handbook on Stuttering, Sixth Edition.

Parts are up-to-date and well-written, and much of the older material is

well-written and still worth reading. But there’s too much obsolete

research, the book is missing too much research from the last decade, and

the organization doesn’t reflect current research areas. The book belongs on

the bookshelf of every researcher and historian in the field, but not on the

bookshelf of clinicians or consumers. Bernstein Ratner did excellent work

updating the areas of her expertise, but the field has become too big for

one person to be an expert in all areas. I hope that the seventh edition

will invite more editors with expertise in more areas, and will restructure

the book, perhaps along an age progression of the disorder, with an effort

to provide information useful to a broader audience. Hopefully we won’t have

to wait twelve years for the seventh edition.
Rating: 3 / 5