SPPA 4864 W.S. Rosenthal, Ph.D Fluency Dysfunctions Professor email: **************************************************************************************************** Required Text: Peters, T.J. and Guitar, B. Stuttering - An Integrated Approach To Its Nature and Treatment, Williams & Wilkins, 1991 Course Description: This is a multi-media, participation approach to the study of fluency disorders. Attendance and participation is essential. Here is what we cover: 1. Identification of stuttering and related fluency disorders. 2. Theories about the causes of stuttering. 3. Treatment methods. We will use extensive film, video, and audio examples. We will use recent and current clinical cases as the core of discussion about treatment. Reading: Read ahead and complete prior to the end of the quarter. Weeks 1 & 2 Text, Chapters 1-4 Weeks 3 & 4 Text, Chapters 5-6 Week 5 Text, Chapters 7-8 Week 6 Text, Chapters 9-10 Week 7 Text, Chapters 11-12 Focus Groups: Groups will be formed to research and report on theoretical, diagnostic, and treatment aspects of fluency disorders as they occur in different age groups. Much of this work will be done in class, so class attendance is essential. (See attached.) Grading: Attendance 20% Focus Group Participation 30% Final Exam on Text and Lectures 50% ___________________________________________________________________________________________________ INSTRUCTIONS FOR FOCUS GROUPS -- FLUENCY CASES Purpose The purpose of the focus groups is to provide a medium for studying, assessing and planning treatment of a variety of fluency cases. Although each group will be responsible for only one case, all participants will interact in such a way as to share information. At the end, each focus group will present a report of its findings for its particular case. Organization Each group will consist of from 3 to 5 members. Roles within the group will be divided in the following way. Theorist - 1 Diagnostician - 1 or 2 Therapist - 1 or 2 The "theorist" will be responsible for researching all theoretical information about the case. The information will likely come from journals and specialized books from the library collection. The group as a whole should determine what questions need to be researched. The "diagnostician(s)" will be responsible for planning a thorough evaluation procedure for the case. As above, the group as a whole should determine the direction of the evaluation. This direction may need to wait on information collected by the theoretician. Ultimately, the diagnostician(s) should indicate not only what procedures are to be followed, but also the expected results. The "therapist(s)" will be responsible for planning a thorough treatment protocol for the case. As above, the group as a whole should determine the direction of therapy. This direction may need to wait on information collected by the theoretician and diagnostician(s). Ultimately, the therapist(s) should indicate not only the therapy procedures to be followed, but also predict the expected outcome. Since the assignments are dependent on information to be collected by others, there will likely be regular revisions of your plans as additional information is brought back to the group. You should not produce a final report until after the last group meeting. In all cases, in addition to explaining what you are going to do, document how and why you are going to do it. Schedule April 29 -- Establish groups and assign cases. Decide roles within group. Decide initial assignments. (45 minutes) May 1 -- Focus groups meet by cases. Exchange information. New assignments. (30 minutes) May 6 -- Focus groups meet by cases. Continue as above. (45 minutes) May 8 -- Focus groups meet by expertise areas; all theoreticians together, all diagnosticians together, and all therapists together. Exchange information about your respective areas. Use new information to adjust approach to cases. (90 minutes) May 13 -- Focus groups meet by cases and finalize plans. (90 minutes) May 15 -- Focus groups 1 and 2 report their cases to the class. May 20 -- Focus groups 3 and 4 report their cases to the class. May 22 -- Focus groups 5 and 6 report their cases to the class. May 30 -- Focus groups 7 reports its case to the class. Expert groups report Note: The last four sessions will include considerable discussion by the rest of the class and the instructors. Some final material will be presented in lecture on May 30. Also note that May 1 will be shortened to accommodate a guest speaker from the National Stuttering Project. _________________________________________________________________________________________________ LECTURE AND ACTIVITY SCHEDULE Lecture Number and Topic: 1. Identification of Stuttering; video examples of two different approaches 2. Identification (con't); video examples of variations in stuttering, before and after therapy. Interiorized and exteriorized. Variations in severity. Is all dysfluency stuttering? Examples of cluttering & Tourette's syndrome. 3. Cluttering; characteristics and video example. Differential diagnosis. Psychogenic stuttering; audio examples. Stories of other cases of adult onset. 4. Etiological theories; Learned (bad habit, operant conditioning, classical conditioning, two-factor, diagnosogenic); Constitutional; Genetic 5. Facts and Myths about stuttering; old universals and new universals (Andrews 1982 article). 6. Integrated theory; psycho-somatic model Dual distribution of psychodynamic and physiological factors. 7. Transactional analysis as a support model for assessing psychodynamic factors; ego states, scripts, games. Before and after video demonstrating ego state changes. 8. Three case examples; (1) Mother's script "Make stutterers", (2) Learned helplessness "Don't grow up", (3) Parent injunction "Don't be fluent". 9. Approaches to treatment; efficacy (Andrews, 1980) Obstacles to successful therapy; games therapists play "Experts" views. 10. Major treatment approaches; Speech modification, fluency shaping. 11. Therapy examples from videos. Set up focus groups and assign cases. 12. Advocacy movement; guest from National Stuttering Project. Groups meet by case assignments. 13. Groups meet by case assignments. 14. Focus groups meet by expert areas. 15. Groups meet by case assignments and finalize plans. 16. Reports-Groups 1 and 2 17. Reports-Groups 3 and 4 18. Reports-Groups 5 and 6 19. Reports-Group 7 Expert groups report Conclusion and last word.