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.


Course Objectives

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:
b. collect case history information and integrate information from clients/patients, family, caregivers, teachers, relevant others, and other professionals
e. interpret, integrate, and synthesize all information to develop diagnoses.


Laboratory exercises.

Midterm examination.


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.


Class discussions.


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.

Laboratory exercises.


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.

Final examination.


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.


Course Requirements

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

Kuster’s website.


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


Important Notes

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.


Office Hours

Mondays:            12:30 – 1:30 p.m. or by appointment

Contact information: or (617) 353-7479.


Teaching Assistant

The TA for this course is Joyce Kosley who can be contacted at



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


                                    Required Readings:

·                    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


Additional recommendations:

·                    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.


Additional Recommendation

·                    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


Additional Recommendation:

·                    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


Additional Recommendations

·                    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


Additional Recommendations

·                    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.


Additional Recommendations

·                    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.


                  Additional Recommendation

·                    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


Additional Recommendations

·                    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.