Developing a quality curriculum in a technological era.

There is considerable rhetoric internationally around the need for national curricula to reflect the changes that are taking place in the world outside school. This raises questions about what a quality curriculum in a technological era should look like, and equally challenging issues about how to achieve the necessary changes in schooling in order for such a curriculum to be realised. This paper summarises the views of 11 experts from seven countries. It introduces a sociocultural framework that highlights the complexity of achieving alignment between policies and practice spanning the national to local school to classroom levels. Three key issues that underpin alignment are then explored, each of which link with the issue of trust:stakeholders engagement;teacher professionalism;summative assessment. By exploring and exemplifying these three issues the paper indicates potential ways of addressing them and provides 'tools to think with' to enhance future curriculum development initiatives.

Reliability and validity evidence of the Assessment of Language Use in Social Contexts for Adults (ALUSCA).

Background: The appropriate use of language in context depends on the speaker's pragmatic language competencies. A coding system was used to develop a specific and adult-focused self-administered questionnaire to adults who stutter and adults who do not stutter, The Assessment of Language Use in Social Contexts for Adults, with three categories: precursors, basic exchanges, and extended literal/non-literal discourse. This paper presents the content validity, item analysis, reliability coefficients and evidences of construct validity of the instrument. Methods: Content validity analysis was based on a two-stage process: first, 11 pragmatic questionnaires were assessed to identify items that probe each pragmatic competency and to create the first version of the instrument; second, items were assessed qualitatively by an expert panel composed by adults who stutter and controls, and quantitatively and qualitatively by an expert panel composed by clinicians. A pilot study was conducted with five adults who stutter and five controls to analyse items and calculate reliability. Construct validity evidences were obtained using the hypothesized relationships method and factor analysis with 28 adults who stutter and 28 controls. Results: Concerning content validity, the questionnaires assessed up to 13 pragmatic competencies. Qualitative and quantitative analysis revealed ambiguities in items construction. Disagreement between experts was solved through item modification. The pilot study showed that the instrument presented internal consistency and temporal stability. Significant differences between adults who stutter and controls and different response profiles revealed the instrument's underlying construct. Conclusion: The instrument is reliable and presented evidences of construct validity.

The Role of Narratives in the Development of Stuttering as a Problem.

Purpose: Narratives are how people make sense of experiences and give meaning to their lives (Bruner, 1990). Use of narrative therapy (White, 2007) with people who stutter to facilitate the development of preferred stories (as opposed to problem-based stories) has been documented in the literature (Logan, 2013; Ryan, O'Dwyer, & Leahy, 2015). The purpose of this research was to explore the role of narratives in the development of stuttering as a problem for people who stutter. This research sought to describe how these narratives develop and to identify the factors that influence this development. Method: Narratives from 6 men who stutter were recorded, transcribed, and analyzed using the "Listening Guide" (Brown & Gilligan, 1992). This is a voice-centered relational method. Results: Findings indicate interaction between participants' narratives about stuttering and their wider self-narratives. Influencing factors identified include relationships, thoughts and feelings, and the dominant stories about stuttering in relevant social structures. An individual's consciousness of these influences was found to be integral to change in their narratives. Conclusions: The findings point to the importance of considering the environment, including significant relationships and social structures, in our understanding of stuttering. They also provide insights regarding intrapersonal and interpersonal processes, which can influence the development of stuttering or pave the way to stuttering becoming less problematic for the person who stutters.

A country-wide probability sample of public attitudes toward stuttering in Portugal.

