HESP 612 Fluency Disorders

Fall 2006, Thurs 9:30-12:00, Lefrak 0135

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

Vivian Sisskin (phone 301-405-4232; e-mail: vsisskin@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. By the conclusion of this course, students should be able to demonstrate knowledge of the nature of stuttering and other fluency disorders, including:

        etiological theories,

        characteristics of the disorder

        anatomical and physiological bases and correlates of fluency disorders

        developmental features of fluency disorders across the lifespan

        psychological correlates of fluency disorder

        linguistic factors relating to fluency disorders, and

        social and cultural considerations in the assessment and treatment of fluency disorders

In addition, students will learn how to (1) utilize assessment procedures for the differential diagnosis of fluency disturbances in children and adults; (2) establish baseline fluency measures and monitor improvement in fluency performance; (3) determine the efficacy of treatment programs; (4) evaluate varied theoretical explanations of the nature of stuttering; (5) understand and compare the benefits and limitations of varied therapeutic approaches to management of both fluency and dysfluency in the stuttering patient; (6) be able to discuss problems, challenges and strategies in the transfer and maintenance of fluency; (7) apply strategies for the treatment of affective and cognitive components of fluency disorders; and (8) differentially diagnose and treat disorders which may mimic stuttering, but which need to be carefully distinguished from stuttering for therapeutic purposes. Finally, students will be able to (9) discuss research needs and methods in fluency disorders, including the documentation of therapeutic efficacy (Evidence-Based Practice).




There will be two projects (fluency measurement/term research project), a mini-assignment (paired pseudostuttering), a take-home mid-term and a final examination (in class).  Information about the projects is included on this syllabus. The pseudostuttering assignment is worth 10%, the fluency measurement project is worth 20% of your grade; the term project is worth 20%, the mid-term and final are each worth 25% of your grade.



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

Manning, Walt (2001). Clinical decision making in fluency disorders (2nd ed.) Vancouver: Singular Thompson Learning.


There is a set of additional readings. Readings marked with an asterisk (*) will be available in the Department Library in a marked binder by the second week of class. All other articles are available by clicking on the syllabus link. Please note: We have provided these to you for convenience and sometimes through the generosity of others. Please do NOT send these articles or chapters on to other people without obtaining our consent and the authors’. About the readings: These additional readings have been provided to you for a number of reasons: they provide rationale, implementation detail and research evidence for some of the treatment approaches that we cover, and provide greater depth of coverage for some topics than we can provide in the limited class time available. They also provide some perspective for lectures when read either before or after classes as specified. Information from these readings will be useful for your examinations and assignments.


Notes: This class has a website. It contains power point presentations for each topic that may be viewed or downloaded from the site. These Powerpoints also contain many internet links and you are advised to be in an internet browser when viewing them. The site is password protected. You must use a username (xxx) and supply a password (xxx); we will provide them to you in class. We ask that you print notes out before coming to class (in any format you like), so that we can move efficiently through the lecture, discussion and practice topics. However, we also advise printing them out only a few days before each class, because each semester we make some last minute changes to them, and we know that you get frustrated if there is not an exact match between lecture materials and your printouts.



As part of your ASHA CCC portfolio, the instructors will provide you with a signed form verifying completion of the learning outcomes in this class. PLEASE PRINT OUT THE LINKED FORM (click here) AND SUBMIT IT ON THE LAST DAY OF CLASS. IF YOU WILL NEED THIS FORM MAILED (AS OPPOSED TO PLACED IN YOUR STUDENT MAILBOX) PLEASE SUPPLY US WITH A SASE.



The default writing style for HESP (as with most of our professional journals) is APA (American Psychological Association). You are expected to use this format in all papers calling for use of references, citations, etc. Since this is the first course in your graduate sequence, now is a good time to become familiar with this format: it will be required for your candidacy paper or thesis. A guide to the format can be found at the HESP web site:  http://www.bsos.umd.edu/hesp/degreePrograms/writing.htm

and at the UMCP library site: http://www.lib.umd.edu/guides/citing_apa.html




August 31

Introduction to the course.

Powerpoint presentation

Lecture and discussion: An analysis of the behaviors which define stuttering. Stuttering phenomenology.

Activity: Clinical observation and inference


Manning, chapter 3.

Buchel, C. & Sommer, M. (2004). What causes stuttering? In PLoSbiology. Full text from http://biology.PLoSjournals.org.

Become acquainted with stuttering terminology: browse this site to get definitions of common features of stuttering, its phenomenology, etc.: http://www.behavenet.com/capsules/disorders/stutter.htm


Assignment: Paired pseudostuttering (Due Sept.14). Pick a partner. During the next week, you and your partner must take turns pseudostuttering in at least three different settings. While one person pseudostutters, the other should observe the interaction, noting listener reactions and the speaker’s responses. Write up your experiences for submission and class report.


September 7

Lecture: Theoretical perspectives on the nature of stuttering (Ratner)

Activity: Discussion: what clinical facts and research findings are required to make a theory right?

Powerpoint presentation


Manning, chapter 2.

