The Gradual Increase in Length and Complexity of Utterance or (GILCU) (Ryan, 2001, pp. 114-121; Ryan & Van Kirk, 1978) is one of the three evidence-based treatment programs which has received recognition as a well-researched evidence-based treatment in at least seven different meta-analyses or reviews of treatment efficacy in stuttering (Brutten, 1993; Bothe, 2002; Bothe, et al., 2003; Conture, 1996; Cordes, 1998; Davidow, Crowe, & Bothe, 2004; Ryan, 2001; Thomas & Howell, 2001). Prolonged speech and the Lidcombe Program are the other two.

GILCU is a 56-step establishment (in-clinic) program starting with reading one word fluently and ending with conversing for 5 minutes with no stuttering. It is based on the principles of operant conditioning (Skinner, 1953). There are also transfer (extra-clinic generalization of fluency to outside environments) and maintenance (performance of fluent speech over time) and follow-up phases.

Evidence for this program has been collected in single-subject designs (e.g., Ryan, 1971, 1974). When a number of these studies had been completed, prospective randomized group designs were used to compare, first, four programs (Ryan & Ryan, 1983) and then later, two programs (GILCU and Prolongation) (Ryan & Ryan 1995). Finally, data (absent only control groups, Ryan, 2001 pp, 272-273) on 208 clients (8 different studies, including the above-cited studies) from the USA and two other countries will be found in Ryan (2001, pp. 118, 122).

University personnel who teach courses in stuttering/fluency disorders or supervise Communicative Disorders students in clinical practica in fluency/stuttering in a university are invited to participate in a project to teach the evidence-based treatment of GILCU, transfer, and maintenance programs in their universities to their CD students through self-instructional materials requiring usually about 3 hours of supervisor and student study. Teaching modules of counting stuttered words (with CD), assessment, using a stopwatch, GILCU, transfer, and maintenance and how to teach them is included.

Email Bruce Ryan (bpryan@csulb.edu) for an Agreement Form. After signing an agreement form and returning it to Bruce Ryan, all participants will receive a FREE copy of the Ryan Fluency Program Workbook (2005 through email in Adobe and one FREE CD and one FREE DVD to teach Counting Stuttered Words and to show models of the program, respectively, through priority mail.

University personnel who have signed agreements, turned them in, and received all materials may contact Dr. Bruce Ryan, at any time through email or telephone with any problems, questions, or other matters of concern.

Although participants may be able to achieve the installation of these procedures in their university, using only the materials above, but if working with adults, they may need the entire book of Ryan (2001) to provide additional procedures, especially in Transfer. This would require them to either purchase a book, or use a library copy, or already have one.

References

Bothe, A. (2002). Speech-modification approaches to stuttering treatment in schools. In J. S. Yaruss (Ed.), Facing the challenge of treating stuttering, Part 1: Selecting Goals and strategies for success. Seminars in Speech and Language, 23, 181-186.

Bothe, A., Davidow, J., Ingham, R., Crowe, B, Bramlett, R., Levy, J., Taylor, K. (2003, November). Systematic Review of Stuttering Literature. Paper presented at the meeting of the American Speech- Language Association meeting, Chicago, IL.

Brutten, G. (Ed.) (1993). Proceedings of the NIDCD Workshop on Treatment Efficacy Research in Stuttering, September 21-22, 1992 [Special Issue]. Journal of fluency Disorders. 18, 121-361.

Conture, E. (1996). Toward efficacy: Stuttering. Journal of Speech and Hearing Research, 39, S18-S26.

Cordes, A. (1998). Current status of the stuttering treatment literature. In A Cordes & R. Ingham (Eds.) Treatment efficacy for stuttering: A search for empirical bases (pp.117-144). San Diego, Ca: Singular.

Davidow, J., Crowe, B., Crowne, T., & Bothe, A. (2004). ³Gradual increase in Length and Complexity of Utterance² and ³Extended Length of Utterance² treatment programs for stuttering: Assessing the implications of strong, but limited evidence. In A. Bothe (Ed.), Evidence-based treatment of stuttering: Empirical bases and clinical applications. (201-230). Mahwah, NJ: Lawrence Erlbaum Associates, Publisher.

Ingham, J. (2003), Evdence-based treatment of stuttering: I. Definition and application. Journal of Fluency Disorders, 28, 197-207.

Ingham, R. Kilgo, M., Ingham, J., Moglia, R., Belknap, H., & Sanchez, T. (2001). Evaluation of a stuttering treatment based on reduction of short phonation intervals. Journal of Speech, Language, and HearingResearch, 44, 1229-1244.

Onslow, M., Costa, L., & Rue, S. (1990). Direct early intervention with stuttering: Some preliminary data. Journal of Speech and Hearing Disorders, 55, 405-416.

Ryan, B (1971). Operant procedures applied to stuttering therapy for children. Journal of Speech and Hearing Disorders, 36, 264-280.

Ryan, B. (1974). Programmed stuttering therapy for children and adults. Springfield, IL: Charles C. Thomas.

Ryan, B. (2001). Programmed stuttering therapy for children and adults (2ND Ed). Springfield, IL: Charles C. Thomas.

Ryan, B. & Ryan, B. (1983). Programmed stuttering therapy for children: Comparison of four establishment programs. Journal of Fluency Disorders, 8, 291-321.

Ryan, B. & Ryan, B. (1995). Programmed stuttering treatment for children: Comparison of two establishment programs through transfer, maintenance, and follow-up. Journal of Speech and Hearing Research, 38, 61-75.

Ryan, B. & Van Kirk (1978). Monterey Fluency Program. Monterey, CA: Behavioral Sciences Institute.

Sackett, D.L. (1998). Evidence-based medicine. SPINE, 23, 1085-1086.

Skinner, B. F. (1953). The science of human behavior. New York, NY: MacMillan. Thomas, C. & Howell, T. (2001). Assessing efficacy of stuttering treatments. Journal of Fluency Disorders, 26, 311-333.

Bruce P. Ryan, Ph.D.
Communicative Disorders Department 305
California State University, Long Beach
1250 Bellflower St. Long Beach, California 90840
Tel/Fax: 562 597 4293 Email bpryan@csulb.edu

added November 11, 2006