Within each child,
there may be unique cognitive demands driving his/her verbal expression and
complicating our assumptions about the amount of linguistic challenge he/she is
experiencing. If we know that language complexity
affects stuttering, then we need to alert students to this issue explicitly. I
think we need to tell children that language is a deliciously complicated code
that could be affecting their efforts to carryover new speech skills. This idea
evolved as I learned more about teaching literacy. We can integrate our knowledge of fluency and
literacy in our lesson plans. Early literacy lessons nowadays include explicit
instruction in phonological and phonemic awareness. School age children are routinely taught the
rules of grammar and composition in native and foreign language classes. So
perhaps it will be simple to include a more detailed understanding of
linguistics as part of a child’s fluency treatment program.
Children learn fluency enhancing
skills by playing speech/language games which gradually become more difficult. “For
most children, fluency can be produced more easily when semantic and syntactic
demands are lower... numerous activities can be implemented to first establish
fluency at a simple level before increasing linguistic demands and expecting
higher levels of fluency.” (1) This is familiar territory for speech language
pathologists (SLP). These games are fun ways to control language complexity
across single word-, phrase-, single- and multi-sentence, story-, and conversational-
levels of linguistic challenge. In this blog entry, I’d like to suggest that
paying closer attention to each child’s expressive language – rather than the
structure of the speech game per se - may be one more way to help them move
beyond the speech games into real life communication.
For example, if reduced speaking rate could be
more explicitly connected to language complexity, would it also be easier to
use? A child can slow down his speech rate in several ways. For example, he can
slow overall oral motor movement and use more frequent pauses. (2) At a two-week Stuttering Foundation of
America workshop I attended in 1992, pauses were combined with phrasing and
Easy Relaxed Approach-Smooth Movement (ERA-SM) (3). An example of phrasing can be found in the Parent Practice for Easy Talking handout
on the website of the Stuttering Center of Western Pennsylvania (4). I’m going
to refer to this collection of behaviors as “phrasing” since this blog is about
paying attention to linguistics in stuttering.
My students have
difficulty with phrasing because it interferes with powerful suprasegmental
aspects of expressive language. Children’s words are woven together with intonation
and emotion to become large parcels of ideas. My students’ eyes glaze over when I explain
that phrasing allows more time for speech-motor planning, word retrieval, and
sentence formulation. To them, the mechanics of phrasing is a distraction and a
challenge to working memory.
So
let’s say we approach his goal from a different perspective. What if we disguise
the mechanics of phrasing with a costume of linguistic relevance? If phrasing
could be made more explicitly meaningful, would it be easier to use. It’s time
to remember our school language lessons! Sentences are constructed to express
“relationships among propositions or chunks of content.” (5) How? By combining ideas in the form of several
kinds of subordinate and coordinate clauses. And it turns out that SLPs familiar
with literacy have a way to measure this. They measure children’s language
complexity by counting these clauses.
I won’t go into detail
here, but, a “T-unit” is a single independent clause “plus whatever other
subordinate clauses or nonclauses are attached to, or embedded within, that one
main clause.” (6) Hypothetically
speaking, if two children recalled the same story book with the same amount of information,
the child using fewer T-units is likely to have done so with more complex
language. She has communicated the information in fewer sentences by embedding
it in more complex grammar.
I am becoming especially
sensitive to the complexity of children’s spontaneous expressive language as
they attempt activities beyond the speech games. The child using more complex language
in his/her independent attempts to own the process of carryover, may be more
dysfluent than the child who uses simpler language. Children who naturally use
more complex language – or who have complex thoughts and reduced language
skills – could be alerted to this possibility. As an SLP, there are times when
I do not feel it best to simplify expressive language for the sake of fluency. There
are times when I would want to nurture the interaction between complex thought
and complex language, taking this time to observe rather than manage stuttering.
Perhaps this could also be a child’s explicit personal goal as well.
What if
we could now teach phrasing as a strategy for expressing complex thoughts? If phrasing was a communication tool to assist listeners in comprehending complex syntax and to add power to
the message perhaps it would feel more natural and easier to use. Phrasing
allows listeners more time to digest complex language. It highlights the most
important concepts being conveyed. Listen to any well-trained public speaker
and you will hear this happening. Perhaps this is how the mechanics of speech
production, [reduced rate + pausing + ERA-SM (or easy onset) + phrasing] might
be disguised as simple communication competence. Maybe this would make fluency
enhancing skills more relevant and accessible.
