University of Pittsburgh — Communication Science and Disorders

CSD 2072: Fluency Disorders

Course Syllabus -- Fall, 2000

J. Scott Yaruss, Ph.D., CCC-SLP
4042 Forbes Tower — (412) 647-1367
jsyaruss@csd.upmc.edu

Course Time: Friday 12:00p — 2:50p
Office Hours: by appointment

Introduction

Welcome to CSD 2072: Fluency Disorders! This course will provide you with a detailed introduction to the nature and treatment of stuttering and other fluency disorders. My overall goal is to give you a thorough understanding of stuttering, while helping you develop the clinical skills needed to accurately diagnose and effectively treat children, adolescents, and adults who stutter.

Course Description

This course will be primarily taught through the process of asking and answering questions about theory and practice in fluency disorders. Each day, we will work through a series of questions that will lead us toward a class discussion and lecture on a specific topic. You will have the questions in advance (available on CourseInfo), so you can think about the topics and the questions while when you are doing the readings. You should also ask your own questions and to look for answers outside the basic reading and class discussions.

Course Rationale

This course is offered to help you develop an understanding of stuttering so you will be prepared to work with people who stutter. Like many of the disorders in our field, stuttering can be complicated and confusing. For this reason, we will discuss a variety of topics from several different fields, including basic aspects of physiology, language development, emotional development, learning theory, counseling techniques, and clinical interaction. We will attempt to integrate all of these aspects to help you develop into effective and efficient clinicians who are comfortable and competent working with people with fluency disorders.

Course Goals

At the conclusion of this course, you should demonstrate a detailed understanding of:

You should also develop some appreciation of what it would be like to be a person who stutters, so you will be better able to understand your client’s perspective.

Finally, you will practice thinking critically about various topics in stuttering so you will be prepared to evaluate new information as it develops throughout you career as a speech-language pathologist.

Course Outline

Each day, we will cover a different topic related to fluency disorders. An outline of daily topics and the assigned readings can be found on the attached page.

Course Materials

Readings will be drawn from two sources: (a) a textbook covering many aspects of the theory and practice of stuttering; and (b) supplemental readings covering particular aspects of clinical method. The readings have been collected into a reader available for you to copy, and it will be in the LRC for you to use as necessary.

Course Requirements and Grading

Participation. By far, the most important aspect of this class will be your participation in class discussions. This will involve asking and answering questions, and posing different viewpoints for consideration. I hope everybody will participate each day, and I will do my best to track your participation and provide feedback about how you are doing in the class discussions. In the end, though, it is up to you to make sure you are contributing to the class on a regular and consistent basis.

Class participation will account for 20% of your final grade. Your participation grade will be determined by how often you contribute to discussions. During the term, you should ask or answer questions in class at least 10 times. These contributions should be substantive (not just "me too" comments) and reflect your thinking about the issues we discuss. If you actively contribute to the discussions in class, you can be assured that you will get a good grade for class participation, and you will get the most out of the class you can.

Experience Assignments. To help you begin to understand what life can be like for a person who stutters and to help you practice treatment techniques, you will complete two experience assignments that involve pseudostuttering, or stuttering on purpose, in a variety of real-life situations in public. After you complete each assignment, you should post a summary of your experiences on the CourseInfo discussion list. Specific instructions for these two experience assignments are provided on the attached page.

The experience assignments will account for 20% of your final grade. Your experience grade will be determined by: (a) how thoroughly you complete the assignments, (b) the detail in your CourseInfo summary, and (c) how much you contribute to discussions about the experiences in class and on CourseInfo.

Paper. Stuttering is a rapidly growing field, and it is impossible for us to cover all relevant or interesting information in a single semester. As a result, you will need to continue learning about stuttering (as well as other communication disorders) throughout your career. To help prepare you for this future, you will write a short term paper (maximum 10 double-spaced pages) on any topic related to fluency disorders. In writing this paper, you should research your topic thoroughly and include relevant references. Specific instructions for the term paper and sample topic ideas are provided on the attached page.

