Academic and clinical education in fluency disorders: an update

This paper presents a survey of the academic and clinical education in fluency disorders provided by American Speech-Language-Hearing Association (ASHA)-accredited training programs. Respondents were 159 programs (out of 256, return rate = 67.4%) that completed a questionnaire seeking information about the courses and clinical experiences they require, the expertise of their faculty and supervisors, changes following the 1993 modification of training requirements for the ASHA certificate of clinical competence (CCC), and preliminary plans for changes in preparation for the 2005 standards. Results, which supplement findings from an earlier survey distributed in 1997 (Yaruss, 1999), indicated that nearly one-quarter of programs allow students to graduate without coursework in fluency disorders, and nearly two-thirds allow students to graduate without clinical practicum experiences. Findings suggest a trend toward fewer required classes taught by less experienced faculty, fewer clinical hours guided by less experienced supervisors, and a greater likelihood that students will graduate without any academic or clinical education in fluency disorders. Given the repeated finding that many speech-language pathologists are uncomfortable working with people who stutter, as well as ASHA's apparent de-emphasis of fluency disorders within the increasing scope of practice in the field of speech-language pathology, these results are a cause for concern about the future of fluency disorders. EDUCATIONAL OBJECTIVES: The reader will learn about (1) the coursework and clinical practicum experiences that are currently required for students in ASHA-accredited training programs; (2) trends indicating a reduction in training requirements for fluency disorders; and (3) ways of improving these requirements.     

Sex Under Pressure: Jerks,Boorish Behavior,and Gender Hierarchy

Pressuring someone into having sex would seem to differ in significant ways from pressuring someone into investing in one’s business or buying an expensive bauble. In affirming this claim, I take issue with a recent essay by Sarah Conly (‘Seduction, Rape, and Coercion’, Ethics, October 2004), who thinks that pressuring into sex can be helpfully evaluated by analogy to these other instances of using pressure. Drawing upon work by Alan Wertheimer, the leading theorist of coercion, she argues that so long as pressuring does not amount to coercing someone into having sex, her consent to sex answers the important ethical questions about it. In this essay, I argue that to understand the real significance of pressuring into sex, we need to appeal to background considerations, especially the male-dominant gender hierarchy, which renders sexual pressuring different from its non-sexual analogues. Treating pressure to have sex like any other sort of interpersonal pressure obscures the role such sexual pressure might play in supporting gender hierarchy, and fails to explain why pressure by men against women is more problematic than pressure by women against men. I suggest that men pressuring women to have sex differs from the reverse case because of at least two factors: (1) gendered social institutions which add to the pressures against women, and (2) the greater likelihood that men, not women, will use violence if denied, and the lesser ability of women compared to men to resist such violence without harm. I would like to thank Marcia Baron, Sylvia Berryman, Elizabeth Brake, Dominic McIver Lopes, Jennifer Warriner, Janet Wesselius, two anonymous reviewers for Res Publica and the audiences at the University of British Columbia Feminism and Philosophy Workshop and the Western Canadian Philosophical Association meetings in Winnipeg for helpful discussion and comments.     

Links between social and linguistic processing of speech in preschool children with autism: behavioral and electrophysiological measures

Data on typically developing children suggest a link between social interaction and language learning, a finding of interest both to theories of language and theories of autism. In this study, we examined social and linguistic processing of speech in preschool children with autism spectrum disorder (ASD) and typically developing chronologically matched (TDCA) and mental age matched (TDMA) children. The social measure was an auditory preference test that pitted 'motherese' speech samples against non-speech analogs of the same signals. The linguistic measure was phonetic discrimination assessed with mismatch negativity (MMN), an event-related potential (ERP). As a group, children with ASD differed from controls by: (a) demonstrating a preference for the non-speech analog signals, and (b) failing to show a significant MMN in response to a syllable change. When ASD children were divided into subgroups based on auditory preference, and the ERP data reanalyzed, ASD children who preferred non-speech still failed to show an MMN, whereas ASD children who preferred motherese did not differ from the controls. The data support the hypothesis of an association between social and linguistic processing in children with ASD.     

