This is a threaded discussion page for the International Stuttering Awareness Day Online Conference paper, "Dysphagia" Wha? -- Do Stuttering Therapists Need to Study the Full Speech-Language-Hearing Curriculum? by Darrell Dodge. Joint practicums From: Ed Feuer Date: 10/1/98 Time: 12:08:53 PM Remote Name: 126.96.36.199 Comments I have advocated a coordinated multidisciplinary team approach for the treatment of stuttering in adults. This has prompted hostility in various forms from those well-invested in the status quo. To get the collaborative team approach off the ground, I have advocated joint practicums in which grad students from speech pathology, psychology and counselling could share stuttering clients. This would call for coordination, first of all by supervising profs, so that each discipline could use its relevant expertise to the necessary healing and strengthening. Re: Joint practicums From: Darrell Dodge Date: 10/9/98 Time: 2:00:08 PM Remote Name: 188.8.131.52 Comments Thanks for your thoughts Ed. I think it would be interesting to discover the efficacy of the informal or ad hoc "teams" that are often set up by parents, PWS, and therapists. I know the "team" I created helped me make behavioral changes during my belated stuttering therapy, even though they didn't have the benefit of talking with one another. If it could be shown that people who don't have such teams suffer a disadvantage in stuttering therapy, that would provide a strong argument against the status quo. And that could lead to experimenting with more formal arrangements in cases where that would be indicated. It's unfortunate that the academic and developmental effects of stuttering have not yet been quantified in a way that is convincing. That would be an important first step. incidence of stuttering and the curriculum From: Woody Starkweather Date: 10/1/98 Time: 3:53:37 PM Remote Name: 184.108.40.206 Comments First, Darrell, thank you for an insightful, articulate, and well developed article. We all care passionately about the curriculum and should do whatever we can to improve it with regard to stuttering. My comment has to do with the idea that the incidence of stuttering should determine the amount of curricular time it gets. This is a silly idea. The severity of the problem should be given the most weight in determining how much time the problem gets in the c curriculum. Those who design the medical school curricula know this. They give adequate time to rare tropical diseases because (a) they can be lethal, and (b) because understanding of any disease can lead to better understanding of other diseases, a point you make eloquently in your own article. If the medical schools followed the idea that incidence should determine curricular time, medical students would spend most of their time studying the common cold. Woody Re: incidence of stuttering and the curriculum From: Darrell Dodge Date: 10/9/98 Time: 2:06:51 PM Remote Name: 220.127.116.11 Comments Thanks for your kind remarks, and interesting comments, Woody. I agree wholeheartedly with your comments on the curriculum. In addition, as I mention in my response to Gunars, I'm not so convinced that stuttering is a rare condition. A great way to enhance the stuttering curriculum is to offer an "Advanced Research Topics" seminar, which allows students to delve into the many fascinating - and often controversial - topics in this area. The second stuttering course here at CU-Boulder offered me an opportunity to study in depth the research of Gerald Zimmerman (among many other things), something I was not able to do in the main stuttering course, which is (of necessity) more clinically based. I suspect that enhanced curricula would increase the number of students who go on to specialize in stuttering therapy. There's apparently a feeling by many students that they don't know enough about stuttering to be competent treating it. And I think this increases the feeling many seem to have that only a PWS can be a competent stuttering therapist - a feeling I don't share. Frequency of incidence of stuttering From: Gunars Neiders Date: 10/7/98 Time: 8:41:02 PM Remote Name: 18.104.22.168 Comments I have been trying to chase down the original studies of incidence of stuttering in the general population. I have heard it said that 1 in 100 people stutter. Does that mean that one in hundred people started out their life stuttering or that at any time in the United States if I randomly took a sample large enough, I would end up having 1 stutterer per 100 people? Where did these figures come from? Re: Frequency of incidence of stuttering From: Darrell Dodge Date: 10/9/98 Time: 2:11:59 PM Remote Name: 22.214.171.124 Comments Various secondary sources I've seen put the incidence of stuttering in the U.S. at about 5% (that is, the percentage of the total population that has ever stuttered), and the prevalence of stuttering at 1% (that is, the number of people in the population who stutter at any given time.) These figures are based on statistical samples, but they are comparable to figures from other countries. In response to your specific question, I think the studies are probably