The paper will account for 20% of your final grade. Your paper grade will be determined by detail in your review and the depth of your thinking (see attached instructions). The paper will be due on November 10th.

Quiz and Final Examination. Mid-way through the class you will receive a take-home quiz to help you synthesize and integrate material presented in the first half of the class. The quiz will be distributed on 10/6/00 and it will be due one week later, on 10/13/00. The format will be multiple choice and short essays. During final exam period, there will be a 2-hour cumulative final examination, similar in format to the mid-term. The quiz will count for 15% of your final grade, and the final exam will account for 25% of your final grade.

Course Policies

Academic Integrity. Students in this course will be expected to comply with the University of Pittsburgh's Policy on Academic Integrity. Any student suspected of violating this obligation for any reason during the semester will be required to participate in the procedural process, initiated at the instructor level, as outlined in the University Guidelines on Academic Integrity. This may include, but is not limited to, the confiscation of the examination of any individual suspected of violating University Policy. Furthermore, no student may bring any unauthorized materials to an examination, including dictionaries and programmable calculators.

Disabilities. If you have a disability that requires special testing accommodations or other classroom modifications, you need to notify both the instructor and the Disability Resources and Services no later than the 2nd week of the term. You may be asked to provide documentation of your disability to determine the appropriateness of accommodations. To notify Disability Resources and Services, call 648-7890 (Voice or TDD) to schedule an appointment. The Office is located in 216 William Pitt Union.

Course Outline

Date

Topics

Readings

Sept. 1

What is stuttering?

Defining fluency, disfluency, and stuttering
Listening to disfluencies in your own speech
Getting comfortable with stuttering

Shapiro, Ch. 1 (pp. 2-29)
Shapiro, Ch. 2 (pp. 46-53)

Sept. 8

Other types of fluency disorders

Professional considerations in stuttering

The role of the SLP; The role of support groups
Scope of practice in stuttering therapy

Shapiro, Ch. 4 (pp. 96-116)

Shapiro, Ch. 11 (pp. 474-512)
Shapiro, App. A3 (pp. 523-533)

Sept. 15

What causes stuttering?

Historical and current views about stuttering

Shapiro, Ch. 3 (pp. 58-93)

Sept. 22
Exp 1 Due

How does stuttering develop?

The developmental course of stuttering
Factors affecting the occurrence of disfluencies
Factors affecting the development of stuttering

Shapiro, Ch. 2 (pp. 32-45)
Yairi et al. (1996)
OPT: Van Riper (1982), Ch. 8

Sept. 29

Evaluating stuttering — General considerations

Decision-making in stuttering measurement
Measuring stuttering behaviors (practice)

Yaruss (1997)
Yaruss (1998a)

Oct. 6

Evaluating preschool children who stutter

The diagnostic evaluation
Making diagnostic decisions

Shapiro, Ch. 8 (pp. 214-262)
Curlee & Yairi (1997)
OPT: Yaruss et al. (1998)

Oct. 13
Quiz Due

Treating preschool children who stutter I

Working with the environment
Counseling parents

Shapiro, Ch. 8 (pp. 262-272)
Zebrowski & Schum (1993)
Logan & Yaruss (1999)

Oct. 20

Treating preschool children who stutter II

Working with the child
Some controversies and different opinions

Shapiro, Ch. 8 (pp. 272-287)
Gottwald & Starkweather (1995)
Harrison & Onslow (1999)

Oct. 27

Evaluating adults who stutter

Considering the entire stuttering disorder
Interviewing adults and making diagnostic decisions

Shapiro, Ch. 10 (pp. 364-405)
Yaruss (1998b)

Nov. 3

Treating adults who stutter I: Basic techniques

Fluency modification techniques
Stuttering modification techniques

Shapiro, Ch. 7 (pp. 180-211)
Murphy (1999)
OPT: Prins (1997), Ingham (1999)

Nov. 10
Paper Due

Treating adults who stutter II: Synthesis

Designing individualized treatment programs

Shapiro, Ch. 10 (pp. 407-434)
Manning (1999)

