SLP 561: Advanced Fluency Disorders

 

                                                                              Spring Semester,   2004

 

 

SCHEDULE:                     M-W: 11:00 -12:15

LOCATION:                      Room 2330 UCOM Speech Pathology and Audiology

CREDITS:                         3 semester hours

INSTRUCTOR:                Stephen B. Hood,  Ph.D., CCC-SLP

                                             UCOM, Office 2102

                                             Office: 380-2628

                                             Home: 342-3927

                                             Email: sbhood@JAGUAR1.USOUTHAL.edu

 

OFFICE HOURS:              M-W: 10:00 - Noon

T-Th:    9:00-11:00

 

Subject to change depending upon clinic schedule. 

               ***Also available by appointment.

 

CATALOG DESCRIPTION:         Study of theories, research and contemporary treatment procedures in the area of disfluency.

 

 

COURSE PURPOSE:

 

SPA 561 is designed to bridge the gap between theory, research and clinical applications.  The course is intended to investigate current trends and to determine common strengths and weaknesses among them.

 

For students with a strong academic background in stuttering, parts of this course may seem like a quick review;  for others, the challenge may appear extreme.  It is my strong hope that the class will develop a unity of curiosity that will lead to provocative class discussions, arguments and attempts at better understanding.  But I cannot do this alone.  Letıs all work together to make class meetings more of a dialog among us than a monolog from me.  This is not to imply a desire to all arrive at the same conclusions, for this would be unrealistic.  Let us strive to come to an understanding based on an appreciation of various theoretical positions, with which we can feel comfortable, and from which we can provide optimum clinical services for our clients.

 

FEAR NOT --  The reading list!!!  It looks more lengthy than it really is.  Redundancy is built into the readings to aid in learning.  The major highlights will be stressed in class, and will be the foundation upon which examinations are built.  No attempts will be made to be "tricky."

 

I am well aware of the cost of textbooks and have tried to limit the number of textbooks for this course.  Many books have been published in recent years, and there really is no "single best book."  With respect to the supplemental readings, we can develop a system wherein copies can be checked out as needed.

 



REQUIRED TEXTS:

 

     Barry Guitar. (1998). Stuttering: An Integrated Approach to its Nature and Treatment.  Williams and Wilkins

 

     Stuttering Foundation of America.  Memphis, TN.  Series of Pamphlets and books.

 

               Stuttering Foundation of America Series

 

 

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 Ainsworth:           If Your Child Stutters: A Guide for Parents

 Starkweather:       Therapy for Stutterers

 Conture:               Stuttering and Your Child: Questions & Answers

 Hood:                   Stuttering:  Words.

 Hood:                   Advice to Those Who Stutter Stutterer

 Gruss:                 Stuttering Therapy: Transfer & Maintenance

 Gruss:                  Counseling Stutterers

 Fraser:                  Do You Stutter: A Guide for Teens

 Fraser:                  Self Therapy for the Stutterer

 Dell:                     Treating the School Aged Stutterer

 Guitar:                  Stuttering: Integration of Therapies

 Gregory:               Stuttering Therapy: Prevention & Intervention

 

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SUPPLEMENTARY READINGS:   Class Handouts and handouts of Power Point slides will be available. 

 

For students who seek additional information about the various topics to be covered, I have a number of personal resources that may be borrowed.

 

Bloodstein, O.  (1995).  A Handbook on Stuttering.  San Diego, CA:  Singular Publishing.

 

Hood, S.  (1978).  The Assessment of Fluency Disorders.  In S. Singh and J. Lynch (Eds.)  Diagnostic Procedures in Hearing, Language and Speech. Baltimore, MD: University Park Press.

 

Starkweather, C. W. and Givens-Ackerman, J.   1997  Stuttering.  Austin, TX: Pro-Ed

 

Van Riper, C.  (1982).  The Nature of Stuttering.  (2nd Edition).  Englewood Cliffs, NJ:  Prentice Hall.

 

Van Riper, C.  (1973).  The Treatment of Stuttering.  Englewood Cliffs, NJ:  Prentice Hall.

