CD732 FLUENCY DISORDERS
Boston University - Spring, 2006
Diane Parris, MS CCC/SLP, BRS-FD
Course Description (4 credits)
This course presents the theory, diagnosis and treatment of fluency disorders in children, adolescents, and adults. As a teacher-clinician, my goal is to develop your understanding and practice knowledge about individuals with stuttering and related fluency disorders so that you can provide quality services to these clients. In this course, we will review the symptomatology of stuttering, survey theories of stuttering, and examine normal versus abnormal fluency development. Then we will focus on diagnosis of fluency disorders and differential diagnosis of stuttering and related disorders of fluency. A central focus will be placed on the design and application of appropriate treatment programs for young children, school-aged children and adults. This will include knowledge in related areas necessary to treat this multidimensional disorder holistically, i.e. motor skills re-training, family involvement, and counseling. Throughout the course, I will involve you in practical experiences to enhance your clinical understanding; this will include discussion of clinical cases, videos of clients and master clinicians, opportunity to meet with individuals who stutter, and classroom experiences as well as assignments.
Required Text and Readings
1. Guitar, B. (2006) Stuttering An Integrated Approach to Its Nature and Treatment, 3rd Edition. Baltimore, MD: Williams & Wilkins.
2. Selected readings (journals & texts) specified in course outline; on reserve in IRC.
Suggested optional texts
Bennett, Ellen M. (2006) Working with People Who Stutter Prentice Hall Publishers.
Bothe, A. (2004) Evidenced Based Treatment of Stuttering, Mahwan, New Jersey:
Lawrence Erlbaum Associates.
Luterman, D. (2001) Counseling Persons with Communication Disorders and Their
Families, 4th Edition. Austin, TX: Pro-ed.
VanRiper, C. (1982).The nature of stuttering. Waveland Publishers
Other readings listed in course outline; suggested websites posted on CourseInfo.
ASHA Standard (2005)
Assessment Method & Criterion
1. To develop an understanding of speech fluency and factors which interfere with it.
ASHA Standard III-B: The applicant must demonstrate knowledge of basic human communication and swallowing processes, including their biological, neurological, acoustic, psychological, developmental, and linguistic and cultural bases.
Homework assignment with follow-up discussion in class.
Students will list ways in which own fluency fluctuates and factors influencing degree of fluency.
2. To describe specific behaviors associated with the disability known as stuttering.
Standard III-C: The applicant must demonstrate knowledge of the nature of speech, language, hearing, and communication disorders and differences and swallowing disorders, including the etiologies, characteristics, anatomical/physiological, acoustic, psychological, developmental, and linguistic and cultural correlates.
Laboratory exercises and discussion.
Students will describe and demonstrate in pseudostuttering exercise, behavioral characteristics of stuttering.
3. To review various theoretical models concerning the etiology of stuttering and the development of the disorder as well as variables that contribute to its maintenance.
Standard III-C: Same as above.
Written midterm examination.
Able to summarize and discuss one contemporary theory of stuttering etiology.
4. To develop assessment practices through examining interviewing methods, various diagnostic measures and instruments used in the assessment of those who stutter.
Standard IV-G-1 b &e: The applicant for certification
must complete a program of study that includes supervised clinical experiences
sufficient in breadth and depth to achieve the following skills outcomes: 1. Evaluation:
Able to code fluency behaviors in order to complete an SSI-3 severity rating accurately. Able to integrate behavioral observations with attitudinal survey to adequately provide diagnostic statement for a child and an adult who stutter.
5. To appreciate the heterogeneity of stuttering as a clinical disorder and to be able to state characteristics of phychogenic and neurogenic forms of the disorder, as well as the cluttering syndrome.
Standard III-D: Standard III-D: The applicant must possess knowledge of the principles and methods of prevention, assessment, and intervention for people with communication and swallowing disorders, including consideration of anatomical / physiological, psychological, developmental, and linguistic and cultural correlates of the disorders.
Able to accurately identify characteristics of psychogenic and neurogenic stuttering, and cluttering. (classroom response system activity)
6. To understand various therapeutic procedures and programs for the treatment of stuttering with consideration of age and cultural issues, including skill development in motor speech modification strategies and counseling skills.
Standard III-D: Same as above.
Able to demonstrate speech modification strategies including easy voice onset adequately as judged by instructor and TA.
7. To develop a clinical approach to the treatment of stuttering and the potential handicap it presents in individuals’ lives, including for those clients with issues related to concomitant phonology and/or language impairments.
Standard IV-G-2-a:The applicant for certification must complete a program of study that includes supervised clinical experiences sufficient in breadth and depth to achieve the following skills outcomes:2. Intervention: a. develop setting -appropriate intervention plans with measurable and achievable goals that meet clients’/patients’ needs. Collaborate with clients/patients and relevant others in the planning process.
Able to design appropriate evidence-based integrated treatment program for either a school aged child or adult (student’s choice) including writing accurate behavioral objectives and 2 sample activities.
Your course grade is based on completion of each of the following assignments. A total of 300 points can be achieved.
