COMPONENT 1 ESTABLISHMENT OF FLUENCY THROUGH
INCREASINGLY LONG AND COMPLEX LINGUISTIC STIMULI
Rationale: To provide a hierarchically based framework of application
of principles for breathstream management, decreased speaking rate,
oral motor planning, light loose articulatory contacts and self-
monitoring.
As the child increases the length and complexity of his/her utterances
they also increase the motor planning required to say these utterances
The motor planning required to coordinate the respiratory, phonatory,
and articulatory systems becomes increasingly complex. As the length of
the sentences increase, we also see an increase in the semantic and
syntactic complexity, as well as an increase in cognitive activity.
For the beginning speaker, language is a part of a complex array of
developing skills, including linguistic and speech motor, which are
essential to the production of fluent speech.
Research:
Conture (1990) - recommends intervention which moves from "simple"
to "complex" behaviors along a continuum of speech behavior.
Costello (1983) - developed an operant therapy approach based upon
extended length of utterance (ELU). Costello also advocates using
nonsyntactic word strings to effectively increase the length of
utterances while building fluency.
Perkins (1992) - reports that stutterers are more likely to be fluent
when using short, simple utterances.
Peters (1991) - incorporates the use of linguistic hierarchies, moving
from single word, to a carrier phrase + word, to a sentence, to two
to four sentences, gradually moving into conversation. Manipulating
clinician models, physical settings, and persons present are additional
components to intervention with young school-age children.
Riley and - noted that their clients stuttered more during longer
Riley (1983) and/or more complex sentences and that improving the
child's sentence formulation skills through a gradual increased
length of utterance program, proved successful in facilitating fluency.
Ryan (1984) - developed an operant therapy program (GILCU) based
upon gradually increasing the length and complexity of utterances.
Ryan reports a 100% success rate using this approach.
Shine (1980) - described stuttering as a discoordination of speech
muscle and language encoding systems, such that muscle innervation
is too slow to keep up with the language idea the child wishes to
express. He feels that beginning therapy with simple responses and
gradually moving toward the more complex aids the child in pre-
organizing his motor-planning strategies.
Stocker (1980) - found that dysfluency in children increases with
increased level of communicative demand placed upon the speaker.
Stocker developed both a diagnostic and therapeutic approach based
upon
Activities/Techniques:
1. Word Level:
a. Memory games are useful in eliciting single word responses.
The child names each picture upon turning it over. The
clinician models the same behavior, reinforcing the childŐs
fluency.
b. Go Fish games, using pictures or words, will elicit single
word responses which can be modeled and reinforced by the
clinician.
c. Bingo/Concentration games - playing concentration/bingo games in
which the client and clinician alternate turning over a card and
naming the item can be successful at developing spontaneous
fluency at the word level.
d. Secret Grab Bag games utilizing objects or picture cards,
drawn from a box or a bag, are fun ways to elicit single
word responses.
e. Classification games (where the child is asked to classify
a number of different pictures or words) provides a more
cognitively stimulating activity at the single word level.
The clinician chooses a number of different categories,
selected according to the childŐs age, and asks the child
to put each response item into the correct category.
Peabody language cards are helpful for this type of
activity.
f. Naming opposites - The client is presented with picture
cards and responds by naming the opposite.
g. Animal Farm - The clinician and the client take turns taking
animals out of a box and putting them on a farm. The client
names the animals as he/she puts them on the farm.
h. Sentence completion - The clinician presents incomplete
sentences which the child completes using one word. For
example:
1) The leaves fall from the _________
2) Turn the light ____________
3) Please tie my ____________
4) Open the ____________
5) The time is 6 o' ______________
2. Phrase Level:
a. Word Combinations - stringing words together in various ways is
the color + noun, noun + noun, and number + noun, can be easily
elicited through Uno, Trouble, Bingo, Concentration/Matching, and
sentence building games.
b. Carrier phrases are easily elicited with games such as
"Chutes and Ladders" and "Candy Land". The child is
instructed to respond at each turn with "I have a ______"
The clinician models this response throughout the game
and reinforces the child for easy, fluent phrase responses.
c. Memory games - Modify the child's response to include a
carrier phrase such as "I have a _______" "I have a match."
"There is a ______" or "This is a _______" may be substituted
or used in addition to "I have a _______"
d. Picture cards - (e.g. Winitz verb cards, Peabody Language
Cards, activity pictures) can be used to elicit a wide
variety of phrase level responses. For example, the
clinician may have the client use the cards in a drill
activity where a phrase response is required describing the
activity in the picture. The level of difficulty may be
increased by having the clinician ask questions such as
"What is the boy doing?" to elicit a response.
e. "Tell me what you do with it" games - By utilizing pictures
or words, the clinician can have the client describe what a
variety of things are used for.
f. "Simon Says" can be modified to be used at a two-phrase
level inserting a pause between "Simon Says" and "touch your
toes". This activity is also helpful in modeling reduced
linguistic complexity and appropriate pauses.
g. Game boards - The clinician prepares a game board that has
various colored squares. As the child lands on each color,
he/she is to pick the same colored card and read the phrase
written on the back of it.