 

Class Handouts will be available.  Those who were USA undergraduates will note that most of these are identical to what you received in the undergraduate course.  In this class, we will go into more depth.

 

I wish that I could assume that some sections of this course will represent a review of materials presented at the undergraduate level.  But this assumption is increasingly dangerous because more and more universities have stopped offering courses in specific topics such as voice and stuttering.  In recent years, this class has become increasingly heterogeneous with respect to commonality of background.

 

For those who feel they have a weak background, I will hold additional ³catch-up² meetings.  For those interested, we can determine a time for this later.  Supplemental additional readings are shown later in this handout, and I can provide additional material, as well. 

 

 

 

STUDENTS WITH SPECIAL NEEDS: It is the policy of USA to accommodate students with disabilities.  Any student with a qualified disability that requires accommodations should see the instructor during the first week of classes. A student must verify that he/she has a qualified disability through Disabled Student Services (460-7213), Student Center Room 270, Ms. Bernita Pulmas, director.

 

POLICY ON ACADEMIC MISCONDUCT: Any dishonesty related to academic work or records constitutes academic misconduct. Academic misconduct is incompatible with the standards of the academic community. Such acts are viewed as moral and intellectual offenses and are subject to investigation and disciplinary action through appropriate University procedures. Penalties may range from the loss of credit for a particular assignment to dismissal from the University. (See The Lowdown, Student Academic Conduct Policy.)

 

PROGRAM ACCREDITATION: The Council of Academic Accreditation (CAA), under the auspices of the American Speech Language Hearing Association (ASHA), has certified the Department of Speech Pathology and Audiology at USA as an authorized educational facility. This means that credentials obtained by graduates in Speech-Language Pathology or Audiology will automatically be accepted by ASHA when these graduates apply for certification. If students wish to contact CAA for additional information, they may do so at the following address:

 

Council of Academic Accreditation

The American Speech Language Hearing Association

10801 Rockville Pike

Rockville MD 20852

 

 

BEHAVIORALLY-DEFINED COURSE OBJECTIVES FOR STUDENT KNOWLEDGE AND SKILL:

Upon completion of the course, the student will:

 

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1.     Demonstrate understanding of the affective, behavioral and cognitive aspects of fluency, disfluency and stuttering

 

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2.     Be able to identify the risk factors that make certain children more vulnerable to the development of stuttering

3.     Describe the similarities and differences between normal nonflunecies, stutter-like disfluencies, and stuttering

4.     Know the core features of stuttering, secondary features of stuttering, and related attitudes and feelings   

5.     Comprehend the development of stuttering in terms of behavioral, emotional and attitudinal components

6.     Be able to apply the principles of learning theory to the onset, development and maintenance of stuttering

7.     Understand the parameters of diagnostic assessment to the overt and covert features of stuttering

8.     Be aware of the general principles of prevention and early intervention in preschool children

9.     Be able to identify the general principles of treatment for borderline stuttering

10.   Demonstrate an understanding of the general principles of treatment for mild, intermediate and advanced stuttering

11.   Describe the similarities and differences to stuttering therapy programs based on ³fluency shaping² and ³stuttering modification² techniques.

12.   Perform disfluency analyses on fluent and stuttered speech in order to determine the overt features of frequency, intensity, duration and type.

13.   Enter selected speaking situations wherein students will assume the role of a person who stutters, and wherein the student will perform fluency shaping and stuttering modification strategies such as:  easy onset, gradual release, cancellation, pull out, preparatory set

 

Objectives 1 through 11 directly address ASHA Standards III-B, III-C and III D. Knowledge of basic human communication processes, Communication Differences and Disorders, and Prevention, Assessment and Intervention.

 

14.   Write narrative summaries of objectives 12, and 13, above

15.   Write narrative summaries of Web Site searches to sites such as: the Stuttering Home Page, Stuttering Foundation of America and the Stuttering Foundation of America

 


Objectives 14 and 15 Address Standard ASHA III-A, Skill in written communication.

EVALUATION AND GRADING:                                                                          

       

       Listed below is the projected time from for assignments, and the projected  grading scale.  These are subject to modification, if necessary.

