Recent advances in the treatment of stuttering: a theoretical perspective.

UNLABELLED Prolonged speech and its variants are widely used in the behavioral treatment of stuttering. Unlike these approaches, which depend on clinician-prescribed speech pattern changes, two behavioral treatment regimens, one for children and another for adults, recently developed at the Australian Stuttering Research Center, promote self-monitoring of speech as a means of controlling stuttering. In these programs, the clients themselves modify their speech in subtle and variable ways to gain control over stuttering and, in that, they appear to be similar to a well-known experimental technique for suppressing stutters known as response contingent stimulation. The present paper provides an integrated explanation for the effectiveness of both clinician-directed as well as client-initiated speech pattern modifications and, in the process, develops a new model of stuttering. It also shows why client-generated speech patterns changes potentially produce faster and more lasting improvement than those changes prescribed by a clinician. LEARNING OUTCOMES The reader will learn about: (1) two hypothesized methods of preparing utterance motor plans--speech concatenation and speech construction; (2) how behavioral treatment programs make use of speech construction to promote fluency in persons who stutter; (3) why therapy procedures based on cognitively driven speech construction produce faster and superior results than those based on motorically driven speech construction; and (4) the empirical evidence that suggests that speech concatenation is the source of stuttering.