3. Sentence Level: Complex multi-sentence level
a. Verb cards - These can be used in several ways; the client
can describe the action taking place in the picture, or two
pictures can be placed side by side and a complex sentence
may be elicited.
b. Picture books - The client is requested to provide a
sentence about each picture. Clinician modeling during this
task my be necessary to obtain the desired response. This
task may be introduced initially where the child simply
repeats back a sentence produced by the clinician.
c. Sequence pictures - The child is presented with sequence
pictures and is asked to arrange them in the proper order
while providing a sentence for each picture.
d. Fokes Sentence Builder - An excellent tool which can be
utilized to gradually increase the length and complexity of
the clientŐs sentences while providing visual stimuli. This
may also be utilized to elicit nonsyntactic word strings of
increasing length.
e. Guessing Games - The clinician and client can play guessing
games using pictures or ideas, where clues are given describing
a person, place or thing. For example, "It's an animal" or
"It's something you eat." The other person must guess the
secret thought.
f. Asking and Answering Questions - Activities which assist the
child in maintaing one's fluency when asking and/or answering
questions is pertinent to the school-age child who stutters.
("Brain Quest: Questions and Answers to Challenge the Mind" is
an excellent, fun set of materials. Each box comes with two sets
of questions and answers for preschool through 8th grade.
Questions are divided into the categories of reading, math,
vocabulary, social studies and science, and grab bag. These
are a wonderful way to supplement the child's regular education
curriculum while practicing fluency skills.)
g. Description activities - Using picture cards, the child is
asked to describe a variety of attributes of the picture.
"What does it look like", "What is it used for?", or
"Where can it be found?" are questions which may elicit
sentence length responses. ("Guess Who" is an excellent game
for eliciting descriptive sentences using visual stimuli.)
h. Jobs/occupations - Provide the child with pictures of
individuals depicting different occupations and instruct the
child to explain what each does.
i. Sentence transformations - Instruct the child to form one
sentence from two; e.g. "I have a coat. The coat is blue;"
to, "I have a blue coat."
4. Story Level:
a. Recount past events:
"What happened on your last birthday?"
"What did you do in school today?"
"Tell me about Christmas?", etc......use a topic that
requires sequencing and specific people/experiences.
b. Sequence cards
c. "What's Missing/Wrong Picture Cards" - The child describes in
two to three sentences what is missing in the picture or what
is wrong with the pictures. This language task, though higher
level in complexity, still remains at a simpler level of
complexity to ensure fluency success.
d. "What if Questions" - This task requires that the child propose
answers to certain hypothetical situations requiring language
reasoning skills ("What would you do if you saw smoke coming
out of a building?")
e. Books with no words - These are especially effective for the
very young child and the dysfluent child who is exhibiting delays
in reading development.
f. Reading Riddles, short poems - For some children who stutter,
reading may be a fluency facilitating task. Reading materials
which incorporate predictable rhyme patterns can assist in
learning how to phrase when speaking.
g. Felt board stories - These are common everyday stories which most
children know. Linguistic complexity is easily manipulated with
this type of material.
h. "All About Me Books" - Becoming more personal adds complexity to
this sentence/story task.
i. "Retell the Story" - Incorporating Rebus type stories in which
the child retells a story facilitates ease in language formulation
and linguistic complexity necessary for fluent speech production.
j. Giving directions - Obtain a variety of shapes or small objects,
two of each. One set is for the child and one set is for the
clinician. A barrier is needed to put between the clinician and
the client. The clinician will ask the client to describe, in
detail, sentence by sentence how to place the shapes or objects
Either a time limit or a certain number of sentences should be
used. The clinician can make it more difficult for the client
by shortening the time, increasing the number of sentences, or
creating other fluency disrupters that would help the client use
his tools for modification. For instance:
Clinician: "You need to make a picture with your objects.
Now you need to tell me, step by step, how to put my shapes
so that I can have a picture that looks exactly like yours."
Client: "Okay. First, put the circle at the top."
The client is expected to use his/her techniques throughout
the game (i.e., stretching, easy onset of voicing, soft
contacts). Response will be elicited through positive
reinforcement by the clinician when the client uses his
techniques.
5. Conversational Level:
a. Role playing
b. Problem solving
c. Opinions and Refutations
Idioms, Proverbs, and Analogies
Telling Jokes
d. General conversation about favorite activities, television
shows, the family, what happened in school
6.Storyline:
a. When presented aloud with the first sentence or two of a story,
the child will appropriately complete the storyline generating a
story of several more fluent utterances. The clinician should
consider the extent of emotionality included in the story line.
Un-emotional stories should be initiated prior to emotionally
loaded story lines. ("Easy Does It: 1 and 2" provide good
guidelines for addressing this component.)