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-

 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.

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 


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
   b. Go Fish games, using pictures or words, will elicit single
      word responses which can be modeled and reinforced by the
   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 
   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
         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

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

   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.)