HESP 612 Fluency Disorders

Fall 1999 Tues 1:3:30

Nan Bernstein Ratner (phone 301-405-4217; e-mail nratner@hesp.umd.edu)


This course is designed to provide the master's level student in speech language pathology with understanding of the complex issues which surround the successful treatment of fluency disturbance. We shall address; (1) assessment procedures for the differential diagnosis of fluency disturbances in children and adults; (2) procedures for establishing baseline fluency measures and monitoring improvement in fluency performance; (3) varied theoretical explanations of the nature of stuttering; (4) varied therapeutic approaches to management of both fluency and dysfluency in the stuttering patient; (5) issues in the maintenance of fluency; (6) treatment of speech tension, anxiety and situational fears; and (7) disorders which may mimic stuttering, but which need to be carefully distinguished from stuttering for therapeutic purposes.


There will be an in-class midterm examination and a final. Students will also complete two fluency projects, described on separate handouts. Each exam is worth 25 % of your grade, and the assignments are each worth 25 %.


There is a text for the course, and some additional readings. The text is:

B. Guitar (1998). Stuttering: an integrated approach to its nature and treatment, second edition. (Baltimore: Williams & Wilkins).

There is a set of additional readings; readings from this set are marked on the syllabus with the note (X)

Notebook: There is an optional course notebook, which contains lecture notes, assessment forms, and other pertinent materials. It will be offered for sale at the BSOS Copy Center.

Videos/Lunch-hour theater

The department has a good selection of videotapes and audiotapes specifically designed to help clinicians develop their skills in working with children and adults who stutter, and to provide some historical perspectives on stuttering therapy. Starting in Sept, I will be showing videotapes at the following times: . I will also make arrangements for additional viewing times if necessary and possible. Students may also check out tapes overnight by making arrangements with me directly (not the office staff!).

Video dates and tentative films (all films subject to change!)

9/15 Van Riper 1: Stuttering diagnostic

9/22 Van Riper 2: Identification

9/29 Van Riper 3: Desensitization

10/6 Van Riper 4: Therapy variations

10/13 Van Riper 5: Stuttering modification/cancellation

10/20 Van Riper 6: Modification/monitoring

10/27 Van Riper 7: Stabilization

11/3 Guitar & Adamzack: 20 years later

11/10 SFA Baltimore tape selections

11/17 SFA treatment tape: school aged-children

11/24 SFA Baltimore tape selections

12/1 SFA: Stuttering and your child; SFA teen tape


Sept. 7

Introduction to the course.

An analysis of the behaviors which define stuttering.


Smith, A. (1990). Factors in the etiology of stuttering. ASHA Reports, 18, 39-47. (X)

Guitar, Chapters 1 & 2

Sept. 14

Theoretical perspectives on the nature of stuttering.


Guitar, chapters 3, 4 & 5

Yairi, E , Ambrose, N , Paden, E. & Throneburg, R. (1996) Predictive factors of persistence and recovery: pathways of childhood stuttering. Journal of Communication Disorders, 29, 51-77.

Perkins, W., Kent, R., Curlee, R. (1991). A theory of neuropsychlinguistic function in stuttering. JSHR, 34, 734-752.

Kolk, H. & Postma, A. (1997). Stuttering as a covert repair phenomenon. In R. Curlee & G. Siegel (Eds). Nature and treatment of stuttering: new directions (2nd edition). Boston: Allyn & Bacon.

Sept. 21

Differential diagnosis of stuttering in children and adults


Guitar, chapter 7

Curlee, R. & Yairi, E. (1997). Early intervention with early childhood stuttering: a critical examination of the data. American Journal of Speech-Language Pathology, 6, 8-18.

Bernstein Ratner, N. (1997). Leaving Las Vegas: Clinical odds and individual outcomes. AJSLP, 6, 29-33.

Ambrose, N. & Yairi, E. (1999). Normative disfluency data for early childhood stuttering. Journal of Speech, Language and Hearing Research, 42, 895-909.

Sept 28

Calculation of fluency measures. Please bring a stopwatch and calculator. Begin overview of treatment approaches Assignment (Non-graded): Paired pseudo-stuttering. See handout for activities.


Yaruss, J.S. (1998). Real-time analysis of speech fluency: procedures and reliability training. AJSLP, 7, 25-37.

Oct 5

Overview of treatment approaches in stuttering.


Guitar, Chapter 6

Blood, G. (1993). Treatment efficacy in adults who stutter: review and recommendations. Journal of Fluency Disorders, 18, 303-318.

E. Conture & B. Guitar (1993). Evaluating efficacy of treatment of stuttering: school-age children. Journal of Fluency Disorders, 18, 253-287.

J. Costello Ingham & G. Riley (1998). Guidelines for documentation of treatment efficacy for young children who stutter. Journal of Speech and Hearing Research, 41, 753-770.

Oct. 12

Treating the adult stutterer: fluency shaping.

Readings: Guitar, chapters 8 & 9


Oct. 19

Treating the adult stutterer: stuttering modification.

Readings: Guitar, chapters 10 & 11.

Oct. 26

Review of Assignment #1; Continuation of adult therapy techniques; operant approaches; Self-Help Groups

Nov. 2

Guest Lecture: Approach Avoidance therapy (Vivian Sisskin); group therapy considerations.


Take-home mid-term examination handed out. (Due Nov.9)

Nov. 9

Desensitization and relaxation; Begin unit: Treating children who stutter.


Guitar, review chapter 5, read chapters 12-14

Take-home mid-term due.

