CDIS 452: Fluency Disorders

Spring 2001

Professor: Lisa R. LaSalle, Ph.D., CCC-SLP

Office: Human Sciences & Services (HSS) #127

Office Phone: 836-3805, Office hours: TBA

Email: lasalllr@uwec.edu

Class meets: HSS #179 on M W 1:00 – 2:15 pm

Goal for this course: You will demonstrate competence in helping people who stutter or people who have another type of fluency disorder. To meet this goal, you need to:

1. Explain basic facts and findings about stuttering and other fluency disorders.

2. Apply theories of stuttering to these facts and findings.

3. Speculate about how theories of stuttering are clinically useful.

4. Explain basics about clinical intervention for people who stutter, and how clinical practice differs according to the client’s diagnosis, age, severity, and presence of concomitant disorders.

Textbooks (rental)

Curlee, R.F., & Siegel, G.M. (Eds.). (1997). Nature and treatment of stuttering: New directions. (2nd ed.). Needham Heights, MA: Allyn & Bacon.

Guitar, B. (1998). Stuttering: An integrated approach to its nature and treatment. (2^nd edition) Baltimore: Williams & Wilkins.

Other textbooks referenced in-class (Availability TBA)

Conture, E. (2001). Stuttering: Its nature, diagnosis and treatment. Boston, MA: Allyn & Bacon.

Manning, W. (2001). Clinical decision making in fluency disorders (2^nd edition). San Diego, CA: Singular.

Grades:

To earn an “A,” you must have completed at least 90% of the assignments (See Appendix A for most of the assignments for this semester). Completing assignments to the best of your ability and attending class regularly to discuss them shows “good faith effort” towards meeting the course goal. Your course grade is an average of two components that reflect the course goal:

q Exam average, based on three take-home essay exams (See Appendix B);

q Fluency case project, with sections graded periodically across the semester. For this case you will: observe current fluency clients, plan assessment and treatment for a fluency client, interact with a simulated client/actor, interact with a real client, apply available clinical literature to help problem-solve aspects of this case, discuss your case with classmates, and analyze your case. More project explanation is forthcoming.

The criteria for the following letter grades are:

A = 90% on assignments and at least an “A” average

B = 80% on assignments and at least a “B” average

C = 70% on assignments and at least a “C” average

D = 60% on assignments and at least a “D” average

So, if you have an “A” average, but you only complete 80% (8/10) of the assignments, the highest you can earn is a “B+” However, completing 100% of the assignments when you have a grade average less than an “A” is not sufficient to earn an “A.” Another way of stating this is that 90-100% assignment completion is necessary but not sufficient to get an “A.” This criterion was revised on 2-26-01 to involve the first three assignments with the assumption that a “good faith effort” would take place outside of class without the need to hand-in assignments. See Revision to syllabus.

Attendance and make-up policy

Attendance in class is expected. I will take attendance most class periods through the assignments that you turn-in. I will not accept late assignments. Of course, occasional exceptions will be made for illness and family emergencies. Because I know that problems occasionally arise with printing problems, I will accept assignments in my office mailbox or as an email attachment later on the same day they are due. If you miss all or part of a class, it is your responsibility to obtain lecture and/or discussion notes from a classmate, view the video you missed, and see me outside of class if you have questions about what you missed.

Notes on updates to the syllabus:
Course outline and schedule:

Wk	Date	Topics		Reading assignments[1]
1.	1/22,24	Introductions Facts and findings of stuttering		Guitar (1998) ch. 1
2.	1/29,31	Physiological aspects of stuttering Genetics and stuttering		Guitar (1998) ch. 2 Felsenfeld (1997, ch. 1)[2]
3.	2/5,7	Environmental aspects of stuttering Parents of children who stutter		Guitar (1998) ch. 3 Yairi (1997, ch. 2 & 3
4.	2/12,14	Psycholinguistic aspects of stuttering Language ability and stuttering		Bernstein Ratner (1997, ch. 5)
5.	2/19,21	Other facts and findings about stuttering Relation of facts/findings to theories		Guitar (1998) ch. 4 Exam #1 due 2/21
6.	2/26,28	Theories of stuttering Learning theories		Starkweather (1997, ch. 4)
7.	3/5,7	Etiologic theories · Anticipatory Struggle Hypothesis · Covert Repair Hypothesis		Bloodstein (1997, ch. 8) Kolk & Postma (1997, ch. 9) Guitar (1998) ch. 5 Case info & background due
8.	3/12,14	Relation of theories to clinical practice: Case studies		Guitar (1998) ch. 6 Conture (1997, ch. 12) Exam #2 due 3/14
3/19 - 23 Spring break!
9.	3/26,28		Clinical intervention · Preschoolers who stutter	Starkweather (1997, ch. 13);
10.	4/2,4		· School-age children who stutter	Guitar (1997, ch. 14)
11.	4/9,11		· Teens who stutter · Adults who stutter	Exam #2 due 4/9
4/16 Easter Monday
12.	4/18 W		· Stuttering modification approach · Fluency shaping approach · Problem-solving fluency cases	Prins (1997, ch. 17) Onslow & Packman (1997, ch. 18)
13.	4/23,25		· Concomitant disorders · Fluency disorders that are not stuttering · Counseling people who stutter and their families	Read clinical literature that relates to your case projects
14.	4/30,5/2		· Case studies Panel of parents of children who stutter	Exam #3 due 4/30
15.	5/7,9		Panel of adults who stutter Panel of clinicians who work with PWS
	5/14 M @ 3 – 5 pm		Final presentation of cases	Fluency case projects due