cited in Bloodstein's 1995 Handbook on Stuttering. You could also try PschInfo and Medline, which seem to offer more precise searches than NIH's PubMed. I think the figures mentioned above have attained credibility over the years because they also make sense to people who do their own informal counts. For example, my high school class of 309 had three people who stuttered and I've heard of others who've done similar "more-or-less" surveys. I've also heard unsupported claims that the incidence of stuttering in the adult population is much lower than 1%, and even as low as 250,000 for the entire U.S.! But because stuttering is a problem that can be hidden by many people-sometimes for a lifetime, I suspect that the 1% figure could actually be low. Why do I think this? Again, anecdote. People who do outreach activities for the National Stuttering Project are always running into people who admit that they stutter and are bothered by it (to the extent of affecting their career options), but not enough to ever take the step of seeking treatment or even coming to a support group meeting. Heck, there are two other people on my block (of only ten houses) who stutter. I wonder how many of these people would not be identified in surveys because they didn't want to discuss it or have never sought treatment? Re: Frequency of incidence of stuttering From: Walt Manning Date: 10/9/98 Time: 4:20:21 PM Remote Name: 126.96.36.199 Comments I agree with Darrell - and by the way, like Woody, I REALLY enjoyed what you said and how you expressed it in your original paper. I also believe there are many more people who stutter, or almost stutter (see Smith and Kelly's chapter in Curlee and Siegel's The Nature and Treatment of Stuttering: New directions (1997). I suspect (not data here)that a large proportion of PWS never show up at our clinic or laboratories. They may never be formally or even informally diagnosed as PWS. But, they have many of the factors that contribute to nonfluent behavior. Like Darrell, I've met manyk people (neighbors, colleagues, friends, etc) who are FAR from fluent. Fluency is on a long continium from people who naturally or learn to speak like Tom Brokaw to those who are classified as neurogenic stutterers. It's far from a categorical classification of stutter/normal speaker. Ain't this conference cool! reply to Darrell Dodge From: meghan Date: 10/12/98 Time: 2:12:19 PM Remote Name: 188.8.131.52 Comments I found your article to be very interesting. You made some great points in your article and there are strengths and weaknesses that go along with each one. It is hard to say whether stuttering should be taught seperately from the rest of the curriculum. Do you believe that if i worked in an elementary school i would not be adequately qualified to work with a third grader who stutters, being that i only had one undergraduate and one graduate class in stuttering? I wonder how much course work other slp's have had in stuttering and if they felt prepared to work with someone who stutters. I am curious to know how the majority of slp's feel about this topic. Thank you, Meghan Re: reply to Darrell Dodge From: Darrell Dodge Date: 10/12/98 Time: 11:39:45 PM Remote Name: 184.108.40.206 Comments Meghan: I hope I made the point that clinical experience is indispensible. I think you've had plenty of course hours in stuttering, assuming the courses were good ones. You've probably also had your 380 of hours of clinical practica, in the range of speech-language areas, plus whatever you've had in the schools. I think that gives you a lot of sound and very applicable experience. It means you've learned how to observe a child and understand how to teach, reward, encourage, and support. You can test for stressors like expressive language delay and concommitant phonological problems, etc. You know how to search the literature for help with clinical problems. I can't imagine why you wouldn't be able to treat stuttering if you had access to some good clinical information and techniques that are specific to stuttering. There are excellent recent books by Walter Manning, Barry Guitar, and Woody Starkweather, not to mention videos and publications by the Stuttering Foundation of America that are at least partly targeted toward clinicians who want to increase their competence in stuttering treatment. It would be great if a school clinician who has been in your situation would chime in here with some encouraging words. SID-4 From: Chuck Goldman Date: 10/17/98 Time: 3:40:46 PM Remote Name: 220.127.116.11 Comments ASHA's SID-4 has done much to help stutterers, clinicians and the public sort out he confusion inherent in every label associated with stuttering. The task force on terminology in particular has produced a very usable document that can be incorporated into graduate level education for clinicians and integrated into therapeitic sessions to help client and clinicain be sure they are talking about the same thing. ASHA itself grew largely out of concern for the disorder of stuttering. As a communication disorder, it needs to be studied along with the myriad of afflictions that can cause speaker/listener