1. Completion of a take home midterm examination. (100 points)
This will focus on the diagnostic process and will entail scoring a speech sample and
interpreting an attitudinal survey for 2 clients, a child and an adult. In addition, a
review of one contemporary theory of stuttering etiology is required; utilize the
Andrews article assigned in the first class and “Voices of the Past” from Judith
2. Completion of one of the following assignments: (100 points)
a) Complete 3 two-page reflection papers: one regarding your own fluency and communication challenges, the events that lead to fluency breakdown, the context, the stressors, and your responses to them; the second, will entail producing pseudo stuttering in 3 speaking situations and writing up your reaction to this; the third, reactions to altering your speech, i.e. producing targets that we train our clients to use. A daily diary will be offered on courseinfo to document thoughts throughout this one-week-long assignment.
b) Complete 2 two-page reflection papers: one regarding your attendance at a meeting of a stuttering support group that summarizes the discussions covered during your visit, the concerns of the individuals participating, and any reactions you found yourself having; the second regarding a personal interview (20 – 30 minutes) that you will have conducted with an individual from the group. You may utilize questions offered during the class addressing diagnostic procedures or one that you design on your own. Include the questions with your paper.
c) Completion of a literature review (4 articles) in an area of fluency and stuttering (e.g. bilingualism and stuttering, concomitant disorders of communication and stuttering, parental interactions with young children who stutter, treatment efficacy, counseling in the treatment of stuttering, etc.). Formulate a question or hypothesis that will guide your literature review. Create abstracts of the four articles. Conclude with a summary statement that discusses what the literature revealed and how this would inform your understanding in the future. Submit the articles with your paper.
3. Completion of a take home final examination. (100 points)
This will require you to design a treatment plan with sample activities for one of the two clients observed for the midterm. You will be required to demonstrate knowledge of the components of an integrated approach to stuttering therapy, specific speech modification techniques, ability to write behavioral objectives, and use of evidence-based literature to support your approach with this particular individual (1 pertinent, recent article must be attached). Two activities will be designed in a lesson plan that you might be able to use in the future with a client of a similar age group.
Important Dates May change with advanced notice:
Midterm Examination due February 27 (Please let me know if this is too
closely scheduled to other midterms)
No class March 6 (intersession)
Second assignment due April 19
Final Exam due May 8 – deliver to my mailbox by 4 PM
There will be no make-up examinations or extensions on papers without prior arrangements with the instructor.
Any student who has a disability or condition that compromises his/her ability to complete the requirements of this course must notify the instructor in writing within one week of the course beginning.
Withdrawal from this class is permitted according to University policy up to the eighth week of class, i.e. March 13, 2006, and not after that date.
Please check courseinfo regularly between classes for announcements.
Mondays: 12:30 – 1:30 p.m. or by appointment
Contact information: or (617) 353-7479.
The TA for this course is Joyce Kosley who can be contacted at firstname.lastname@example.org.
Lectures, Topics, and Readings
Jan 23 Introduction to the course: purpose and goals, requirements
Fluency as a continuum; characteristics of stuttering
Lab portion of class:
“Transcending Stuttering” video and discussion
Contributing factors to speech discontinuities; reflecting on own speech
· Guitar text - Chapter 1
· Andrews, G., Craig, A., Feyer, A., Hoddinott, S., Bowie, P., Neilson, M. (1983). "Stuttering:A review of research findings and theories circa 1982." JSHD, 48, 226-246.
Jan 30 Etiological Theories of Stuttering:
“Voices of the Past” and Current Theories
Lab portion of class:
Explain the cause of stuttering to a parent; to a client
· Guitar text - Chapters 2 through 4
· Ratner, N.B. (1997). Stuttering: a psycholinguistic perspective. In R.F.Curlee & G.M. Siegel (Eds.) Nature and Treatment of Stuttering: new directions. P.p.99-127. Needham, MA: Allyn and Bacon.
· Smith, A. (1999) Stuttering: A Unified Approach to a Multifactorial, Dynamic Disorder. In Bernstien Ratner and Healy (Ed.), Stuttering Research and Practice, Mahwah, NJ: Lawrence Erlbaum Associates. Chapter 3.
· Adams, M.R. (1990). The demands and capacities model I: theoretical elaborations. Journal of Fluency Disorders, 15, 135-141.
· Starkweather, C.W. & Gottwald, S.R. (1990). The demands and capacity model II: clinical applications. Journal of Fluency Disorders, 15, 143-157.
· Ingham, R. et al. (2003). Towards a functional neural systems model of developmental stuttering. Journal of Fluency Disorders, 28, 297-318.
Feb 6 The Development of Stuttering & Assessment Protocol
Lab: Van Riper video and discussion; pseudostuttering
· Guitar text - Chapter 5
· Silverman, F.(2004) Stuttering And Other Fluency Disorders, "Onset of Stuttering” (pp.96-110). Needham Heights, MA: Allyn & Bacon.
· Starkweather, C.W. (2002). The epigenesist of stuttering. Journal of Fluency Disorders, 27, 269-288.