Appendix A

Weekly assignments

All assignments need to be word-processed and printed out in duplicate. One copy you will drop in a basket in the beginning of class for my record-keeping purposes; the other you keep to take notes on, trade with a classmate, etc., depending on the specific purpose for that assignment. I will show you two electronic options (email attachment, DeptDir) that will suffice for my record-keeping needs.

The purpose of the assignments is to assess how well you comprehend assigned readings, and to provide a basis for class discussions. Eight to ten assignments based on the readings in your texts and/or learning experiences are planned. Eight numbered assignments are shown here. It is also your responsibility to answer the questions that follow each of the chapters assigned in the Guitar (1998) text to guide your comprehension of the chapters. Ask about that which you do not understand from the readings.

Assignment #1 due 1/31/01 based on Felsenfeld, S. (1997). Epidemiology and genetics of stuttering. In R.F. Curlee and G.M. Siegel (Eds). Nature and treatment of stuttering: New directions. (2nd ed.). Boston, MA: Allyn & Bacon. pp. 3-22. (ch. 1). Some references also made to chapters 1 & 2 in the Guitar (1998) text.

1. One of the most important points that Felsenfeld (1997) makes for the purposes of our study of stuttering is the following:

“Environmental factors are acknowledged to be important in determining the degree to which a phenotype will be expressed...the predisposing conditions that result from the effects of a major gene are not considered impervious to outside influences...(p. 13).”

Based on other supporting information Felsenfeld gives in this chapter, information about the nature of stuttering that Guitar (1998) provides in the first two chapters, and our in-class clarification of “cause,” describe why any given child may stutter. Limit yourself to a short paragraph.

2. In reference to the predisposition of stuttering, what does Felsenfeld (1997) mean by the statement that “...knowledge of a condition’s ‘heritability’ does not by itself enhance outcomes for individual patients (p. 4)”? Limit yourself to a short paragraph.

3. Choose five of the following terms that Felsenfeld (1997) and/or Guitar (1998) use to describe the epidemiology and genetics of stuttering. Use your own words to define these terms. Were there any other terms you found that needed defining?

· epidemiology

· incidence vs. prevalence

· intrinsic vs. extrinsic variables

· dizygotic vs. monozygotic twins

· alleles

· polymorphic genes

· phenotype

· first-degree vs. second-degree relatives

· proband

· continuously distributed vs. categorical conditions or traits

Assignment #2 due 2/7/01 based on Yairi, E. (1997). Home environment and parent-child interaction in childhood stuttering. In R.F. Curlee and G.M. Siegel (Eds). Nature and treatment of stuttering: New directions. (2nd ed.). Boston, MA: Allyn & Bacon. pp. 24-48. (ch. 2).

Choose 3 of the following 5 questions to answer and everyone does #6!

1. Why has parent counseling often been the primary means of treating childhood stuttering?

2. Summarize the information Yairi provides on the differences in family history of stuttering (genetics) between people who stutter and those who do not. In so doing, differentiate between adults and children who stutter.

3. Yairi concludes his section on socioeconomic status by stating that “It is interesting to note that in spite of the disparity in their results, all investigators speculated that higher incidences of stuttering...may have resulted from upward social mobility pressures (p. 31).” Why might upward social mobility pressures relate to stuttering? Support your opinion with facts and findings that you have learned to date.

4. What are the broad theoretical and practical implications of the Glasner and Rosenthal (1957) study, which is described on p. 35?

5. Do mothers of children who stutter interrupt more frequently than mothers of children who do not stutter? Explain. If a mother noticeably interrupted her child’s disfluencies, why might she show such a tendency?