BACKGROUND: Negative public attitudes toward stuttering have been widely reported, although differences among countries and regions exist. Clear reasons for these differences remain obscure. PURPOSE: Published research is unavailable on public attitudes toward stuttering in Portugal as well as a representative sample that explores stuttering attitudes in an entire country. This study sought to (a) determine the feasibility of a country-wide probability sampling scheme to measure public stuttering attitudes in Portugal using a standard instrument (the Public Opinion Survey of Human Attributes-Stuttering [POSHA-S]) and (b) identify demographic variables that predict Portuguese attitudes. METHODS: The POSHA-S was translated to European Portuguese through a five-step process. Thereafter, a local administrative office-based, three-stage, cluster, probability sampling scheme was carried out to obtain 311 adult respondents who filled out the questionnaire. RESULTS: The Portuguese population held stuttering attitudes that were generally within the average range of those observed from numerous previous POSHA-S samples. Demographic variables that predicted more versus less positive stuttering attitudes were respondents' age, region of the country, years of school completed, working situation, and number of languages spoken. Non-predicting variables were respondents' sex, marital status, and parental status. CONCLUSION: A local administrative office-based, probability sampling scheme generated a respondent profile similar to census data and indicated that Portuguese attitudes are generally typical.

Public attitudes toward stuttering in Europe: Within-country and between-country comparisons.

INTRODUCTION: Epidemiological research methods have been shown to be useful in determining factors that might predict commonly reported negative public attitudes toward stuttering. Previous research has suggested that stuttering attitudes of respondents from North America and Europe (i.e., "The West"), though characterized by stereotypes and potential stigma, are more positive than those from several other regions of the world. This inference assumes that public attitudes within various regions characterized by "The West" are similar. PURPOSE: This study aimed to determine the extent to which public stuttering attitudes are similar or different both within regions of three different European countries and between or among five different European countries or similar geographic areas. It also aimed to compare these European attitudes to attitudes from 135 samples around the world using a standard measure. MATERIAL AND METHODS: Using convenience sampling, 1111 adult respondents from eight different investigations completed the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) in the dominant language of each country or area. In Study I, the authors compared attitudes within three different regions of Bosnia & Herzegovina, Italy, and Norway. In Study II, the authors compared attitudes between combined samples from Bosnia & Herzegovina, Italy, and Norway (with additional respondents from Sweden), and two other samples, one from Germany and the other from Ireland and England. RESULTS: Attitudes of adults from the three samples within Bosnia & Herzegovina, Italy, and Norway were remarkably similar. By contrast, attitudes between the five different countries or area were quite dramatically different. Demographic variables on the POSHA-S did not predict the rank order of these between-country/area differences. Compared to the POSHA-S worldwide database, European attitudes ranged from less positive than average (i.e., Italians) to more positive than average (i.e., Norwegians and Swedes). CONCLUSION: Factors related to national identity appear to play a significant role in differences in public attitudes in Europe and should be explored in future research.

Event- and interval-based measurement of stuttering: a review.

BACKGROUND: Event- and interval-based measurements are two different ways of computing frequency of stuttering. Interval-based methodology emerged as an alternative measure to overcome problems associated with reproducibility in the event-based methodology. No review has been made to study the effect of methodological factors in interval-based absolute reliability data or to compute the agreement between the two methodologies in terms of inter-judge, intra-judge and accuracy (i.e., correspondence between raters' scores and an established criterion). AIMS: To provide a review related to reproducibility of event-based and time-interval measurement, and to verify the effect of methodological factors (training, experience, interval duration, sample presentation order and judgment conditions) on agreement of time-interval measurement; in addition, to determine if it is possible to quantify the agreement between the two methodologies METHODS & PROCEDURES: The first two authors searched for articles on ERIC, MEDLINE, PubMed, B-on, CENTRAL and Dissertation Abstracts during January-February 2013 and retrieved 495 articles. Forty-eight articles were selected for review. Content tables were constructed with the main findings. MAIN CONTRIBUTION: Articles related to event-based measurements revealed values of inter- and intra-judge greater than 0.70 and agreement percentages beyond 80%. The articles related to time-interval measures revealed that, in general, judges with more experience with stuttering presented significantly higher levels of intra- and inter-judge agreement. Inter- and intra-judge values were beyond the references for high reproducibility values for both methodologies. Accuracy (regarding the closeness of raters' judgements with an established criterion), intra- and inter-judge agreement were higher for trained groups when compared with non-trained groups. Sample presentation order and audio/video conditions did not result in differences in inter- or intra-judge results. A duration of 5 s for an interval appears to be an acceptable agreement. Explanation for high reproducibility values as well as parameter choice to report those data are discussed. CONCLUSIONS & IMPLICATIONS: Both interval- and event-based methodologies used trained or experienced judges for inter- and intra-judge determination and data were beyond the references for good reproducibility values. Inter- and intra-judge values were reported in different metric scales among event- and interval-based methods studies, making it unfeasible to quantify the agreement between the two methods.