 

        20 %  Examination 1                           February 18

        25 %  Examination 2                           May 5. 10:00 AM

          5 %    Project I                                  January 28

        10 %  Project II                                   February 25

        10 %  Project III                                  March 10

        25 % Project IV.                                 April 14

          5 %    Project V                                 April 28

 

Projected Grading Scale:

 

               A:  90 - 100

               B:  80 - 89

               C:  70 - 79 ----  Iım struggling

               D:  60 - 69 ----  Iım sinking

               F:  < 60     ----  Iım Downing

       

Attendance

       

Since attendance is important to learning, students are expected to attend class.  However, the class is operated on the assumption that university students are responsible for their own behavior, including attendance, so formal attendance will not be taken for the purpose of computing your final course grade.  You are responsible for the material presented in class, and unless there is sufficient reason, time spent during office hours is not designed for individual tutoring of materials missed due to absences.

 

Students must be in class on the day of examinations.  Absences not previously granted by the instructor must be accompanied by a formal university or medical excuse.  This will be discussed in class.  Hopefully, members of the Mobile Chapter of the National Stuttering Association will visit class.  This will be announced well in advance.   Attendance on this date will be mandatory.

 

Tentative Course Outline

 

This year's group of students will again be heterogeneous.  Much of what we will be covering will involve reviewing and expanding upon things you should already know (assuming your long term memory cells are functioning) as well as getting into some things that are new and different.  If you find yourself getting confused, please see me as soon as possible.

 

We will watch a number of video tapes.  These tapes will highlight things that cannot as easily be presented via straight lectures or through reading assignments.  In order to do this, there may be a delicate balance between how much time we can spend with various modes of presentation. (In past years, most students found the tapes to be very helpful, but some students found them to be dull and boring.  I will need your feedback on this.  How much time is spent on lecture and how much time is spent with supplemental video tapes will depend upon you as a class.) 

 

 

Changes in Course Requirements:

 

Should the requirements for completing this course change, students will be notified, and with consideration for time restrictions and student load.

                                     Class Outline and Projected Time Frames

 

Unit I.  The Nature of Stuttering: Models of Stuttering

 

        Jan 12, 14, 21           Intro and Orientation to SPA 561.

                                  Models of Stuttering:

                      Behavioral and Emotional Dimensions

                      Sheehanıs Iceberg of Stuttering

                                                                           Temporal Sequencing and Episodic Variation

                      Core Features, Secondary Features, Attitudes & Feelings

       

                   Required Readings

 

                                 Guitar,  Chapters 1and 4

                                 Hood,  SFA Booklet. 

                                  Stuttering Words.  Definitions Pgs. 9-12

                                 Class Handouts

 

Unit II.  Application of Learning Theory to Stuttering

 

        Jan 26, 28, February 2.        Classical and Operant Conditioning

Brutten and Shoemaker Model

Van Riper

Sheehan

 

                              Required Readings:

                                  Guitar: Pages 89 - 100.

           Handouts

                                                                           Review of Learning Theory

                                                                           Brutten and Shoemaker Model

                                                                           Sheehanıs Model: Approach-Avoidance Conflict

                                                                           Van Riperıs Models: PGAGH, and MIDVAS

 

Unit III.   ³Normal Nonfluencies,² ³Stutter-Like Disfluencies² and the Onset and Development of Stuttering

 

        February 4, 9           

 

                              Required Readings

           Guitar:  Chapter 5

           Class Handouts

                                                                           Van Riperıs 4 Stages

                                                            Douglass and Quarrington:  Interiorized/Exteriorized

                                                            ³Schematic Portrayal of the Moment of Stuttering² (again)

 

Unit IV.  Assessment of Stuttering

 

               Feb 11, 16.

Case History – Predisposing, Precipitating and Perpetuating Factors

                                         Parent Interview, Client Interview, Collecting Speech Samples

Disfluency Analysis

                                         Stuttering Severity Instrument

                                         Cooper Assessment of Stuttering Severity

                                         Modified Erickson Scale

                                         Perceptions of Stuttering Inventory

                                          Communication Attitude Test

 

                              Required Readings:

                                                                           Guitar:   Chapter 7

                                                     Handouts

                                                                           Hood,    Disfluency Analysis Worksheet

                                                                           Riley,    SSI

 

EXAM I:              February 18

 

The next units will deal with (a) working with older teens and adults who stutter,  (b)  working with school aged children, and (c) with the prevention and early intervention in young children,  The text and lectures will be heavily supplemented by video tapes designed to show examples of therapy procedures. 