Dec. 1

Treating school-age children who stutter I

Assessment and diagnosis of school-age children
Treatment goals and techniques

Shapiro, Ch. 9 (pp. 293-344)
Dell (1993)

Dec. 8
Exp 2 Due

Treating school-age children who stutter II

Working with schools and families

Wrap-up / Summary

Shapiro, Ch. 9 (pp. 344-362)
Ramig & Bennett (1997)

Dec. 15

FINAL EXAM

Supplemental Reading List

Curlee, R.F., & Yairi, E. (1998). Early intervention with early childhood stuttering: A critical examination of the data. American Journal of Speech-Language Pathology, 6, 8-18.

Dell, C.W. (1993). Treating school-age stutterers. In R.F. Curlee (Ed.), Stuttering and Related Disorders of Fluency (pp. 45-67). New York: Thieme-Stratton.

Gottwald, S.R., & Starkweather, C.W. (1995). Fluency intervention for preschoolers and their families in the public schools. Language, Speech, and Hearing Services in Schools, 2, 117-126.

Harrison, E.., & Onslow, M. (1999). Early intervention for stuttering: The Lidcombe Program. In R.F. Curlee (Ed.), Stuttering and Related Disorders of Fluency (2nd ed.). (pp. 65-79). New York: Thieme-Stratton.

Ingham, R.J. (1999). Performance-contingent management of stuttering in adolescents and adults. In R.F. Curlee (Ed.), Stuttering and Related Disorders of Fluency (2nd ed.). (pp. 200-221). New York: Thieme-Stratton.

Logan, K.J., & Yaruss, 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.

Manning, W. (1999). Management of adult stuttering. In R.F. Curlee (Ed.), Stuttering and Related Disorders of Fluency (2nd ed.). (pp. 160-180). New York: Thieme-Stratton.

Murphy, W. (1999). A preliminary look at shame, guilt, and stuttering. In N. Bernstein Ratner & E.C. Healey (Eds.), Stuttering research and practice: Bridging the gap (pp. 131-144). Mahwah, NJ: Lawrence Erlbaum Associates.

Prins, D. (1997). Modifying stuttering–the stutterer’s reactive behavior: Perspectives on past, present, and future. In R.F. Curlee & G.M. Siegel (Eds.), Nature and Treatment of Stuttering: New Directions. (2nd Ed.). (pp. 335-355). Needham Heights, MA: Allyn & Bacon.

Ramig, P.R., & Bennett, E.M. (1995). Working with 7- to 12-year-old children who stutter: Ideas for intervention in the public schools. Language, Speech, and Hearing Services in Schools, 26, 138-150.

Shapiro, D.A. (1999). Stuttering intervention: A collaborative journey to fluency freedom. Austin, TX: Pro-Ed.

Van Riper, C. (1982). The nature of stuttering (2nd Ed.). Englewood Cliffs, NJ: Prentice-Hall.

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

Yaruss, J.S. (1997). Clinical measurement of stuttering behaviors. Contemporary Issues in Communication Science and Disorders, 24, 33-44.

Yaruss, J.S. (1998a). Real-time analysis of speech fluency: Procedures and reliability training. American Journal of Speech-Language Pathology, 7(2), 25-37.

Yaruss, J.S. (1998b). Describing the consequences of disorders: Stuttering and the International Classification of Impairments, Disabilities, and Handicaps. Journal of Speech, Language, and Hearing Research, 49, 249-257.

Yaruss, J.S., LaSalle, L.R., & Conture, E.G. (1998). Evaluating stuttering in young children: Diagnostic data. American Journal of Speech-Language Pathology, 7(4), 62-76.

Zebrowski, P. & Schum, R. (1993). Counseling parents of children who stutter. American Journal of Speech and Language Pathology, 2, 65-73.

