Stuttering 53but not impossible. Without making judgments about the veracity of the mother’s report, they
acknowledge that the evaluation will be in ter est ing and that careful, detailed testing will be neces-
sary.
The speech and hearing clinic is the only private provider of ser vices for persons with com-
munication disorders in the small city. The clinic sees few children who stutter because these
ser vices are covered by the public schools. Two speech- language pathologists and an audiologist
serve walk- ins who come to the clinic, and Michelle and Alice arrive promptly at 9:00 a.m. The
receptionist takes the necessary background and payment information, and at 9:15 a.m. the stut-
tering evaluation commences. One clinician begins interviewing Michelle in her office, while the
other plays with Alice on the f loor of the “Kids’ Room” of the clinic. This large room is cluttered
with hundreds of toys and games, a child’s kitchen consisting of toy plates and utensils, and an
oven using the heat from a light bulb for baking. There is even a 5- foot- tall play house made of rub-
ber walls and plastic win dows, with a door allowing only children to enter.
To say that Alice is precocious is an understatement. She has just turned 3, and the clinician
evaluating her is amazed at her speech and language development. Talking to Alice is like talking
to a small adult. The first statement Alice makes is, “What a beautiful play house; may I go inside?”
Unfortunately, the statement is made with a stutter. She actually says, “Wh, wh, wh, wh, what a
beaut, beautiful ppppppplay- house. [pause] Mmmmmay I g, g, g, go inssssssssside?”
The clinician interviewing Michelle asks about Alice’s delivery; when she first sat up, crawled,
walked, and talked; and other questions about her growth and maturation. Every maturational
and growth milestone shows Alice to be an extremely bright youngster. The clinician also queries
Michelle about relatives with a stuttering prob lem and is not surprised to learn that Alice’s uncle
stutters. The clinician learned in college that stuttering runs in families. She also asks how much
time Alice spends with the stuttering relative. Apparently, this is a close- knit family, and Alice’s
frequent babysitters are her aunt and her stuttering uncle. The clinician also asks Michelle to
describe stuttering because sometimes parents consider normal nonfluencies to be abnormal.
The clinician evaluating Alice is awestruck at the child’s advanced language structure and
dumbfounded by her stuttering. As Alice talks about the steps necessary to bake a cake in the toy
kitchen, the clinician notes her excessive and abnormal dysf luencies. Alice not only has excessive
repetitions, prolongations, and hesitations, but many of them are also abnormal— fundamentally
dif fer ent from the nonf luencies produced by normal speakers. But it is the strug gle in Alice’s
speech that alarms the clinician. The child loses eye contact; contorts her face when trying to
force an utterance; and even has tongue, lip, and jaw tremors, the most advanced sign of stutter-
ing. Alice’s pitch rises during utterances because of the increase in laryngeal muscular tension.
Her speech is punctuated by gasping, with the ever- pres ent schwa vowel “uh” between and within
words. Never has the clinician seen such an advanced case of stuttering in such a young child.
After the evaluation is concluded, the two clinicians meet with Michelle in the conference
room. Alice and the receptionist play in the Kids’ Room while the results of the stuttering evalu-
ation and treatment options are discussed with the anxious parent. The clinicians comment on
Alice’s remarkable language development and its pos si ble role in her stuttering. They explain
that some children stutter because their language development far exceeds their motor speech
abilities. The result is a gap between language demands and speech production capabilities, and
consequently, these children are excessively dysf luent. The clinicians also explain the role of an