Journal of Fluency Disorders 35 (2010) 155–156

Letter to the Editor

Authors’ response to Drs. Melnick and Shields’ review of Manning (2010)

I would like to thank the two reviewers who took the time to read the third edition of the text. I appreciate that sucha task requires much time and effort. It is clear to me that they took their job seriously for I found the comments to bethoughtful and informed. I took pleasure in Dr. Melnick’s opinion that the text provides insight to both new, as well asexperienced clinicians about the experience of stuttering and the dynamic nature of therapeutic change. I appreciate Dr.Shield’s recognition of the expanded and modified “Clinical Decision Making” and “Clinical Insight” boxes designedto illustrate key issues in the chapters. I also welcome the acknowledgement by both reviewers of the reorganization ofchapters and the addition of new sections on the characteristics of developing expertise, constructivist-narrative therapy,evidence-based practice, assistive devices for promoting fluency, the Lidcombe program, and studies of genetics andneuroimaging as they relate to fluency.

I particularly value the affirmative response by both reviewers regarding the organization and readability intendedto engage the reader. Beyond the importance of including accurate and relevant information, I am especially sensitiveto the goal of connecting to the individual reader; every word in the text was chosen in terms of how it would resonatein the head of the reader.

For the most part, I agree with the few, somewhat less positive comments and suggestions. For example, althoughboth reviewers appreciated the information and the audio and video clips included on the On Line Companion (OLC),Melnick expresses the wish for additional examples of stuttering behavior. Fortunately, the flexibility of OLC willpermit me to include additional examples in the future. The OLC also allows for the inclusion of new informationintended to update particularly important issues that will be linked to the text by chapter, topic, and page number. Ina related issue, the power point slides on the OLC are intended as a starting point for instructors who can, of course,add to and modify the slides according to their needs.

Shields comments that in Chapter 2 (The Nature of Fluency and Nonfluent Speech: The Onset of Stuttering), Ido not provide a comprehensive definition of stuttering. I am assuming that by this she means my own definition forthe frequently cited definition by Wingate (1964) is on page 50. Because I felt some obligation to take a stand andprovide my own view of stuttering etiology and development (which is frequently altered with my awareness of newinvestigations) I produced the two relatively long paragraphs on pages 58 and 59. While not exactly a definition ofstuttering, they do provide, I think, a comprehensive description of the depth and breadth of developmental stuttering.

I fully appreciate Melnick’s rationale for his suggestion of discussing assessment and treatment procedures foryounger speakers prior to presenting those for adults, given that stuttering in adults is often seen as being more complex.For some diagnostic and intervention issues, of course (e.g., remission or persistence of stuttering like disfluencies),this could be debatable. We have wrestled with the sequencing of these chapters for younger and older speakers onmany occasions when preparing editions of the text. If there is ever a fourth edition (a topic that, for the moment, isfar back in my head), the order of these chapters may be rearranged to follow the more common order.

I also agree with Melnick’s suggestion that Chapter 4 (Beginning the Assessment Process with Adolescents andAdults) might well have included a discussion of how language and concomitant learning or communication problemsimpact assessment decisions with this older population. Although, as he points out, these topics are discussed in thefollowing chapter on assessment of younger speakers, these issues also impact assessment decisions with adolescentand adult speakers. He also suggests that Chapter 5 should include more detailed information on the evaluation oflanguage and phonological problems and again, given the extent of the research on these topics, I agree.

0094-730X/$ – see front matter © 2010 Elsevier Inc. All rights reserved.doi:10.1016/j.jfludis.2010.02.001

156 Letter to the Editor / Journal of Fluency Disorders 35 (2010) 155–156

Melnick comments that Chapter 8 (Successful Management of Stuttering for Adolescents) should include the latestresearch on the ongoing Pagaclone trials. This is one of the best examples of newer information that will be placed onthe OLC.

Shields makes a point in Chapter 9 (Facilitating Fluency for Preschool and School-Age Children) regarding thediscussion of counseling for younger children—particularly cognitive restructuring as it relates to narrative therapytechniques. She suggests that some consideration should be given to a child’s age and level of cognitive developmentwhen selecting the most appropriate counseling methods. She prudently suggests that for narrative therapy to beeffective, younger children would need to have well-developed metacognitive and metalinguistic abilities. This iscertainly the case and I agree that these are important issues to consider.

There are, of course, volumes of information to consider for possible inclusion in a text. As I mention in the Preface,the issue is often not what to include but what can reasonably be left out. I am acutely aware that for any one book, thereis a point where it can become too long, possibly intimidating, or too expensive for readers. The volume of researchthat becomes available must be evaluated, sifted and synthesized, and difficult choices must be made. One book is justthat, and for many reasons, effective clinicians will consult many sources.

Finally, the opportunity to respond to the reviewers provides the chance to comment on an interesting aspect ofcreating a text in the rapidly changing world of publishing technology. In order to meet a variety of market needs, it isnow possible to purchase electronic versions of this text. The book is currently available on two websites, each withvarious options. For example it is possible to view previews of preface and each chapter, view online versions of thebook, purchase downloads of the entire book or individual chapters, or even arrange for “rental” of electronic versionsof the book for 6 months, or one or more years! Possibly because I am a member of the baby boomer generation I findit difficult to have a friendly relationship with electronic versions of books or manuscripts.

There are, of course, advantages for selecting from among the various options including saving money by purchasingor renting only selected chapters. For example, I imagine that some students will be apt to purchase only those chaptersthat provide information about the diagnosis and treatment of developmental stuttering rather than acquiring otherchapters or purchasing the entire book. However, the other chapters, especially those that precede those on diagnosisand treatment, provide a context for what follows and inform many of the diagnostic and treatment decisions discussedin those chapters. As the reviewers point out, the first chapter “provides a tone for the book (Melnick) and “provides avery effective introduction to the remaining chapters” (Shields) concerning issues such as the characteristics of effectiveclinicians, the development of clinical expertise and the variable of humor as an overarching indicator of cognitivechange. Chapter 6 (Facilitating the Therapeutic Process) while not specifically about diagnosis or treatment issues, setsthe stage for understanding the dynamic nature of therapeutic change and essential issues related to evidence-basedpractice. The ability to appreciate the context and the larger view of an issue is essential for the clinician as well as theclient. The essential difference really, for the clinician, is that while learning the techniques of change is necessary forbecoming a technician, learning the underlying, often dynamic principles of change is necessary for becoming a wiseand effective professional.

Walter Manning ∗School of Audiology and Speech-Language Pathology,

The University of Memphis, Memphis, TN,United States

∗ Tel.: +1 901 678 5828;fax: +1 901 525 1282.

E-mail address: wmanning@memphis.edu

4 February 2010