 

Since SPA 561 is now being taught in the spring rather than the fall semester, more of you will have had experiences working in stuttering clinic. I hope that those of you who have had, or are now having clinical experiences with stuttering, will bring examples of your experiences to the class for group discussion.

 

This section of the course will be far more meaningful to you if you, and your fellow classmates, become highly involved in class discussions.  This is especially true for those of you who had stuttering clients in the fall, or who have them this spring.

 

                  Class participation will be both encouraged and appreciated! 

 

Unit V.  Therapy for Older Teens and Adults

 

               February 23 - March 29

 

               Required Readings:       Guitar Chapter 8 and 9

                                         Handouts

                                         Skim through these SFA Booklets for general overview of information.

                                          Therapy for Stutterers

                   Self-Therapy for Stutterers

                   Advice for Those Who Stutter

                   Do You Stutter?  A Guide for Teens

 

 

               February 23-25 Fluency Shaping and Stuttering Modification

              

 

               March 1             ASHA Video– Recovery from Stuttering

           Recovery Tapes: Manning, Murphy, Others: on your own

               March 3             SFA:  Van Riper and Jeff --  Diagnosis and Identification

               March 8             SFA:  Van Riper and Jeff. -- Desensitization

               March 10           SFA   Van Riper and Jeff  -- Variation

               March 22           SFA   Van Riper and Jeff  --  Cancellation

               March 24           SFA   Van Riper and Jeff  --  Monitoring

               March 20           SFA   Van Riper and Jeff -    20 Years Later

 

 

 

       

Unit VI.     Therapy for Child Aged Children

 

        April 5 - 19

 

               Required Readings:       Guitar:  Chapter 11 and 13

                                         Handouts

                                         Skim through these SFA Booklets for general overview of information.

                                         Treating the School-Aged Stutterer

              

               April 5    Video by Bill Murphy

               April 7     SFA Video by Kristin Chmela

               April 12   SFA Video by Barry Guitar

April 14   Video Tape by Peter Ramig

               April 19   Speaking of Courage

 

 

Unit VII   Prevention and Early Intervention

 

        April 21, 26, 28    

       

               Required Readings:       Guitar.    Chapter  14

 

                       Skim through these SFA Booklets for general overview of information.

                          If Your Child Stutters

                              Prevention and Early Intervention with Children

                                      Stuttering and Your Child

 

                       Handouts

Suggestions to Help Children Talk Fluently

Stuttering Therapy: Possible Problem Areas to Explore and Possible Things to Do.

 

 

                                                                            CLASS PROJECTS

 

Project I.  Visiting the Internet. 

 

Whether your professional interests are in the area of stuttering, or something else, it will be important that you become familiar with information that is available on the Internet.  The purpose of this last section is to point you in this direction.  Hopefully, you will be able to generalize this information about Listservs and home pages to those which deal with others disorder areas.

 

 

            The Stuttering Home Page

 

Judy Kusterıs stuttering home page contains a tremendous amount of information about stuttering and links to other stuttering pages.  The address is:

 

                                           http://www.stutteringhomepage.com

                      

For this project, you are required to visit the Stuttering Home Page.  An example of the type of thing you are apt to find on the Stuttering Home Page is the poem by Michael Caggiano, which is included toward the back of your Handout Packet on page 61.

       

Your task is to select three (3) more reports, papers, stories or other items of interest.  Please select your papers from among the following four topics: Personal Paths Toward Recovery, PWS Speak for Themselves, Therapy for Stuttering, or Information About Stuttering.

              

                    (Due on January 28.)