disturbances. There is no other profession that specializes in this. As we have learned through the years language skills bridge the span that includes motor, cognitive, and psychosocial functioning. To remove the study of stuttering from other such disorders is ill conceived. Dysphagia, on the other hand, is less likely conceived as a communication disorder and therefore seems less tied into the history and intent of ASHA. I guess that disciplines, categorizations, and labels are human made. Nature never read our books. Re: SID-4 From: Darrell Dodge Date: 10/19/98 Time: 12:48:01 AM Remote Name: 18.104.22.168 Comments Thanks for your comments, Chuck. I think we should all be very grateful that nature doesn't read our books!! Something about dysphagia that should be pointed out is that competence in assessing and treating swallowing disorders is extremely important to the hospital-based SLP in terms of credibility. It is a medical issue that places the SLP on a "more equal" footing with the OT's, PT's, and physicians. And anything that increases the participation of the SLP probably helps. There are also conditions, such as the later stages of MS, where swallowing disorders and speech disorders are virtually indistinguishable. In these cases, severe speech problems could be an indication that unreported swallowing problems are occurring. In almost all cases, the swallowing problem is considerably more important than the speech difficulty. More pertinent to the discussion here, I found that studying swallowing disorders filled in a few hazy areas of my understanding of the function of structures involved with speech. And there is no better demonstration of the fact that many of the muscles involved with stuttering are innervated by brain regions that mediate survival responses, as well as speech and language output. Regards, - Darrell Dodge I Believe That.... From: Krista Affeldt-Bacon Date: 10/18/98 Time: 10:10:34 PM Remote Name: 22.214.171.124 Comments I believe that the educational speech-language clinician has many, many hats to wear. I find it quite difficult sometimes to get too indepth in my therapy sessions as we may only meet 2 times a week for 20 minutes or less sometimes. I would find it a great help if there was a specialist who came into the school, even if periodically, who would touch base with the student(s) who stutter to assist them in areas that are difficult for us to get to. I often times find it uncomfortable to play the role of social worker or psychologist when I don't feel I have had adequate training to assist in helping the student deal with those feelings and personal challenges associated with stuttering. I feel that stuttering classes should be included in the SLH programs but that if one becomes very interested in stuttering, that they should be allowed to branch off to become a therapist who specializes in stuttering. This could be much similiar to some programs who offer and school tract and a medical tract or an augmentative communication tract. I feel that we all have our "specialties" and we aren't able to draw on those areas enough as we are too busy changing hats during the course of our 8 hour day. Re: I Believe That.... From: Darrell Dodge Date: 10/19/98 Time: 12:17:18 AM Remote Name: 126.96.36.199 Comments Thanks for your comments, Krista. I think that your idea of having a school stuttering specialist (or specialists in large districts) would be an excellent way for schools to respond to the needs of their students who stutter. Stuttering therapy really is very different from many other types of speech-language therapy. A school SLP with 75 clients, three or four of whom are children who stutter, is not going to be able to provide those children with the kind of attention they need. Given the unique characteristics of stuttering therapy, I think it would be much more efficient to have a specialist, who could then assemble a multi-disciplinary team along the lines that Ed wrote about. This specialist and the team could be powerful advocates for children in the school setting, ensuring that their therapy is maintained and that teachers and parents are included, listened to, and communicated with. This would also provide much-needed continuity in school-based stuttering treatment, from entry, all the way through high school, if necessary. It would also facilitate group treatment, which can be incredibly important, given the strong peer pressure among adolescents and teens. This would also solve a problem that seems to be widespread: school SLP's who feel that they lack the clinical competence to treat stuttering. Thanks again. - Darrell Dodge Close Vocal Folds, now open them From: Alyssa Cozzens Date: 10/19/98 Time: 2:29:01 AM Remote Name: 188.8.131.52 Comments Several years ago, I wouldn't have had a clue on how to do exactly that. I would have to agree with you that everything you've learned about concerning speech, speech disorders, and swallowing disorders have helped you in stuttering therapy. As a student, I have yet to experience hands on therapy with any patients. The material and techniques I have learned in my classes have all built upon each other. I have had one semester of Fluency coursework to date; however, each class helps to prepare me how to help my future clients with fluency disorders as well as any others. More emphasis on stuttering courses From: Teri Stock Date: 10/19/98 Time: 3:45:54 PM Remote Name: 184.108.40.206 Comments I would like to comment on the article, "Dysphagia" Wha?