ABSTRACT
A review of the literature concerning the etiology of stuttering reveals the widely held view that stuttering develops and is maintained due to a complex, ever-changing interaction of constitutional and environmental factors (Conture, 1990; Fosnot, 1993; Gregory, 1986; Gregory & Hill, 1980, 1993; Hanley, 1985; Peters & Guitar, 1991; Riley & Riley, 1979; Starkweather, Gottwald, & Haifond, 1990; Wall & Myers, 1995). Since the early 1970s a framework for differential evaluation and treatment of stuttering has evolved at Northwestern University. My colleagues and I have adapted a decision tree originally proposed by Gregory and Campbell (1988), and shown in Fig. 12.1.. This process was guided by the overarching notion that optimally effective treatment should be grounded in knowledge of both client variables and environmental factors and the ways in which they may interact. Gregory (1973) and Gregory and Hill (1980) presented a model for differential evaluation including both case history and clinical evaluation components supported by a review of research findings and collective clinical experience. Further development and refinement of this assessment protocol has been influenced by an ongoing review of research findings focused on linguistic and motoric skills of children and adults who stutter; environmental factors shown to influence stuttering; and continuing broad clinical experience attending to communicative, attitudinal, and behavioral factors in treating individuals who stutter (Gregory, Hill, & Campbell, 1995; Gregory & Hill, 1993). Many contributors to the field have reinforced the need for broad ranging evaluation procedures (Conture, 1990; Hanley, 1985; Peters & Guitar, 1991; Starkweather et al., 1990; Wall & Myers, 1995). Research studies and clinical reports reveal that individuals who stutter do not form a homogeneous group (Riley & Riley, 1979, 1983). Individuals clearly present differing profiles of factors. Some factors appear to indicate greater risk for stuttering, whereas others appear related to the likelihood of recovery from stuttering. Ultimately, all factors need to be considered when making decisions about clinical management.