 

Project II.    ³Normal Nonfluency² Analysis

 

The class will be divided into three groups of three students each and one group of two students.  Each group will select one (hopefully different)  faculty member.  The assigned task is for you to tape record a two minute/200 word spontaneous speech sample, perform an analysis of speaking rate, articulation rate and disfluency.  Try to get a narrative sample that is largely monolog, as in a situation where the person might be lecturing, or giving a lengthy response to answer a question.  Submit a narrative paragraph describing your procedures and results, as you would do in writing a diagnostic report.  Details will be given in class.

                                                                                                                                                                                                  

        Turn in your transcript, worksheet, summary report and audio tape by February 25.

 

 

Project III.  Stuttering Self Analysis

 

You are to tape record yourself while you engage in a monologue of sufficient length to allow the analysis of a 200-word spontaneous speech sample.  Your speech should realistically simulate the stuttering of a person who would be in Van Riper's third stage of stuttering (Peters and Guitar-- Intermediate Stuttering).  Then, perform a disfluency analysis, complete the disfluency analysis worksheet and write a descriptive narrative, as you would for a diagnostic evaluation report.

 

               Turn in your transcript, worksheet, summary report and audio tape by March 10.

 

Project IV.  Modeling the Target Behaviors

 

It is important that the clinician understand, to the extent possible, the overt and covert dimensions of stuttering.  This is what Joseph Sheehan referred to as the "stuttering equivalent."  It is also important that the clinician be able to MODEL the desired target responses for the client.

 

Listed below are your assignments.  I suggest that you think about them and begin to practice them.  (You might be well advised to wait until after the corresponding portions of the Van Riper tapes before actually "doing them for real.")

 

Partly to assist in the learning process, and partly for moral support, you will see that some of these assignments are to be conjunctions in a class member who can serve as your partner.

 

NOTE:  If the assignments listed below are to tough for you, then you may need to also do some easier ones, for practice, desensitization, etc.  See me individually for details.  I can get you a reference book by Richard Ham which will help.

 

 

Listed below are the five topic areas.  You are to write one summary report for each of the topic areas, so there will be a total of five reports in all.  

 

For each of the five assignments, write a summary.  These summaries will be graded on the bases of both style and content.  (These should be carefully prepared, well written and word-processed).

 

                   These are due on or before April 14.

 

NOTE:   We will go over these five concepts in class, and you will have a good opportunity to observe how to do these behaviors while watching the Van Riper video tapes.

 

        1. Learning To Stutter

 

For this assignment you will need to get into three different situations where you can talk with three different people; e.g., store clerks or gas station attendants, etc. Or, you might stop people on the street and ask directions on how to get somewhere. Be sure that the situation requires some actual discourse, and not just words and short phrases.  (For example, in stead of just asking ³Where is Airport Boulevard² you could expand this and say something like ³I am terribly lost and I hope you can help me.  I am trying to find the intersection of Airport Boulevard at Cody Road.²)   Keep good enough eye contact to evaluate the reactions you get from the listener.  For each different situation, engage in one of the following:

 

a.  Fake moderately frequent part-word repetitions with associated struggle behaviors;

b.  Fake moderate frequent silent blocks with associated struggle behavior

c.  Fake moderately frequent vocalized and/or nonvocalized prolongations, with associated struggle

 

Write a report to summarize your experiences.  How did you do?  How did you feel?  What listener reactions did you obtain?

 

               2. Cancellations

 

For practice, you and your partner(s) are to make up a list of ten questions (e.g., what is your favorite kind of pet).  In your answer (complete sentences, please) voluntarily stutter on the subject word; then pause for three seconds and say the word again, engaging in a slow and deliberate utterance of the word.  Your partner needs to observe to be sure that you finish the word, pause long enough, and to be sure that you are not too fluent the second time.  (No need to write a report on this one).

 

Select three words that occur regularly in everyday conversations.  Over a period of three to five days, deliberately stutter, then cancel on these words, at least five times each day.  When you cancel, be sure to finish the word, pause immediately afterwards for at least two seconds, and then repeat the word, slightly prolonging and increasing the strength of the articulatory movement.  Do not identify your efforts unless your listener asks what you are doing.  Write a report of the words you picked, the situation you selected, the adequacy of your pauses, the quality of your repeats, your listenerıs reactions and your own feelings about the experience.