--Do Stuttering Therapists Need to study the Full Speech-Language-Hearing Curriculum?, by Darrell Dodge. I believe that it is important for individuals who want to specialize in stuttering therapy to receive the full SLH curriculum. However, I don't believe that there are enough courses that focus on stuttering therapy and how to approach it. As a graduate student, I am currently taking a fluency seminar course and find it extremely helpful. I had very minimal coursework in fluency disorders and felt that if I wanted to provide therapy to individuals with fluency disorders I would not be prepared. This is the very reason I chose to take the fluecny course. I do feel that I am receiving more out of the course due to my previous knowledge in other areas such as phonology, language, and hearing. By having knowledge in these other areas, it has helped me to undersatnd that stuttering is not something to be taught in five weeks, it is something that takes a great deal of time to understand. I wish that stuttering courses would receive the same curriculum time as does phonology, language, and hearing courses. With more knowledge in all areas this is the only way to provide adequate treatment to individuals with communication disorders. I feel that undergraduate and graduate school curriculums need to put more emphasis on teaching stuttering treatment techniques, history of stuttering research, and counseling. With these areas included into the curriculum it will give future Speech-Language Pathologists a understanding of how to handle individuals with fluency disorders. Re: More emphasis on stuttering courses From: Darrell Dodge Date: 10/19/98 Time: 10:56:09 PM Remote Name: 220.127.116.11 Comments Thanks for your participation, Teri. Your very good point is the "other side of the coin" brought up by Woody Starkweather in his post several weeks ago: the need to enhance the stuttering curriculum. It sounds like the seminar course you're taking is similar to the advanced stuttering research topics course offered at CU-Boulder. Perhaps even more important is the reinstatement of the requirement to have clinical practica in stuttering--particularly if the student is going to practice in the schools. There is considerable evidence that people are just not getting enough exposure to stuttering Tx and Dx. Thanks again. - Darrell Dodge SID-4 multidisciplinary interaction From: Ed Feuer Date: 10/20/98 Time: 2:23:24 AM Remote Name: 18.104.22.168 Comments A few questions: On ASHA's SID-4 page there is a list of "professional issues." One of these is "multidisciplinary interaction." Does that mean anything or is only so much window dressing? One of the reasons that some SLPs are hostile to the coordinated mulidisciplinary team approach is that they feel it is a threat to the "integrity" of the profession. Yet this is the same profession that harms its own integrity by going into dysphagia and thereby invading the realm of the occupational therapists. Ñ Ed Feuer firstname.lastname@example.org Re: SID-4 multidisciplinary interaction From: Darrell Dodge Date: 10/21/98 Time: 12:23:38 AM Remote Name: 22.214.171.124 Comments Ed: If SLP's who treat stuttering are uncomfortable about a "multidisciplinary team" approach to stuttering therapy, it is based on an uneasiness about involving specialists who may not understand stuttering, not about the integrity of their profession. It is absolutely essential--given the strong pscyhological component of developmental stuttering (which you supposedly acknowledge)-- that everyone involved in the treatment of a person who stutters be on the same page. If one member of the team harbors an opinion (professional or not) that the client is "faking" or that stuttering is "all in someone's head," then the integrity of the *therapy* process is compromised and real damage could be caused to the client. There are so many "strange" things about stuttering therapy (like voluntary stuttering -- which just doesn't look logical to many people) that specific training and experience in this therapy is required. In the past, you've proposed putting "assertiveness trainers" and other quasi-professionals on such teams. I understand and applaud your thoughts here. But a lot of these "trainers" may suffer from the delusion that anyone can do anything if they try hard enough in their particular area of interest. Unfortunately, they don't tend to work with populations of people with impairments. It is asking a ton of SLP's to go out and arrange for or provide specific training in stuttering for a group of professionals who are in other fields. I know -- in fact -- that many SLP's already do this to create a cadre of support people (primarily psychologists and psychotherapists) on which they can rely in some cases. I think your campaign would be well served