Experience Assignment Instructions

Assignment #1 — Stuttering in Public (Due 9/22/00)

Purpose:

Assignment:

Questions to answer in your brief summary (posted on the Discussion List on CourseInfo):

Assignment #2 — What would it be like to be in stuttering therapy? (Due 12/8/00)

Purpose:

Assignment:

Questions to answer in your brief summary (posted on the Discussion List on CourseInfo):

 

Fluency Disorders — Paper Instructions

Paper Overview

Rationale:

Purpose:

Length, Structure, and Grading:

Possible Topics. The paper can be written on any topic related to stuttering. After selecting your topic, discuss it with me so I can help point you in the direction of some appropriate readings. Sample topics include:

(Note that several of these topics mirror those covered in the class. If you select a topic that is similar to a class discussion, please be sure to incorporate additional information and references that were not discussed in class.)

 

Daily Questions — Fall, 2000

Sept. 1 What is stuttering?

What are common definitions for terms used to described speech fluency?

What is fluency? disfluency? dysfluency? nonfluency? stuttering?

Why are there so many different terms for interruptions in speech?

What are the various types of disfluencies people produce?

Why are some disfluencies characterized as normal and others characterized as stuttered?

What is the difference between stuttering events and the stuttering disorder?

Who produces disfluencies?

What is a person who stutters? What is a stutterer?

What is the difference between a person who stutters and a person who does not stutter?

What is the distribution of stuttering in the population?

Why is it important for clinicians to become comfortable with stuttering?

How can we do this?

Sept. 8 Other types of fluency disorders

What is cluttering?

What is the cause of cluttering?

What are the primary symptoms of cluttering?

How is cluttering treated?

What is the relationship between cluttering and learning disorders?

What is the difference between cluttering and developmental stuttering?

What is neurogenic stuttering?

What is the cause of neurogenic stuttering?

What are the primary symptoms of neurogenic stuttering?

How is neurogenic stuttering treated?

What are the similarities and differences between neurogenic and developmental stuttering?

What is psychogenic stuttering?

What is the cause of psychogenic stuttering?

What are the primary symptoms of psychogenic stuttering?

How is psychogenic stuttering treated?

What are the similarities and differences between psychogenic and developmental stuttering?

What are the similarities and differences between psychogenic and neurogenic stuttering?

Professional considerations in stuttering

What is the role of the SLP in treating people who stutter?

What skills should SLPs possess if they are to successfully treat stuttering?

Which of these skills come from outside the field of speech-language pathology?

How can SLPs help their clients achieve fluency goals?

What does it take to be a good stuttering clinician?

What is the role of support groups in treating people who stutter?

Should clients participate in both support groups and treatment?

What is the role of the SLP in helping people who stutter make contact with support groups?

What are the major support groups for people who stutter in the U.S.?

Sept. 15 What causes stuttering?

Why are there so many different theories about the cause of stuttering?

What is one of the primary factors that leads to changes in beliefs about the cause of stuttering?

What are some "historical" theories (1800s/early 1900s) that we no longer believe to be true?

What is the theory of cerebral dominance or hemispheric conflict?

When was it first proposed?

What evidence was originally used in support of this theory?

How does it relate to our current understanding of stuttering?

What role does learning theory play in the onset and development of stuttering?

What is classical conditioning?

What is operant conditioning?

What role do classical and operant conditioning play in the production of disfluencies?

What role do classical and operant conditioning play in the development of stuttering?

What are the theories of anticipatory struggle and anticipatory avoidance?

What is instrumental avoidance? How does it relate to the stuttering disorder?

What is an approach-avoidance conflict?

What is the two-factor theory?

What is the diagnosogenic theory?

What evidence was used in support of this theory?

Why is this theory no longer believed to accurately describe the "cause" of stuttering?

What is the continuity hypothesis?

What is the role of speech-motor control in the development of stuttering?

What is the role of the larynx in the production of disfluencies?

What evidence is there that speech motor factors affect the development of stuttering?

What is the theory of temporal discoordination? What evidence is there regarding this theory?

What do researchers and clinicians currently believe to be the cause of stuttering?

What is an interactionist theory?

What is the demands and capacities model? What does it tell us about stuttering?

What does it mean to say that stuttering is a multifactorial disorder?

What does it mean to say that stuttering has multiple etiologies?

