About the presenter: J. Scott Yaruss, PhD, CCC-SLP is Associate Professor of Communication Science and Disorders at the University of Pittsburgh, teaching classes on stuttering and counseling methods, and Associate Director of Audiology and Communication Disorders at Children's Hospital of Pittsburgh. A Board-Recognized Specialist and Mentor in Fluency Disorders, his research examines the linguistic, motoric, and temperamental factors that contribute to the development of stuttering in young children and on methods for evaluating treatment outcomes in children, adolescents, and adults who stutter. Yaruss has published numerous article and is a frequent presenter, helping clinicians feel more comfortable working with individuals who stutter. He is the co-author of The Source for Stuttering: Ages 7-18 and the Overall Assessment of the Speaker's Experience of Stuttering (OASES).

You can post Questions/comments about the following paper to the author before October 22, 2008.

Too Much, Too Little, Just Right

by J. Scott Yaruss
from Pennsylvania, USA

Changing speaking patterns presents a significant challenge for young children who stutter. Clinicians can help children learn make changes in their speech by ensuring that they understand not only what changes they must make, but also why those changes help their speech. The problem is that very young children may not be able to easily understand all of the concepts that are important for achieving success in therapy. Although concepts such as "slower rate" or "reduced physical tension" may seem clear on the surface, their application is not necessarily straightforward--particularly for children whose speech and language abilities are still developing.

One way that clinicians can help children develop the understanding they need is through the use of analogies for describing complicated concepts. Many clinicians have discussed the analogies they use to help their young clients understand the goals and methods of therapy. The purpose of this "clinical nugget" is to share some analogies that the present author has found useful with preschool and young school-age children who stutter.

Many of the most commonly used concepts in stuttering therapy involve slowing speaking rate or reducting physical tension. Initially, young children may not understand the difference between "fast" vs. "slow" rates or "increased" vs. "decreased" tension. This is similar to the challenge that young children in articulation therapy may experience when learning the difference between correct and incorrect sound production. In articulation therapy, clinicians may even need to begin the therapeutic process by teaching the concepts of same vs. different and right vs. wrong before she can successfully implement standard therapy techniques such as identification or discrimination tasks.

In stuttering therapy, the lesson that children must learn is even more complicated. In articulation therapy, the clinician can focus solely on correct vs. incorrect productions -- there are only two options that need to be understood (right vs. wrong). In stuttering therapy, however, it is possible for a child to slow speaking rate or reduce physical tension too much. Thus, for changing speaking rate, there are three options: too fast rate (which increases the likelihood of stuttering), too slow rate (which makes it difficult to communicate), and "just right" rate. The same is true for tension reduction strategies: too much tension (common during moments of stuttering), too little tension (which makes it impossible to speak), and just right tension.

Without this third level (just right), children may not understand the true target of their speech modifications. They may simply think that they need to "slow down" without understanding how much they need to slow down. When children understand that they are trying to achieve something in between too fast and too slow, they willl achieve greater success with their modifications. Of course, teaching this third level makes the therapeutic task more difficult.

Fortunately, young children can understand the difference between too much, too little, and just right. In fact, the concept is central to a popular children's story: Goldilocks and the Three Bears. In the story, the main character learns that some of the porridge is too hot, some of the porridge is too cold, and some of the porridge is just right. Similarly, children who stutter can learn, for example, that some speaking rates are too fast, some speaking rates are too slow, but others are just right. (A couple nice opportunities to review the story or Goldilocks and the Three Bears are here and here).

To help children understand this concept, we can expand the analogy to include many different non-speech examples. The more tangible the examples are, the easier it is for the child to grasp the concepts. For example, a Matchbox or Hotwheels car can be pushed too fast. If it is, it is likely to crash! (Check Roary the Racing Car for an example of too fast!) A toy car can also be pushed too slowly, in which case it will not be able to win a race. Only if the car is pushed just right will it be able to compete. Another simple example is running: if a child runs too fast, he is more likely to fall down. If he runs too slowly, he will not with the race. He has to run just right. Similar examples can be found in video games (higher levels are harder than lower levels because the game plays too fast), driving (if the child's parents drive too fast they will get a ticket, but if they drive too slowly they will hold up traffic), shooting baskets (if the child tries to shoot too quickly, he is likely to miss, but if he goes too slowly, then another player may take the ball), drawing and coloring (if they color too quickly, they will go outside the lines; if they color too slowly, they won't have good control over the crayon), and more. (One additional advantage of these activity-based analogies is that they are all easily applicable to group therapy.)

These and other analogies can help young children understand the concepts of too much, too little, and just right; however, the child still need to spend a considerable amount of time practicing these changes in their speech if they are going to be able to achieve success in therapy. In fact, all of these discussion about concept will not actually do the child any good at all unless the clinician repeatedly ties the concept back to the act of producing speech. Thus, after introducing the analogies, the clinician must explain how going "too fast" when running relates to going "too fast" when speaking.

For example, the clinician can say something like this: "When we try to run too fast, we're more likely to trip. That's just like talking! When we try to talk too fast, we're more likely to have trouble saying what we want to say. Of course, if we try to run too slowly, we won't win the race, so we have to run at just the right speed. When we're talking, we don't want to go too slowly. We want to go at just the right speed. Let's practice that!" And then, the clinician can reinforce the lesson by engaging in a practice activity in which the slower rate (or other speech target) is practiced.

By blending the use of concrete, tangible analogies with direct work on speech modifications, clinicians can help their young clients improve their understanding of their speech therapy goals as well as their ability to use their speech techniques in real-world situations.

You can post Questions/comments about the above paper to the author before October 22, 2008.

May 28, 2008
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