Fluency Techniques for Speech Therapy

The purpose of speech therapy for children who stutter is to help them learn how to communicate effectively and easily. Sometimes that means eliminating the stutter all together, such as with preschoolers experiencing developmental disfluencies. But often, especially for our older clients, the stuttering may never fully go away. Our job then is to help them communicate to their best ability and to help them learn how to handle stuttering and disfluencies when they arise.

Take a look at our therapy ideas below. Scroll down to the age group that you are working with and see what we recommend at each of these ages.

What Does the Current Research Say?

A systematic review of the literature was conducted in 2006 and you can find the link to the full review here:

http://ajslp.pubs.asha.org/article.aspx?articleid=1757629

Or, I can just summarize it for you 🙂

Basically, a bunch of researchers got together and said “I wonder what everyone’s figured out as the best ways to treat stuttering” and they compared a whole ton of studies. They took the best research out there and compiled this list of the best therapies. Here’s what they came up with:

Response Contingency Therapy for Children who Stutter

Based on the results of their findings, they decided that the most effective therapy for children who stutter is response contingency. This is the type of therapy that had the best positive outcomes for children who stuttered. A while back, I did an entire article on response-contingency therapy in preschoolers and you can see that entire step-by-step process here. I even include a video demonstrating it because it’s a bit counter-intuitive.

https://www.speechandlanguagekids.com/stop-stuttering-preschoolers-current-research-based-methods/

Other Evidence-Based Strategies for Children who Stutter:

Never you fear, evidence-based stuttering therapies abound! The compilation of research studies also mentioned that the following therapies were also found to be effective as well, though maybe not as conclusively effective as the response contingency one above.

• EMG (Electromyography): Requires use of computer
• Gradual Increase in Length and Complexity of Utterance (GILCU) Therapy: Start with saying one word fluently and then build up
• Prolonged or Smooth Speech: Lengthening words and natural pauses
• Regulated Breathing (especially with parent involvement): Breathing exercises to focus attention on breath for fluency
• Stuttering Modification: Pull-outs and other traditional methods

Woo Hoo! Options! Let’s dive into each of those separately:

Electromyography (EMG) for Children who Stutter

Ok, so apparently this is a therapy where you use an electromyography system to monitor a person’s electrical signals and when your speech is relaxed and slow, the device switches off the auditory feedback. When your speech is fast or tense, the device switches on DAF and FAF, to slow your speech.

Overall, it’s super complicated and not something you’re going to be able to do unless you already have all this equipment. And chances are, if you already have this equipment, then you know what to do with it. So, I’m not going to go into it here. If you’re a parent and are interested in trying this type of therapy with your child, you’re going to need to find a specialist who has this equipment and regularly performs this type of treatment. Moving on!

Gradual Increase in Length and Complexity of Utterance (GILCU) Therapy:

To explain what this therapy is, I bring you the description straight from the creator’s mouth, Dr. Ryan:

“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.”

The basic concept is that you have the student start by just saying a single word without stuttering. Once they can do that, then you have them say two words. Then, three. And so on and so forth until they can speak for 5 minutes without stuttering. The program also includes ideas for carryover and generalization.

I tried to find a place where you can purchase this program but it seems to be only mentioned in the literature and I couldn’t find a copy of the actual article. It seems that it should be described in great depth here: The Gradual Increase in Length and Complexity of Utterance or (GILCU) (Ryan, 2001, pp. 114-121; Ryan & Van Kirk, 1978), though I’m not sure how you locate that.

My recommendations would be to use this framework within your therapy though you don’t necessarily have to follow it exactly the way Dr. Ryan intended. In other words, start in therapy with having the child speak fluently in shorter utterances and gradually increase the length of utterance. As the utterance gets longer and the stuttering becomes more frequent, include some of the other techniques mentioned here to help the child achieve fluent speech.

Prolonged or Smooth Speech for Children who Stutter:

We consider this technique a fluency shaping technique which means it is a strategy that is taught to the stutterer to use to prevent stuttering (not to fix a stutter once it happens). With this type of therapy, the therapist will show the student how to slow down his speech, prolong vowels to make words last a little longer, and ease into all speech sounds. This results in a slow, calm manner of speech.

Speaking like this often results in the student speaking with fewer stutters or disfluencies. The downside though is that you sound pretty funny if you do this all the time. Over time, the student can learn how to speak like this in a less exaggerated way so that their speech sounds more normal. In the meantime, this can be used to help a stutterer feel the sensation of speaking smoothly and can be used to prevent disfluencies in high-stress situations.

Regulated Breathing for Children who Stutter:

In this type of therapy, the therapist will start by teaching the child how the respiratory system works and what it means to inhale, exhale, hold breath, breathe deeply, and breathe shallowly. The therapist will demonstrate all of these things and use charts and models to help the student understand the respiratory system. The student will also practice the different types of breathing as well.

Once the child fully understands the respiratory system and its role in fluent speech, the therapist will have the child practice passive breathing in a steady, controlled manner. They will work on having the student become able to identify when he is inhaling and when he is exhaling. This can be achieved and practiced using yoga breathing exercises.

Next, the therapist will teach the student that speech happens on the exhalation and that it is important not to force it out too quickly or let it out too slowly. The therapist will help the student practice saying single words with a normal exhalation. Then, the therapist will gradually increase the complexity of utterance as the child continues to maintain appropriate exhalation (see the section above about gradually increasing utterance complexity).

Once the student is able to use normal exhalation for single words and short sentences, the therapist will teach him how to chunk phrases and sentences so he can breathe appropriately. This may include talking about taking breaths at the ends of sentences or paragraphs as needed.

At this point, the therapist will simply analyze the student’s speech and note any odd breathing patterns and help the child identify when they are doing them and how to go back to normal breathing patterns. For example, if the student seems to be taking breaths rapidly when speaking in conversation, the therapist will point this out and help the student learn how to say more on fewer breaths.

Stuttering Modification: Pull-Outs and Others

Stuttering modification is based on the Van Riper approach. For an excellent explanation of the Van Riper approach, which includes stuttering modification, click on the link below:

4 Stages of Therapy:

1. Identification: The student identifies what type of stuttering they do and learns about stuttering.
2. Desensitization: The student confronts their stuttering along with their negative emotions about stuttering and learns to accept it.
3. Modification: The student learns stuttering modification techniques to help in moments of stuttering
   1. Cancellations- after stuttering, there is a pause and the word is said a second time using an “easy” stutter.
   2. Pull-outs- when a person begins to stutter, they are to say the rest of the word with ease.
   3. Preparatory set techniques- when the person anticipates a word to be difficult, they are encouraged to work through all sounds of the word slowly and calmly.
4. Stabilization: The student increases self-awareness and becomes able to use techniques and strategies himself.

Structured Curriculums for Children and Teens who Stutter:

Feeling overwhelmed?

Honestly, so was I.

That’s why I dug in and put all of these strategies together into step-by-step Curriculums that tackle fluency therapy from four different angles:

• Foundations for Fluency Curriculum: Coordinating breath with speech, becoming more aware of your disfluencies, and dealing with negative reactions to disfluencies
• Stuttering Curriculum: From indirect stuttering therapy for preschoolers up through direct strategies to help older children and teens when they find themselves in moments of disfluency
• Cluttering Curriculum: For children and teens who speak rapidly with many disfluencies
• Word-Finding/Word-Retrieval Curriculum: Help for children and teens who struggle to come up with the right words for things when they need them

Subscribe to our SLK Curriculum today and you’ll get access to all four of these Fluency Curriculums along with all of our other SLK Curriculums so you can have one streamlined system that you can use for every client on your caseload.