 

Prewrite three questions to ask during a single telephone call.  Underline one word in each question on which you will fake a moment of stuttering.  Pause for at least two seconds and then cancel by repeating and "improving" your fake.  Continue your cancellation report with the same type of information requested in the previous assignment.

 

Enter three different commercial locations where you can ask directions, seek information, or purchase an item.  In each of these three situations, fake at least three moments of moderately severe stuttering accompanied by tension and struggle.  Pause for at least two seconds, then cancel the stuttering using a slow, exaggerated transition.  If possible, have your partner(s) along to evaluate your performance.  Continue your cancellation  report with a summary of your experiences.

 

               3. Pullouts

 

Just for practice to get started, take a word list and read 10 words aloud, while looking in a mirror.  Fake various kinds of stuttering behaviors on each of the different words.  During the middle of the fake, gradually work to "freeze" yourself in the articulatory posture, and then very gradually relax the freeze and then slowly and deliberately pull out of the stuttering moment. 

 

After you become proficient with the 10 words, continue talking informally to your partner about any topic you wish.  Converse long enough for each of you to collect 15 faked moments of stuttering followed by a gradual pull out.  If any of your fakes or pull outs are unsatisfactory, your partner is to signal you and you are to cancel the behavior and do it again.  You do not need to write a report for this.

 

Select a word that occurs fairly often in your everyday conversations.  Then set a target of faking moderate to severe moments of stuttering followed by a pull out.  You are to do this 25 times.  Remember, the pull out must be slow, gradual, deliberate, and vocalized.  Collect your 25 examples as rapidly as possible, but you can allow yourself up to three days to do this if necessary.  Keep a written running evaluation during the process, using criteria as noted earlier, so that you can write a report to summarize your performance.  Did you have any problems with this?  Were there any situations where you planned to do one thing, but avoided?   Write a report to summarize your efforts.

 

               4. Preparatory Sets

 

In ten different situations, utter the first two or three words of each sentence with a slow, continuous, strong articulatory pattern.  Be sure you start each word with a gentle onset.  Write a report on your efforts.

 

        5. Proprioceptive Monitoring, High Stimulus Speech and Transitions:

 

For this, you and your partner(s) are each to enter into four realistic situations.  During situation one, you are to engage in a high degree of 100% continuous phonation.  During the second situation you are to engage in a low degree of 100% continuous phonation.  During the third situation you are to engage in strong, exaggerated co-articulatory transitions on approximately 10% of the words spoken.  During the fourth situation, you are to engage in mildly exaggerated co-articulatory transitions on roughly 10% of the words spoken.  Write a report to summarize your experiences.

 

        Due April  14

 

 

Project V.  Modeling Turtle Talk

 

For this assignment, you are to engage in a ten minute "play therapy" situation with a normally developing child between the ages of 3 and 7.  (It is ok to use one of your clients for this, but be sure to first get permission from your clinic supervisor.) Tape record and analyze the interaction, paying particular attention to your own speech in terms of such things as: speech rate, articulation rate, fluency/disfluency, turn taking, pausing, prosody, etc.  Write a report to summarize your experience.  As specifically as possible, comment on how you did with respect to your articulation and speech rates, your turn-taking, and your prosody.  (Turn in your audio tape along with your report).

 

               Due April 28

 

 

OPTIONAL                This is given to you for informational purposes, and not as an assignment.  However, some of you may be interested in checking it out.

 

At the present time there are three Listservs devoted solely to stuttering.  These Listservs have some 300 - 400 subscribers.  Of course not all subscribers are active participants, but some are.  Sometimes, there are lines of discussion which are fascinating: sometimes, the topics are boring and qualify for a ³fast delete.²  If you find a topic of interest, you can post a response, which will automatically go to each of the several hundred subscribers.

 

You might find it interesting to visit one of these Listservs.  If you do, I would suggest that you may find the discussions on STUTT-L to be the most meaningful.

 

A Listserv is an electronic communication group.  People send messages to the main computer and the computer then mails out the message to everyone who has subscribed to the list.  In order to participate, you need to tell the main computer that you want to be on the list.  When you do, the computer will send you information about the list.

 

       If you wish to participate in this, let me know and I will sign you up for it.