if you encouraged SLP's to make exploratory efforts in such directions, rather than condemning them for not doing things exactly as you would like. I apologize to you, Ed -- and to readers who may not know the long history of this issue -- for the stridency of this response. But I think it would be beneficial to re-cast your campaign in a more positive image. Most people respond much better if we praise them for what they are doing right, rather than criticising them for what we think they are doing wrong. I'm sure, with your persistence, that such efforts would pay dividends for you and your worthwhile cause. Regards, - Darrell Dodge SID-4 multidisciplinary interaction From: Ed Feuer Date: 10/21/98 Time: 12:54:58 PM Remote Name: 126.96.36.199 Comments Darrell, Of course, the others on the collaborative team would have to accept the speech therapy model. And it would be up to SLPs to recruit such people whose expertise would be applied in a modular plug-in method, as needed, in the SLP's bigger therapeutic picture. As for "specific training," I think a reading of Van Riper's The Treatment of Stuttering would be sufficient in many instances Ñ and the SLP could elaborate on specifics. Remember what Van Riper said on page 201 of that book: "We feel that stuttering needs a global therapy, a total push, if it is to yield to clinical intervention and that it must be attacked from every quarter and with every available weapon." As for "asking a ton," I don't think so Ñ not if the needs of the client truly come first. I support better training of SLPs who treat stuttering. ItÕs my belief that better trained SLPs would make better coordinators in a multidisciplinary team approach. Ñ Ed Feuer email@example.com I agree, but.... From: Kris Date: 10/21/98 Time: 8:59:23 PM Remote Name: 188.8.131.52 Comments I agree with the idea of increasing the coursework and clinical clock hours in the area of stuttering, but not to the point of having stuttering becoming its own entity in the curriculm. I currently work in the public school system and am enrolled in a Masters program. This semister I am in a stuttering class and we have discussed the requirements, or lack of requirements, in graduate and undergraduate programs. The general consenses is that each student should take at the very least one undergraduate and one graduate class in the area of stuttering ( I understand that in some universities you don't even have to take any courses in stuttering). I think that requiring more classess and clinical clock hours would be helpful in working with students who stutter, but not especially practical as we need to address the many, many areas of speech and language disorders. Adding counseling to the curiculum would also be helpful, but extending the requirements beyond a course or two would not be practical. Being exposed to the basics of counseling, and then having the knowlege of resouces and referrals would be more beneficial. (Besides- I'm going to be in school long enough the way it is!! :) Others have mentioned the idea of a "stuttering specialist" - now there's a great idea! We now have specialist for Autism, and feeding and swallowing, why not a stuttering specialist. Someone with expertise is always a welcome site! Re: I agree, but.... From: Darrell Dodge Date: 10/21/98 Time: 11:44:34 PM Remote Name: 184.108.40.206 Comments Hi Kris and thanks for responding - ASHA's SID-4 is developing just such a clinical specialty in stuttering. I'm well aware of all the course requirements that MA students have. There really are a lot of areas to cover. I agree that it might be overkill (at least in the present environment) to have more than two graduate courses in one area like stuttering. I suppose one reason I wrote my article was to express the idea that one doesn't necessarily have to learn everything about stuttering in a stuttering course. If a person interested in stuttering as a specialty goes through a speech-language-hearing curriculum with stuttering in mind, there are bound to be many many insights along the way. The effect is similar to having a separate course in which stuttering is compared and contrasted with other speech disorders. Not to mention the areas like phonology and language, where problems can not only coexist with stuttering, but can be the source of stressors that aggravate or even help trigger stuttering development. I've found that this effect works for other areas in the curriculum as well. After all, this synergy is why SLH works as a unified curriculum. Thanks again. - Darrell Dodge "Dysphagia" Who? From: Susan Franklin Date: 10/28/99 Time: 11:44:29 PM Remote Name: 220.127.116.11 Comments I am currently enrolled in a graduate level stuttering course at Southern University in Baton Rouge, La. I truly enjoyed your article. You truly touched on a subject that often bothers me. I want to be not only a good SLP but also a competent one. WE are required to take only 48 hours of coursework. I know that 48 hours will never totally prepare any clinician! How would you design a graduate program where students will feel confident in their abilities without having to stay in school forever??