Feb 13 Clinical Assessment of Fluency Disorders – Procedures
Lab: scoring disfluencies; SSI-3
(More practice with during TA office hours)
· Guitar text- Chapter 6 and 7
Feb 21 Counseling Fundamentals: Role and Characteristics of the Clinician
Lab: What constitutes extraordinary listening? Small group work.
· Luterman – Chapters 1 & 2
· Bloom and Cooperman. (1999) Synergistic Stuttering Therapy, Boston, MA. Butterworth-Heineman, Chapter 9.
· Gregory, C. (2003) Counseling. In Gregory, H. Stuttering Therapy, Boston, MA. Allyn and Bacon. Chapter 8.
· VanRiper, C. (1982) The Nature of Stuttering, The Self-Concepts of Stutterers (Chapter 10). Prospect Heights, Ill: Prentice-Hall.
Feb 27* Treating People Who Stutter *Midterm exam due.
An integrated approach
Lab: Practicing motor speech behaviors
Easy Relaxed Approach – Smooth Movement (ERA-SM)
· Guitar text - Chapter 8
· Starkweather, W. (1999) The Effectiveness of Stuttering Therapy: An Issue For Science? In Bernstien Ratner and Healy (Ed.), Stuttering Research and Practice, Mahwah, NJ: Lawrence Erlbaum Associates. Chapter 16.
· Langevin, M. & Kully, D. (2003) Evidence-based treatment of stuttering: III. Evidence-based practice in a clinical setting. Journal of Fluency Disorders, 28, 219-236.
Mar 6 NO CLASS – intersession break
March 13 Treating the Adult Who Stutters (continued)
Lab: Writing behavioral objectives; reporting on feelings and attitudes
· Guitar text – Chapter 12
· Boberg, E. (1994). Behavioral Transfer and Maintenance Programs for Adolescent and Adult Stutterers. Stuttering Foundation of America Pub. # 19. Memphis, TN: SFA.
· Sheehan, J. (1994). Relapse and Recovery. Stuttering Foundation of America Pub. # 19. Memphis, TN: SFA.
Mar 20 Counseling and Counseling Techniques
Lab: Practicing effective techniques in small groups
No readings – use this week to catch up on readings.
Mar 27 The Adult Who Stutters
Differentiating other disorders of fluency
Lab: Group therapy - Joseph Germono video and discussion
· Helm-Estabrooks, N. (1993). Stuttering Associated with Acquired Neurological Disorders. In R. Curlee (Ed.), Stuttering and related disorders of fluency. New York: Thieme-Stratton.
· Mahr, G. & Leith, W. (1992) Psychogenic Stuttering of Adult Onset.
JSHR, 35, 283-286.
April 3 Treatment of the School-Aged Child Who Stutters
Lab: Writing for IEP’s
· Guitar text - Chapters 10 & 11
· Bernstein Ratner, N. (1995, April). Treating the Child Who Stutters with Concomitant Language or Phonological Impairment, Language, Speech, and Hearing Services in the Schools , (pp.180 - 186). Rockville, MD: ASHA.
· Yaross, J.S., (1999) Utterance Length, Syntactic Complexity, and Childhood Stuttering. JSHLR, 42, 329-344.
· Logan, K., Yaross, J.S. (1999) Helping Parents Address Attitudinal and Emotional Factors With Young Children Who Stutter. Contemporary Issues in Communication Science and Disorders, 26, 69-81.
· Culatta, R. & Goldberg, S. (1995). Stuttering Therapy: An Integrated Approach to Theory and Practice, Culture and Stuttering (chapter 5). Needhan Heights, MA: Allyn & Bacon.
April 10 The School-Aged Child
The Interface of Language and Fluency / Cluttering
Guest speaker: Dr. Anthony Bashir, PhD
· Guitar text – Chapter 13
· Daly, D. (1993) Cluttering: Another Fluency Syndrome. In R.Curlee (Ed.), Stuttering and related disorders of fluency, New York: Thieme-Stratton.
· Blood, G. (1995, April). POWER2: Relapse Management with
Adolescents Who Stutter, Language, Speech, and Hearing Services in the Schools , (pp.169-179). Rockville, MD: ASHA.
April 19* The Preschool Age Child Who Stutters *Assignment due
Lab: Case study and discussion (multicultural issues)
· Guitar text - Chapter 9
· Gottwald, S., (1999) Family Communication Patterns and Stuttering Treatment Research. In Bernstien Ratner and Healy (Ed.), Stuttering Research and Practice, Mahwah, NJ: Lawrence Erlbaum Associates. Chapter 13
· Louko, L. (1995, May). Phonological characteristics of young children who stutter, Topics in Language Disorders, 15:3, 48 - 59.
Ambrose, N.G. & Yairi, E. (1999) Normative Disfluency Data for Early Childhood Stuttering. JSLHR, 42, 895-909.
· Onslow, M. (2003) The Lidcombe Program of Early Stuttering Intervention, Austin, TX. Pro-Ed. Chapter 1.
April 24 Parent Counseling
Lab: Parent guest speaker; students prepare interview questions
· Luterman – chapter 8
May 8 Final examination project due at noon.