Strategies to optimize the impact of nutritional surveys and epidemiological studies.

The development of nutrition and health guidelines and policies requires reliable scientific information. Unfortunately, theoretical considerations and empirical evidence indicate that a large percentage of science-based claims rely on studies that fail to replicate. The session "Strategies to Optimize the Impact of Nutrition Surveys and Epidemiological Studies" focused on the elements of design, interpretation, and communication of nutritional surveys and epidemiological studies to enhance and encourage the production of reliable, objective evidence for use in developing dietary guidance for the public. The speakers called for more transparency of research, raw data, consistent data-staging techniques, and improved data analysis. New approaches to collecting data are urgently needed to increase the credibility and utility of findings from nutrition epidemiological studies. Such studies are critical for furthering our knowledge and understanding of the effects of diet on health.

Witnessing stories: Definitional Ceremonies in Narrative Therapy with adults who stutter.

BACKGROUND: Narrative therapy (White & Epston, 1990) was developed as an approach to counselling, as a response to the power relations that influence people's lives. Its use with people who stutter has been documented. A basic tenet of narrative therapy is that the dominant problem-saturated narrative is challenged by externalizing the problem, in due course facilitating development of an alternative narrative. Within this process, the definitional ceremony involving outsider witnesses is a key procedure used to influence change. AIMS: This paper describes definitional ceremonies, and their application within a narrative approach to therapy for stuttering. The analysis of a specific definitional ceremony is presented, leading to an exploration of identity as a public and social achievement. METHODS: A definitional ceremony involving a woman who stutters and family members was recorded and analysed using two methods: interpretative phenomenological analysis and Heideggerian hermeneutic phenomenological analysis. Details of the clinical application of definitional ceremonies with this client are described. RESULTS AND CONCLUSIONS: Results from both methods of analysis were found to be similar. Notable results include the fact that the stuttering per se was not presented as the problem; rather, the impact of stuttering, especially the experience of bullying, was a dominant theme. This paper shows how definitional ceremonies can open opportunities for clients to present themselves in a preferred way, forming the basis for a new story and revised identity. Emerging themes can be identified for reflection and discussion with the client for therapeutic benefit. EDUCATIONAL OBJECTIVES: (1) to describe and explain to readers the process of narrative therapy, with special attention to the use of definitional ceremonies; (2) to provide detail regarding the clinical processes involved with a specific definitional ceremony with one client; (3) to have the reader appreciate the specific importance of involving outsider witnesses in the therapy process; (4) to discuss the outcomes of the use of this particular definitional ceremony.

The European Clinical Specialization on Fluency Disorders (ECSF).

UNLABELLED: The European Clinical Specialization on Fluency Disorders (ECSF) project consists of one-year post-qualification fluency specialization training and a harmonized graduate fluency program. It was developed by eight European universities/colleges to provide the means whereby graduates would meet comparable standards of competence to practice in the field of fluency disorders. In this paper we describe criteria that guided the consortium in their decision making process to create an optimal learning environment for participants. A review of the first completed course cycle, with 23 international participants, is discussed. EDUCATIONAL OBJECTIVES: After reading this article, the reader will be able to: (1) articulate the rationale for development of the ECSF-course; (2) summarize the content of both the harmonized undergraduate fluency course and the postgraduate fluency specialization course; (3) summarize the benefits of the suggested model for fluency specialization.