Nov. 16

Cognitive and linguistic factors in early stuttering; Indirect management of fluency problems in children.


Ratner, N B (1996) Stuttering: a psycholinguistic perspective In R Curlee & G Siegel (Eds ) Nature and treatment of stuttering: new directions, 2E Boston: Allyn & Bacon

Ratner, N B (1993) Parents, children and stuttering. Seminars in Speech and Language, 14, 3), 238-250 (X)

Onslow, M , Andrews, C & Lincoln, M (1994) A control/experimental trial of an operant treatment for early stuttering. Journal of Speech and Hearing Research, 37, 1244-1259

Nov. 23

School models for fluency treatment; treating adolescents; stuttering in the presence of concomitant problems.


Guitar, review 156-194

Ratner, N B (1995). Treating the child who stutters with concomitant communication problems Language, Speech and Hearing Services in Schools, 17, 207-218.(x)

Blood, G (1995) Power 2 : relapse management with adolescents who stutter. Language, Speech and Hearing Services in Schools, 26, 169-179 (x)

Nov 30

Counseling issues in fluency treatment.

Dec 7

Catch-up day, topic to be announced

Dec 14

Acquired stuttering; cluttering.


Daly, D (1993). Cluttering. In R. Curlee (ed.) Stuttering related disorders of fluency. NY: Thieme, pp 179-204. (X)

Myers, F. (1996). Annotations of research and clinical perspectives on cluttering since 1964. Journal of Fluency Disorders, 21, 187-199.

Helm-Estabrooks, N (1993) Stuttering associated with acquired neurological disorders In R Curlee (ed ), op cit., pp 205-219. (X)

Roth, C , Aronson, A , Davis, L (1989). Clinical studies in psychogenic stuttering of adult onset. JSHD, 54, 634-646. (x)

PROJECT #2 DUE on DEC 14, unless arranged otherwise.

Dec 21

Final examination, in class.


Research a topic on PubMed: http://www.ncbi.nlm.nih.gov/PubMed/

Explore the Stuttering Home Page: http://www.mnsu.edu/comdis/kuster/stutter.html

See actual brain imaging of stuttering: http://www.msnbc.com/onair/nbc/dateline/stutter/braintext.asp

For folks working on departmental research files, pull down data and/or programs from the CHILDES Archive:



Assignment #1: Calculation of fluency measures.

Obtain a copy of the "Tom" tape from Mary or Jean. It is available for overnight loan, but MUST be signed out after 4 pin and brought back before 9 am Use the following transcript to locate the speech sample.


That's possible, yeah.

But I've gone through all kinds of programs and

I've read up on what I think that how stuttering can sometimes be cured through psychological counseling.

So when I read that it's like , 'Oh yeah that's the new hopeŠŠ

I'm just that way because of my past failures.

I know, but it's just that I tend to look forward rather than dwell in the present which isn't always good.

Well, let's seeŠ

I would say being called on in class or being where a teacher would say, 'Let's go in a circle for group discussion'Š

And he starts on the opposite side of the roomŠ

and I just happen to be the last one.

That's the worst case.

Calculate the following measures:

Total number of words spoken: Rate of speech (words per minute):

Part-word repetitions:

% of words spoken , % total dysfluencies

Whole-word repetitions:

% of words spoken, % total dysfluencies

Overt blocks:

% of words spoken, % total dysfluencies


% of words spoken, % total dysfluencies

Other abnormal speech behaviors: describe and quantify.

Describe the frequency (percentage) of normal disfluencies, including filled pauses, unfilled pauses which do not appear to be blocks, and phrase revisions and/or maze behaviors.

Describe and comment upon any secondary behaviors you observe in the sample.

Finally, give your impression of Tom's fluency - how significant his problem is, and what areas seem to need primary attention (for class discussion).

It is helpful to both of us if you annotate the transcript, and show the basis for all of your calculations.


Pick one (1) of the following assignments to complete. All assignments should be typed, and are due on the day indicated, unless you have arranged otherwise with me.

1. Select a theory of stuttering. Review five primary sources which describe the theory Explain why this particular theory about the underlying defect in stuttering is particularly compelling to you (Suggested page length of discussion: 10-15 pages).

2. Generate a research proposal to answer a question about the nature, assessment or treatment of stuttering (or another fluency disorder) Establish, through a short review of the research (five to ten sources), what is currently known and what particular gap in our knowledge base about stuttering you wish to fill. (Suggested page length: 15 pages).

3. Talk to me about using data from the Fluency Project to test a hypothesis about stuttering in very young children.

4. Subscribe to the Stutt-L, Stut-HLP or Stutt-X e-mail bulletin boards (See the Stuttering Home Page for instructions). Monitor the list and participate as you wish Select a topic which appears to be generating active discussion on the bulletin board, or begin discussion on a topic of interest to you Integrate the comments made by persons who stutter, therapists and family members with published literature on the problem area. If your client discussed this topic area, how would you respond to him or her'? How can speech-language pathologists contribute positively to the problem as discussed on the bulletin board? (Suggested page length: 10-15 pages; topics vary widely and wildly; see me for guidance)

5. Find a web site that provides information about stuttering. Critique its factual content. Delineate which facts/advisement are supported by evidence and which are not or are equivocally supported. Provide me with a printout of the web site in addition to your analysis.

6. Participate as a coder on one of the following projects: SLI and Fluency (Rescorla, Ratner & Boscolo); parental fine-tuning at stuttering onset (Miles and Ratner), Effects of TO on Stutter Frequency (Onslow & Ratner).

7. Student choice. Just be sure to get your project approved by me.