Customer Reviews

A Handbook on Stuttering

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3 star:		(5)
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This is probably the most important book on stuttering in print today. It is also one of the driest volumes in speech-language pathology I have ever read. Will tell you more about stuttering than you may want to know. Significantly, the material on treatment covers only 50 pages out of 600, so this is not the book you want to spend your money on if you are a speech therapist looking for treatment material. This is more of an overview of every scrap of research done on the subject since day one. Touches on every study ever done on the subject. Difficult reading because of its very dry, academic nature. Reads like one long journal article. ZZzzzzzz

This should be titled "Everything you wanted to know about stuttering but were afraid to ask." I own every edition of this book, going back to when it was a little pamphlet published by Chicago Easter Seals. Each edition has gotten better and this most recent one, obviously, is the best. There is no more comprehensive review of stuttering research available anywhere. A must-have for anyone who is seriously interested in the disorder of stuttering.

Everything you want to know about the history of research, theory, and treatment of stuttering is contained in this book. I have used it (and its predecessors) as textbooks in my course, as a reference in my own research, and as a resource just about any time somebody asks me "has anybody ever studied...?" If it's been written about, it's in the Handbook. This is truly an indispensable text and it should be on the shelf of every speech-language pathologist who evaluates or treats individuals who stutter.

I needed this book for a class. Although it is quite dense, it is overall a good book.

Oliver Bloodstein's A Handbook on Stuttering for Professional Workers was
first published 1959. He wrote brief summaries of all of the research
findings in the field of stuttering. This totaled 88 pages. In 1969 he
expanded the booklet and shortened the title to A Handbook on Stuttering.
New editions were published in 1975, 1981, 1987, and 1995.

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 8) 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.

Publishers will only produce one 'encyclopedia of stuttering' at a time, and this is it. If you want one source for a broad range of information on stuttering research, this would probably be it. Of course, it would be better still to go to multiple sources and get multiple opinions on the many subjects covered here.

I'd like to point out, for those who don't know. that the author studied with Wendell Johnson at the University of Iowa, and Johnson's teachings have stayed with him to this day, decades later. If you read the contemporary literature on stuttering, you will find different authors stating flatly that Johnson's diagnosogenic theory of the origin of stuttering failed the test of evidence, and is now rejected by the field. Yet Bloodstein's own theory of stuttering is a barely re-worded version of Johnson's theory. Bloodstein will give lip service to evidence that stuttering is inherited, and thus organic in nature - he has to, the science is now too powerful to deny - but his own ideas continue to require a learned origin for stuttering.

Bloodstein is not alone here - there are other leading figures in the field who, while giving the same lip service to published evidence for genetic factors and brain abnormalities, still cling to psychological explanations for stutter. At one time, scientists believed that there was a substance they called phlogiston that was involved in fires. Then the role of oxygen was discovered, and the phlogiston theory was dropped - forever. Unlike chemistry and physics, in the field of stutter research, workers still manage to cling to their master's discredited theory by rewording it and refusing to square it with more recent evidence.

I would encourage anyone interested in the history of the field of stuttering research to read this book from front to back. It is not a how-to of clinical therapy, so don't expect that. But as you read it, keep in mind that the author carries the banner of a discredited theory, and one that should never have been accepted in the first place. Wendell Johnson's influence on the field of stuttering held it back decades, and still, through Bloodstein and others, continues to drag it down. Any author of an authoritative overview like this one runs the risk of inserting his own prejudices into the text. Forewarned is forearmed, so just read with an eye to those prejudies.

The good: This book is incredibly comprehensive when it comes to stuttering theory and research. Look up anything at all about stuttering and you'll find at least two references, if not ten. It also does a good job of incorporating historical perspectives and research from several disciplines.

The bad: The book reads like an encyclopedia -- maybe even like a dictionary. If this is your textbook for your fluency class, set aside a LOT of time for reading it. There is hardly any information on how to treat disfluency; standardized treatment programs are described in theoretical terms and outlined, but that's it. You could read the book cover to cover and still not know what some of the basic techniques of stuttering treatment actually look like.

So it's not a useful book for treatment, but it's a good "library" title on disfluency for a student or professional. I would not recommend it for clients or interested non-professionals -- it's too dry and theoretical, and assumes a good amount of background knowledge.

I first used one of Bloodstein's earlier versions of the Handbook when I took my first stuttering class in 1983, that was a long time ago, but then, like today there is nobody better! When I first heard that a new version was coming out I was duly excited but my excitement was tempered when I found there was to be a co-author, Nan Bernstein Ratner. What would become of "our" beloved Handbook with this intruder participating? Much to my surprise, the Handbook is more readable and user-friendly while maintaining its integrity as one of the most reliable sources of information on stuttering. We are all-grateful for this book and know that all stuttering books are compared to Bloodstein's Handbook.


This book is for the serious student of stuttering and may be best used in conjunction with other textbooks for the beginning student or clinician. However one uses it, you will be well served by Handbook of Stuttering.

This item was purchased for a college level class. The book is full of studies and in depth research and information on stuttering. It is very dense at times.

Dr. Bloodstein's work will endure long after the current "how to make stuttering disappear" books via sleight of hand or "secret techniques" have been "swept away by the reality of their utter failure". Not an easy read, but an essential one for any clinician, scientist, or person who stutters. A complete reading will make one well-informed as to the nature of stuttering and decades of research findings- plus Bloodstein's cogent synthesis and interpretations. The critique on therapy in the back of the book is compelling, but all too often ignored.