6. Experiential assignment: A must-do: Practice “pseudo-stuttering” or “fake stuttering” so that it sounds convincing. Think about people who stutter from the Voices to Remember video. Repeat and/or prolong sounds; Use word-initial / utterance-initial loci; Determine what associated behaviors “come naturally.” Pair-up with a classmate to keep each other honest and to be observers for each other. Pick a speaking situation in which to fake stutter (e.g., phone call; restaurant; another class). Be brave. Just do it. Note your listener(s’) reaction(s) and your own reactions and feelings. Briefly explain your experience. Be prepared to report your experiences to the rest of the class.

Assignment #3 due 2/14/01 based on:

· Yairi, E. (1997). Disfluency characteristics of childhood stuttering. In R.F. Curlee and G.M. Siegel (Eds). Nature and treatment of stuttering: New directions. (2nd ed.). Boston, MA: Allyn & Bacon. pp. 49-78. (ch. 3).

· Bernstein Ratner, N. (1997). Stuttering: A psycholinguistic perspective. In R.F. Curlee and G.M. Siegel (Eds). Nature and treatment of stuttering: New directions. (2nd ed.). Boston, MA: Allyn & Bacon. pp. 99-127. (ch. 5).

Choose 4 of the 6:

1. What is spontaneous recovery? Why do you think it occurs? Use some of the data reported by Yairi to support your opinion.

2. Why does Yairi criticize the early studies of speech characteristics at the onset of stuttering conducted by Johnson & Associates (1959)?

3. Use some of the data presented in the handout to construct a list of the top three measures you think should be taken in an assessment of a child who is suspected of stuttering. Briefly, why did you choose these three?

4. Bernstein Ratner presents a number of interesting studies in her section on “Language ability and stuttering.” One area she does not address, however, is what differences between the language abilities of adults who do and do not stutter could be due to the history of stuttering that separates these two talker groups. Speculate about what one of these differences might be.

5. Why should we be cautious about saying that parents should slow their speech rate when talking to their child who stutters. Support your answer with studies cited by Bernstein Ratner.

6. In her summary, Bernstein Ratner states that “...stuttering, particularly in children, follows linguistically lawful patterns of frequency and location within conversational speech (p. 119).” List some of the findings she reports upon in this chapter that support this statement.

Assignment #4 due 2/28/01 based on Starkweather, C.W. (1997). Learning and its role in stuttering development. In R.F. Curlee and G.M. Siegel (Eds). Nature and treatment of stuttering: New directions. (2nd ed.). Boston, MA: Allyn & Bacon. pp. 79-98. (ch. 4).

Choose 6 of the 11, and everyone do #12

1. Starkweather begins by stating that “...this chapter is more of a guide for clinicians than it is a theoretical statement of how stuttering is acquired (p. 79).” Based on the whole essence of the chapter, why does he state this?

2. What is meant by “contingent”? How does a “contingency” happen?

3. What is the relationship signified by a “response contingency”?

4. What is the relationship signified by a “stimulus contingency”?

5. What is the difference between “classical conditioning” and “operant conditioning”?

6. What is meant by “extinction”?

7. What is meant by “reduction of a learned response”?

8. Give an example of the role of generalization in stuttering.

9. Explain in your own words Van Riper’s “giant in chains” phenomenon.

10.What is one of aspect of stuttering that is described by a stimulus contingency?

11.What is one of aspect of stuttering that is described by vicarious learning?

12.Experiential assignment: must-do: Get into groups of 3-5: One of you in the group logs on to a listserv known as STUTT-L. Instructions for how to log on are provided at www.stutteringhomepage.com . Once the one member of your group is logged on this listserv, “lurk” and forward the more interesting posts to her group members by email. Then the group should meet to discuss a “thread” (a series of several posts from different people on a given topic) that relates to stuttering topics that we’ve read about or discussed in class. Someone is designated the group recorder and summarizes your group’s discussion.

Assignment #5 due 3/7/01 based on:

· Bloodstein, O. (1997). Stuttering as an anticipatory struggle reaction. In R.F. Curlee and G.M. Siegel (Eds). Nature and treatment of stuttering: New directions. (2nd ed.). Boston, MA: Allyn & Bacon. pp. 169-181 (ch. 8).

· Kolk, H. and Postma, A. (1997). Stuttering as a covert repair phenomenon. In R.F. Curlee and G.M. Siegel (Eds). Nature and treatment of stuttering: New directions. (2nd ed.). Boston, MA: Allyn & Bacon. pp. 182-203 (ch. 9).