Guitar - Stuttering : An Integrated Approach to its Nature and Treatment

BARRY GUITAR, PhD

Professor
Department of Communication Sciences
University of Vermont
Burlington, Vermont

Acquisitions Editor: Matt Hauber

Development Editor: Amy Millholen

Editorial Coordinators: Andrea Klingler and Kerry McShane

Editorial Assistant: Parisa Saranj

Production Project Manager: Kim Cox

Marketing Manager: Jason Oberacker

Designer: Stephen Druding

Artist: Bot Roda

Compositor: SPi Global

5th Edition

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Library of Congress Cataloging-in-Publication Data

Names: Guitar, Barry, author.

Title: Stuttering : an integrated approach to its nature and treatment / Barry Guitar.

Description: Fifth edition. | Philadelphia : Wolters Kluwer, [2019] | Includes bibliographical references and index.

Identifiers: LCCN 2018049600 | ISBN 9781496346124 (paperback)

Subjects: | MESH: Stutteringtherapy | Stutteringetiology | Stutteringdiagnosis

Classification: LCC RC424 | NLM WM 475.7 | DDC 616.85/54dc23 LC record available at https://lccn.loc.gov/2018049600

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Stuttering is an intriguing and mysterious disorder. In the past 50 years, we have learned many secrets about what is different in the brains of those of us who stutter. Yet many unanswered questions remain. For example, we dont know exactly how these brain differences result in the speech disfluencies that we see in the onset of stuttering in children. We also dont know how the usually mild beginnings of stuttering becomefor some childrensevere, struggled behaviors accompanied by avoidance and emotional turmoil.

This book is an attempt to present the latest scientific findings and theoretical perspectives and integrate them with the best clinical approaches for evaluating and treating stuttering. As I worked on this new edition, I realized that my current thinking has been influenced deeply by my own stuttering therapist, Charles Van Riper, who summarized his final thoughts (1990) about stuttering in this way:

• Stuttering begins when the brain mistimes the complex movements required for fluent speech.
• The childs responses to these mistimings are the repetitions and prolongations that we observe as stuttering begins.
• Most children recover from stuttering because of maturation or because they do not react to their lags, repetitions, or prolongations by struggle or avoidance (Van Riper, 1990, 317 [italics mine]).
• The struggle and avoidance are learned and can be modified, although the mistimings are always there.

Some of my thinking in this edition focuses on the children who do not recover because they do react to their repetitions and prolongations. I view our therapies for preschool children as preventing these struggle and avoidance reactions and minimizing the stuttering they would be reacting to. We do this by helping them feel ok about their stuttering and teaching them how to talk more fluently. I also think that once the struggle and avoidance reactions are learned, they can be modified by reducing the (nonconscious) threat and (conscious) fear of stuttering that trigger these reactions. A combination of a strong, supportive client-clinician relationship and a program of reducing fear and shame, and confronting and tolerating the moment of stuttering to reduce tension, and then easing out of it will diminish struggle and avoidance. The resulting experience of feeling in control of stutters will further reduce maladaptive behaviors and negative feelings.

Have I anything more to say? Yes. I hope if you have suggestions for improving the next edition of this text, youll let me know.

Barry Guitar
bguitar@med.uvm.edu

Thank you to all my clients and students. You taught me as much as I taught you.

And thanks to my colleagues in Communication Sciences and Disorders and in Psychological Sciences whose writings and conversations, in person and via e-mail, have helped me become woke.

A round of applause for Andrea Klingler, Mike Nobel, Kerry McShane, and Amy Millholen, whose editorial talents made this book what it is.

Cheers for Bot Rodathe talented illustrator who gave life to all my notions about what might be helpful to put in visual form.

Kudos to Adinarayanan Lakshmanan Sivakumar (Siva) and his team who have done a wonderfully thorough job of compositing my manuscript into the printed page.

Hooray! Rebecca McCauley and Charlie Barasch, who have edited each chapter, making them more readable, updated, and cogent than my original drafts.