Sept. 22 How does stuttering develop?

What is the typical developmental progression of stuttering?

What are some prominent theories about the development of stuttering?

What is the Alpha-Delta Hypothesis?

What is the Stuttering Continuum?

What are Van Riper’s tracks of stuttering development?

What are the characteristics of sudden onset of stuttering in children?

What do these different developmental pathways mean for the diagnostic process?

What factors affect the likelihood that speech disfluencies will occur?

How predictable is stuttering?

What linguistic factors contribute to the production of disfluencies on specific words?

What linguistic factors contribute to the production of disfluencies on specific utterances?

What paralinguistic factors contribute to the production of disfluencies

What situational factors contribute to the production of disfluencies?

What factors increase the likelihood that a person will speak more fluently?

Why are these factors believed to affect people’s fluency?

What does people’s speech sound like for each of these different factors?

What do these factors mean for the treatment of stuttering?

What risk factors contribute to children’s development of stuttering?

Do each of these factors play a role for every child who stutters?

How do your determine which factors are present in a given child?

Sept. 29 Evaluating stuttering — General considerations

What is the purpose of the diagnostic evaluation…

…for preschoolers? …for school-age children? …for adolescents? …for adults?

What is the difference between measuring stuttering events and the stuttering disorder?

What are the relevant measures to consider when counting stuttering events? Why?

How do these measures differentiate children who stutter from children who do not stutter?

What are the basic decisions that need to be made when preparing to measure stuttering events?

What is the difference between counting words vs. syllables?

What is the difference between counting disfluencies vs. stuttering?

What is the difference between real-time and off-line measurement?

Why is it important to examine stuttering events in a variety of different speaking situations?

What is your plan for developing skills for measuring stuttering events?

Oct. 6 Evaluating preschool children who stutter

What is the meaning of the term differential diagnosis?

What are the components of a complete diagnostic evaluation for a preschool child?

Why are each of these components included?

How do these components relate to the risk factors for developing stuttering?

What components should you focus on if you only have a short time to evaluate the child?

What are the primary questions you should ask parents during an interview and why should all of these questions be asked?

What does it mean to say that a child "needs" treatment?

How do you determine which children need treatment?

How do you know if you made the "right" decision?

What is the controversy about recommending treatment for preschoolers who stuttering?

What is the ultimate goal of treatment for preschool children who stutter?

Oct. 13 Treating preschool children who stutter I (Working with the environment)

What are the primary objectives for working with the family of preschoolers who stutter?

What are some specific goals you might use for the modifying the environment?

Why will you select these goals?

What evidence is there to support the selection of these goals?

What impact will these goals have on the child who stutters?

How will you help family members to achieve these goals?

How will you determine if the treatment is working?

How do the theories of stuttering development relate to these environmental modifications?

How do you help parents deal with the guilt they may feel regarding their child’s stuttering?

Why do parents feel this guilt?

What do you do if this guilt seems to be getting in the way of the child’s success in treatment?

How do you help parents help their children develop healthy attitudes toward stuttering?

How do you know if it’s appropriate to talk to a child about his or her speech?

Oct. 20 Treating preschool children who stutter II (Working with the child)

What is the difference between direct and indirect therapy?

How do you determine which approach to use with a given child?

What are the pros and cons of direct and indirect therapy approaches?

What is the Lidcombe Program for treating childhood stuttering?

On what theoretical principles is this approach based?

What evidence is there in support of this approach?

How do you administer this type treatment?

How does this approach relate to the "diagnosogenic theory" of stuttering?

What is the purpose of teaching children to speak more slowly and easily?

On what theoretical principles is this approach based?

What evidence is there in support of this approach?

How do you administer this type of treatment?

How do we determine whether or not treatment is working?

What does it mean if a preschooler has significant physical tension during stuttering?

How do we help preschoolers reduce physical tension?

What does it mean if a preschooler has significant negative speech attitudes?

How do we help preschoolers improve speech attitudes?

Oct. 27 Evaluating adults who stutter

What is the goal of the diagnostic evaluation for adults who stutter?