Bloodstein, O. & Bernstein Ratner (2007, to appear). Theories of stuttering. In A Handbook on Stuttering, sixth edition. Vancouver: Thomson Delmar. Note: this is a long reading – look through and appreciate the many approaches that have been taken to understanding stuttering. (click here for pre-publication text draft)

DeNil, L. & Kroll, R. (2001). Searching for the neural basis of stuttering treatment outcome: recent neuroimaging studies. Clinical Linguistics and Phonetics, 15, 163-168. (click here)

Sommer, M.,  Koch, M., Paulus. W.,  Weiller, C.,  & Buchel, C. (2002). Disconnection of speech-relevant brain areas in persistent developmental stuttering. Lancet, 360, 380-384. (click here)

Bernstein Ratner, N. (2000). Performance or Capacity – the model still requires definitions and boundaries it doesn’t have. Journal of Fluency Disorders, 25, 337-346 (from an entire issue devoted to the Demands and Capacities Model of stuttering). (click here)


September 14

Overview of treatment approaches in stuttering. Evidence-based practice and stuttering.

Fluency shaping approaches

Powerpoint: treatment concepts, Powerpoint: EBP and stuttering therapy

Try your hand at modifying rate, onset, breathing, etc., What DAF is like, Evaluation of treatment tape.

Pseudostuttering assignment due.


Manning, chapters 6 and 8 (for next two weeks).

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. (click here to read)

Bernstein Ratner, N. (2005). Evidence-based practice in stuttering: some questions to consider. Journal of Fluency Disorders, 30, 163-188. (click here)

*Schwartz, H. (1999). A primer for stuttering therapy. Boston: Allyn & Bacon. Chapter 3 (pp 48-63).

Hancock, K., Craig, A., McCready, C., McCaul, A. et al. (1998). Two- to six-year controlled-trial stuttering outcomes for children and adolescents. Journal of Speech, Language and Hearing Research, 41, 1242-1252.  (click here)


September 21

Stuttering modification

Powerpoint: stuttering modification

Activity:  practicing cancellations and pullouts

Readings: (next two weeks)

Eichestadt, A., Watt, N. & Girson, J. (1998). Evaluation of the efficacy of a stutter modification program with particular reference to two new measures of secondary behaviors and control of stuttering. Journal of Fluency Disorders, 23, 231-246. (click here)

Blomgren, M., Roy, N., Callister, T. & Merrill (2005). Intensive Stuttering Modification

Therapy: A Multidimensional Assessment of Treatment Outcomes. Journal of Speech, Language, and Hearing Research, Vol. 48, 509–523. (click here)

Langevin, M. & Kully, D. (2004). Evidence-based treatment in stuttering: evidence-based practice in a clinical setting. Journal of Fluency Disorders, 28, 219-236. (click here)

Blood, G. (1995). Power2: Relapse management with adolescents who stutter. American Journal of Speech-Language Pathology, 26, 169-179. (click here)

Bothe, A. C. (2002). Speech modification approaches to stuttering treatment in schools. Seminars in Speech and Language, 23, 181-186. (click here)


September 28

Changing attitudes and emotions that impede therapeutic progress; Avoidance reduction therapy (Use Powerpoint slides from last week).


October 5

Decision-making in early diagnosis and intervention cases


*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. (May also be obtained via the ASHA web site if you are a NSSHLA member).

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. (click here)

Bernstein Ratner, N. & Guitar, B. (2006).  Treatment of very early stuttering and parent-administered therapy: the state of the art. In N. Bernstein Ratner & J. Tetnowski (eds.). Stuttering Research and Practice II: Contemporary Issues and Approaches.  Mahwah, NJ: Erlbaum. (click here)

Onslow, M , R. Menzies & A. Packman (2001) An operant intervention for early stuttering. Behavior Modification, 25, 116-139. (click here)


October 12

Diagnostic procedures for assessing stuttering in children and adults;

Surface features: Calculation of fluency measures. Discussion: what should be measured; what can be measured? Please bring a stopwatch and calculator.

Activity: Practice tapes: counting and inferencing

Powerpoint presentation


Manning, Appendix D

*Yaruss, J.S. (1998). Real‑time analysis of speech fluency: procedures and reliability training. AJSLP, 7, 25‑37. (also available at ASHA web site if you are a member)

Manning, chapters 4 & 5

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



October 19

Diagnostics (continued)





October 26

Treatment planning; School models for fluency treatment, writing IEPS (Powerpoint slides).


Activity: developing goals and objectives


Manning, review chapter 8.