Regulation of hypothalamic-pituitary-adrenal activity in response to cognitive therapy in patients with generalized anxiety disorder

The aim of this study was to evaluate the efficacy of cognitive therapy (CT) in the treatment of generalized anxiety disorder (GAD), as it would be reflected through both psychological and psychoneuroendocrinological parameters. For this purpose, a group of outpatients with GAD were treated with CT for up to a maximum of 24 sessions. In order to assess psychological and biological changes, anxiety-related symptoms were evaluated according to the Hamilton Anxiety Rating Scale (HAM-A), and the hypothalamic-pituitary-adrenal (HPA) function was determined through assessment of circulating cortisol levels. A significant decrease in the HAM-A scores, along with significant changes in plasma cortisol levels, were observed after completion of treatment with CT. These observations contribute to demonstrate that the effect of certain psychotherapeutic approaches, such as CT, may be observed at both psychological and biological levels.     

The Diving Bell Meets the Butterfly: Identity Lost andRe-Membered

Jean Dominique Bauby, former editor of Elle, suffereda stroke to his brain stem that left him with locked-in syndrome. Subsequently, through blinking his left eye, he writes his memoirof this experience, The Diving Bell and the Butterfly. Thispaper explores the meaning of embodiment, especially as one'sbody bears upon one's personal identity. It explores the variouschallenges and threats to selfhood that result from Bauby'sexperience and recounts how Bauby rises to the challenge throughhis memory and imagination.     

An Integral Psychology Response to Helminiak's (2001) “Treating Spiritual Issues in Secular Psychotherapy”

This article is a response to D. A. Helminiak's (2001) “Treating Spiritual Issues in Secular Psychotherapy” from the perspective of K. Wilber's integral psychology. The article consists of 3 sections: (a) a selective summary of integral psychology, including the perennial philosophy, 10 levels of development, lines of development, temporary states, types of orientations, the self, and the 4 quadrants; (b) various conceptual issues; and (c) usefulness to mental health practitioners (MHPs). Although D. A. Helminiak's endeavor to formulate a clear and functional definition of spirituality is commended, his claim of novelty is shown to be unwarranted. It is argued that K. Wilber's integral model is more comprehensive, clear, coherent, and helpful to MHPs.     

Ignorance May Be Bliss, But Thought Suppression Promotes Superficial Cognitive Processing

This study examined the impact of thought suppression on the quality of cognitive processing and self-reported mood. While completing a stream-of-consciousness task about two topics sequentially, participants were either instructed to suppress negative thoughts or were given no suppression instructions. Computer-based content analyses indicated that thought suppression led to significantly less causal reasoning and discrepancy seeking. However, the suppression of negative thoughts also resulted in a more positive mood. Results suggest that thought suppression can improve mood but it comes with the cognitive cost of superficial processing.     

Visual-Motor Integration Problems in Low Birth Weight Infants

This paper represents a review of the research that focuses on a population of strong clinical interest on a national and international scale—infants born with low birth weight (LBW). Among the numerous developmental deficits commonly associated with this group, one of the most frequently cited problems is poor fine- and visual-motor integration. In addition to the direct perceptual-motor development concern, the literature provides a reasonable case that such deficits place this population at increased risk for subnormal academic performance and difficulties with specific daily living (self-help) activities. By assessing the infant at an early age and designing specific strategies for intervention, clinical psychologists can play a major role in improving fine- and visual-motor behavior in this population.     

Exploring the Complexities of Familism and Acculturation: Central Constructs for People of Mexican Origin

We examined the relationships between three dimensions of familism: importance of family, family support, and family conflict with acculturation, assessed orthogonally (Mexican and American cultural contributions assessed independently), and the relative contribution these factors make to psychological adjustment among 248 (124 women, 124 men) adults of Mexican origin. After controlling for sociodemographic characteristics, positive associations were found between importance of family and the biculturalism of Mexican and American cultural identity; family support and Mexican cultural identity; but no associations between family conflict and level of acculturation. Psychological well-being was positively associated with Mexican cultural identity and family support, whereas psychological distress was associated with greater family conflict and lower family support. The greater relative contribution of Mexican cultural identity to familism and well-being, and the importance of assessing acculturation orthogonally are discussed. This research was supported in part by a Minority Supplement to National Institute of Mental Health Grant MH47193 to the Research Center on the Psychobiology of Ethnicity, Harbor-UCLA Medical Center and by a research award from Pitzer College to Norma Rodriguez.