How does this goal differ from that for preschoolers who stutter?

What are the basic procedures involved in evaluating adults who stutter?

What aspects of the stuttering disorder should we measure?

How do we assess the speaker’s fluency?

How do we assess the speaker’s attitudes and feelings?

How do we assess other aspects of the stuttering disorder?

What is the International Classification of Impairments, Disabilities, and Handicaps?

How does the ICIDH differ from the ICD?

How can the ICIDH be used to describe the stuttering disorder?

How should we define impairment, disability, and handicap for describing stuttering?

Where do stuttering events fall in the ICIDH?

How does the ICIDH relate to the process of evaluating stuttering in adults?

When do we recommend treatment for adults who stutter?

Do we always make the same treatment recommendation for adults who stutter?

What do we do if we cannot provide the treatment a specific individual appears to need?

What are the basic approaches to stuttering treatment for adults who stutter?

What are the overall goals of treatment for adults who stutter?

What are some ways of achieving these goals

Nov. 3 Treating adults who stutter I: Basic techniques

What is fluency modification?

What are some other terms that have been used to describe this type of treatment?

What are the basic principles upon which this approach is based?

What is the goal of this approach to treatment?

How do you determine whether this approach is appropriate for a specific client?

What are the basic treatment procedures?

What data are there to indicate the efficacy of this approach?

How can you determine whether your treatment is working?

What are the potential pitfalls of this approach to stuttering and how should you deal with them?

What is stuttering modification?

What are some other terms that have been used to describe this type of treatment?

What are the basic principles upon which this approach is based?

What is the goal of this approach to treatment?

How do you determine whether this approach is appropriate for a specific client?

What are the basic treatment procedures?

What data are there to indicate the efficacy of this approach?

How can you determine whether your treatment is working?

What are the potential pitfalls of this approach to stuttering and how should you deal with them?

Nov. 10 Treating adults who stutter II: Synthesis

What factors affect the nature of your clients’ individualized treatment program?

What factors might lead an adult client to come to therapy?

What kinds of issues might you need to address in therapy for adults who stutter that are not directly related to stuttering?

How do we combine the "speech modification" and "stuttering modification" treatment approaches for individual clients?

How do we help clients transfer their speaking skills (fluency and stuttering modifications) to other settings and maintain them over the term?

How do we prepare clients to deal with relapse?

How do you develop the skills needed to help adults who stutter?

Dec. 1 Treating school-age children who stutter I: Assessment and Goals

What are the components of a complete diagnostic evaluation for a school-age child?

Why are each of these components included?

What components should you focus on if you only have a short time to evaluate the child?

What are the primary questions you should ask parents during a complete interview?

What questions should you focus on if you have only a short time to interview the parents?

What if you can’t get any time at all with the parents?

What does it mean to say that a child "needs" treatment?

How do you determine which children need treatment?

What do you do if a child appears to need treatment but does not "qualify" for treatment?

What do you do if the child does not need or want treatment but the parent wants the child to have treatment?

What are the basic procedures for treating school-age children who stutter?

How are these techniques related to the treatment for adults who stutter?

What modifications do you need to make to your treatment because of the children’s age?

What modifications do you need to make to your treatment if you are working in the schools?

Dec. 8 Treating school-age children who stutter II: Working with Schools and Families

What are some potential roadblocks to treating school-age children who stutter in the school setting and how do you overcome these roadblocks?

What do you do if a child is not motivated to participate in treatment?

What do you do if a child is fluent in the therapy room but not in the classroom?

What do you do if your child is grouped with other children who do not stutter?

How do you work with the family when you’re in a school setting?

What should you do if you don’t have any access to the family during treatment?

What should you do if the family has different goals for treatment than you or the child?

How do you help school-age children improve their attitudes toward stuttering

How do you help school-age children deal with teasing?

What do you do if the child is reacting inappropriately to teasing?

What do you do if the child has strongly negative emotional reactions to teasing?

Wrap-up

What questions do you still have about stuttering?

What specific resources should you use for learning more information about stuttering?