Manning, chapters 1 & 7

Manning, chapters 10 & 11 (putting it all together)

Dyer Olsen, E. & Bohlman, P. (2002). IDEA ’97 and children who stutter: evaluation and intervention that lead to successful, productive lives. Seminars in Speech and Language, 23 (3), 159-164. (click here)

Sisskin, V. (2002). Therapy planning for school-aged children who stutter. Seminars in Speech and Language, 23 (3), 173-179. (click here)


November 2


Indirect/Direct treatment for toddlers (Powerpoint slides); Cognitive and linguistic factors in stuttering (Powerpoint slides); operant and GILCU approaches to stuttering treatment (powerpoints); stuttering and concomitant disorders (Powerpoint slides)


*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

Weber-Fox, C. (2001). Neural Systems for Sentence Processing in Stuttering.  Journal of Speech, Language and Hearing Research, 44, 814-826. (click here)

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


November 9

Multicultural considerations in diagnosis and treatment (Powerpoint slides) ; Pharmaceuticals and “Devices” (Powerpoints); begin acquired stuttering (see notes for November 30)


Bernstein Ratner, N. (2004). Fluency. In B. Goldstein (ed.) Bilingual Language Development and Disorders in Spanish-English Speakers. Baltimore, MD: Brookes. (click here)

Maguire, G., Yu, B., Frankin, D. & Riley, G. (2004). Alleviating stuttering with pharmacological interventions. Expert Opinion in Pharmacotherapy, 5, 1-7. (click here)

Lincoln, M., A. Packman & M. Onslow (2006). Altered auditory feedback and the treatment of stuttering: a review. Journal of Fluency Disorders, 31, 71-89. (click here to read)


November 16

Self-help groups. A give-and-take with people who stutter


Reeves, L. (2006). The role of self-help/mutual aid in addressing the needs of individuals who stutter. In Bernstein Ratner, Nan & John Tetnowksi (Eds.). Current issues in stuttering research and practice. Mahwah, NJ: Lawrence Erlbaum. (click here)

Activity: Be prepared to ask two questions of our guests.



November 23: Happy Turkey!


November 30

Acquired stuttering (Powerpoint slides); cluttering (Powerpoint slides); Readings:

Manning, pages 304-315, review.

*St. Louis, K. & F. Myers (1997). Management of cluttering and related fluency disorders. In R. Curlee & G. Siegel (eds.) Nature and treatment of stuttering: new directions (2nd ed.) 313-332. (Avail. In readings notebook in HESP Library).

Baumgartner, J. & J. Duffy (1997). Psychogenic stuttering in adults with and without neurologic disease. Journal of Medical Speech-Language Pathology, 5, 75-95. (click here to read article)

De Nil, L., R. Jokel & E. Rochon (in press). Neurogenic stuttering: a review of etiology, symptomology and clinical intervention. To appear in E. Conture & R. Curlee (eds.) Stuttering and related disorders of fluency (3rd ed.) NY: Thieme. (click here to read this article)


December 7

Lecture: TBA. Catch up and review; unfinished business, unanswered questions…


December 14

Final examination, in class.

Research project DUE no later than DEC 20.



Research a topic on PubMed:

Explore the Stuttering Home Page:





Suggested template for pseudostuttering assignment:

(You do not need to do it in chart form, but please address these concepts)


Where you did the assignment:


Your main concerns before you pseudostuttered:


How you stuttered:


What behaviors you observed in your listener:


How you interpreted these behaviors:


What you partner saw and interpreted:


How your feelings might relate to those of a person who stutters:


How this might affect the way you relate to a client who stutters:


Project #1: Calculation of fluency measures.


For this assignment, use the CDs we supply to you; these are a LOAN, and must be returned with your assignment. (If you cannot use CDs, ask us to loan you a VHS tape).  OR access the file at the website HERE (if you are not on a cable or ISN line, this could be a slow download!)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 hope……


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 see…


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


And he starts on the opposite side of the room…


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 further diagnostic and therapeutic needs ‑ how significant his problem is, and what areas (behavioral, affective, cognitive) 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.


IMPORTANT: This is an exercise meant to give you practice in evaluating the frequency of stuttering and concomitant behaviors. It does not have a strictly right or wrong answer. PLEASE do this assignment independently; it is not meant to be a team project.


Fluency project #2:

Option 1:

Annotated research bibliography for the year 2005, to be published in the ASHA Perspectives, Division 4.  (Only two students may pick this option and must work together with Nan).


Option 2:  Research paper. The topic may be a SPECIFIC treatment option in stuttering, whether “mainstream” or “alternative” (for example, hypnotherapy, self-modeling, acupuncture, image therapy, etc.), or a specific hypothesis about the nature of stuttering (e.g., any in your text or the Valsalva reflex, laryngospasms, etc.) or characteristics that distinguish people who stutter from those who do not. For your chosen topic,

Consult and document at least 3 (but preferably more, if more are available) primary source articles or books that relate to this topic. A primary source is an article or book of original research, rather than a textbook or summary article or chapter. The original source for an alternative treatment or model may be web-based, but you must include a copy of the web materials as an appendix and use peer-reviewed published literature in its evaluation.

1)      Discuss the evidence base for the treatment, model or characteristic you have chosen – is it sufficient to guide treatment or research? What additional information might be necessary to validate the treatment, model or characteristic? Offer directions for future research.

2)      Please confine your answer to no more than 10 pages, typed, double-spaced.


Option 3:

            Critique a model or position paper/issue of recent interest in fluency disorders.  Examples might include: