Fluency Enhancing Techniques: Phrasing

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

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