I had the privilege of
coaching a student for the English portion of her Bat Mitzvah this month. [Pausing
+ phrasing + rate reduction+ easy onset] were particularly effective for this bright,
energetic and charming young woman. One practice strategy was to select two
sentences from anywhere in her presentation and record how long it took her to
read them. She read the same two sentences several times over, changing how long it took to say them.
The goal was flexibility, discovering the feeling of modifying speech rate at
will. She repeated this exercise several
times with different pairs of sentences. But it seemed that an even more
effective coaching tip was for her to think about what part of each sentence
she wanted her audience to really get. She’d spent many hours thinking about
her message, putting it into words, and editing it to her satisfaction. It was critical that she consider how her
delivery might convey that message most
effectively. The mechanics of speech now had linguistic relevance. It was the
message that mattered.
“Later language
development is characterized by growth in the ability to communicate in flexible
ways for diverse purposes.” (7) Our language is dependent upon the speaking
situation. The language used to give a Bat Mitzvah speech or an oral report in
science class is not the same as the language of conversation. Expository language is generally more complex than
conversational language. Research indicates
that, in general, our conversational language becomes more complex as we get
older. However, not expository language. “…even young school age children were
able to use subordination [e.g., subordinate clauses] as frequently as middle
aged adults, but young children require a task that is cognitively challenging
to reveal their syntactic competence.” (8). This implies that when children who
stutter present oral reports in class, participate in class discussions, or
recall the events of an exciting day, they are challenged not only by the
speaking situation (e.g., emotion, time pressure, listener reaction), but by more
complex language demands as well.
Most children seem to
acquire basic language skills in a magical sort of way. There is a developmental
progression guiding the infant’s babbling to the first grader’s adult-like
language. But studies suggest that “…later syntactic development is not
primarily a matter of acquiring new grammatical structures. Rather, it seems to
be more a process of learning how to use existing structures with greater
efficiency and dexterity to communicate complex thoughts in a way that is clear
and informative.” (9) This brings to mind the children I’ve met who appeared to
be high potential learners. These
bright, gifted, and talented children are driven by an intellect beyond age and
grade level expectations. (10) They have big ideas but lack the speech motor
planning/execution skills and sentence formulation abilities to respond with
the speed, precision, and efficiency required to reveal what they are thinking.
I’ve come to the end
of another blog that, upon reflection, seems to state the obvious. Show
children how the grammar lessons they tolerate in school may actually be
relevant to their attempts at carryover of greater fluency. I listened to a
radio interview couple weeks ago with an author who said that he writes stories
to answer questions he has about the world. This is my new mantra. Perhaps this
blog was my first experience walking my way through the question, “Why have I
been attracted to literacy issues in my work as a fluency specialist?” The
answer may only be new to me!
(1)
Peter
R. Ramig & Darrel M. Dodge (2010) The Child and Adolescent Stuttering
Treatment and Activity Resource Guide, NY: Delmar Cengage Learning, p. 147
(2)
Peter Reitzes, (2009) “Pausing and Stuttering”, http://www.mnsu.edu/comdis/isad12/papers/therapy12/reitzes12.html
(3)
Kristen
Chmela (2008) “Using a Reading Bucket
Activity in School Age Stuttering Therapy”. Kristen refers to both ERA-SM and
pausing/phrasing in this article. ERA-SM is somewhat similar to what others
refer to as easy onset.
(5)
Cheryl
M. Scott & Nickola Wolf Nelson (2009) Sentence Combining: Assessment and
Intervention Applications, in Written
Language Assessment and Intervention, American Speech Language Hearing
Association Self-Study 8190. P. 12
(6)
Ibid
p. 14
(7)
Marilyn A. Nippold et. al. (2005) Conversational vs. Expository
Discourse: A Study of Syntactic Development in Children, Adolescents, and
Adults, Journal of Speech Language and
Hearing Research, 48, p. 1048
(8)
Ibid.
p. 1057
(9)
Ibid.
p. 1058