Paying attention to therapy discourse: identifying therapy processes and practice in talk about talk.

Therapy discourse between the client and clinician has specific objectives to ameliorate problems associated with communication and swallowing disorders and is highly specialized. Analysis of this interaction that is the essence of therapy demonstrates the roles played by participants, revealing layers of meaning and assisting clinicians to redefine and refine their ideas about therapy. In this article, the authors analyze a series of extracts of therapy interaction to explore how therapy rapport is coconstructed by participants through talking and how roles are negotiated during the process of problem solving in therapy.

"Cajoling" as a means of engagement in the dysphagia clinic.

Rapport and cooperation are key features of many clinical interactions including those of speech-language pathologists (SLPs) and clients. A desirable by-product of rapport can be described as "engagement" where participants share a mutual focus while working toward a common goal. Through an analysis of clinical discourse, this article maps the trajectory of engagement as manifest in interactions between a SLP and a client with right hemisphere damage and dysphagia. The analysis shows that, in response to some apparently inappropriate comments made by the client, the SLP responded with teasing or what she called "cajoling" behavior. Cajoling accompanied by humor and laughter became the SLP's way of gaining and maintaining cooperation in this context. Instead of such behavior being viewed as "unprofessional," careful mapping of this behavior across several interactions served to demonstrate its value in the ultimate joint achievement of goals. Implications for how such constructions of engagement may be manifest through talk in the SLP clinic are discussed.

Intelligibility of dysarthric speech: perceptions of speakers and listeners.

BACKGROUND: Many factors influence listener perception of dysarthric speech. Final consensus on the role of gender and listener experience is still to be reached. The speaker's perception of his/her speech has largely been ignored. AIMS: (1) To compare speaker and listener perception of the intelligibility of dysarthric speech; (2) to explore the role of gender and listener experience in speech perception; and (3) to examine the relationship between speaker perceptions of intelligibility and formal clinical intelligibility ratings. METHODS & PROCEDURES: Study 1 examines listener perception of intelligibility of dysarthric speech. Twenty people with acquired dysarthria, ten speech language therapists (SLTs) and 20 naive listeners heard audio recordings of dysarthric speech and used direct magnitude estimation (DME) to rate perceptions of speech intelligibility. Differences in perception across gender and listener experience (SLTs versus naive listeners) were examined. Study 2 tackles the speaker's perception of his/her own speech intelligibility. Using the same groups of participants and DME, speakers rated their own speech intelligibility. SLTs and naive listeners then rated their perception of the speakers' intelligibility. Differences in perceptions between speakers and listeners were compared. Further analysis examined differences across gender and listener experience. Finally, ratings of speakers' perception of their own intelligibility were compared with intelligibility scores on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS) (1981). OUTCOMES & RESULTS: Study 1 showed no statistically significant differences in perception of intelligibility across the three listener groups, although results suggest that speakers rate perceptions of intelligibility differently to SLTs and naive listeners. Despite some individual differences in ratings between speakers and listeners in Study 2, overall there are no significant group differences and methodological limitations to this section of the study are highlighted. In Studies 1 and 2 there are no statistically significant differences across gender and listener experience, although SLTs are less consistent in their ratings of speech when compared with naive listeners. There is no statistically significant relationship between formal intelligibility assessment scores and the speakers' perception of intelligibility. CONCLUSIONS: This study contributes to an understanding of perceptions of dysarthric speech. The lack of gender differences in listener perception supports earlier findings in other areas of SLT. The strong relationship between SLT and naive listeners' perceptions suggests that SLTs are not more critical of dysarthric speech. The discrepancy between formal assessment measures and speakers' perceptions of intelligibility has implications for clinical practice. The need for further research in the area is highlighted.

Multiple voices in Charles Van Riper's desensitization therapy.

BACKGROUND: Charles Van Riper (1905-94) author, researcher and practitioner, was one of the major contributors to the field of stuttering in the 20th century. His series of Action Therapy videotapes provide a useful model of how therapy was implemented by a master clinician. AIMS: Van Riper's session with a client is analysed to reveal how voices are used by these two participants during desensitization therapy, and to demonstrate how Van Riper's expertise manifests itself during the session. METHODS & PROCEDURES: Interaction between Van Riper and a client during the desensitization stage of therapy was transcribed, annotated, and analysed using Goffman's (1974) frame analysis. Elements in the extensive discourse (about 4800 words exchanged) were chosen to illustrate a range of distinctive voices used by Van Riper and the client during this 'crucial' stage of therapy. OUTCOMES & RESULTS: Van Riper shifts his voice throughout the session. His comments are sometimes directed to the viewing audience, at which times he tends to use the voice of an exegeter. When directing his comments to the client, he uses two voices: an authoritative one and one that aligns with the person's feelings. The voice of the client is often silenced, especially when Van Riper is being authoritative. Sometimes Van Riper uses his expertise by speaking through the voice of the client. This is especially true when summarizing what the client might be feeling. The true voice of the client emerges only occasionally. Detailed discourse analysis focusing on the roles played by participants as revealed through footings taken by speakers show complexity in the interaction that is not obvious at surface level. CONCLUSIONS: By using discourse analysis, the multiple voices that Van Riper uses to achieve the complex tasks involved in desensitization can be specified.

Judging stuttering in an unfamiliar language: the importance of closeness to the native language.

In order to test the hypothesis that closeness to the listener's native language is a determining factor when identifying stuttering in an unfamiliar language, three panels of different linguistic background were asked to make judgements of stuttering in a sample of Dutch speakers. It was found that a panel speaking Dutch and a panel speaking English (both West Germanic languages) performed better in identifying Dutch people who stutter and people who do not stutter than a panel speaking Brazilian Portuguese (a Romance language) thus confirming the existence of a closeness of language influence. Further analysis showed that when the native language is more remote from the unfamiliar language there is the possibility of a higher risk for false positive identification.

Changing perspectives for practice in stuttering: echoes from a Celtic past, when wordlessness was entitled to time.

Changing perspectives for practice in stuttering therapy are informed by the changes in knowledge, social values, and belief systems of a society. The International Classification of Functioning, Disability and Health (ICF; World Health Organization, 2001) has a sociological emphasis with a focus on the ability and functioning of the person, and it is currently fostering changes in perspectives for working with those who stutter. These perspectives are reflected in Irish social mores in the 7th and 8th centuries, when social and legal codes enshrined the rights of people with speech disabilities in law and recognized the dignity and integrity of people with such disabilities. The society of the time showed awareness and acceptance of people with disabilities, and it provided the supports to enable their participation in society. To a large extent, these principles contrast with the predominantly impairment-based focus that has been the heritage of the speech-language pathology profession in the 20th century. In order to review changing emphases in stuttering therapy and to consider applications of a sociological approach to stuttering, an outline of historical perspectives of the profession of speech-language pathology is presented. The evolution of the ICF is also outlined, moving from an impairment-based focus to a more sociological perspective. Both perspectives provide a historical context for consideration of approaches to working with stuttering, reflecting the ICF and echoing principles that were practiced in an ancient Celtic society.

Therapy talk: analyzing therapeutic discourse.

Therapeutic discourse is the talk-in-interaction that represents the social practice between clinician and client. This article invites speech-language pathologists to apply their knowledge of language to analyzing therapy talk and to learn how talking practices shape clinical roles and identities. A range of qualitative research approaches, including ethnography of communication, conversation analysis, and frame theory, provides a background for the case presentation of a 13-year-old girl who stutters. Asymmetry is a feature of the therapeutic discourse presented , with evidence of recognition of the client's communicative competence emerging. Applications of analyzing therapy talk are discussed, illustrating the relevance of this approach for clinicians.