How
can we help students use fluency enhancing strategies beyond the speech therapy
room? Transferring greater fluency to a variety of settings can be a big
challenge. If family and friends are reminded of this, they can partner with children,
not blame them, when carryover of new speech skills requires problem-solving
and patience.
A
common tool for carryover is called the “hierarchy”.[1] A
hierarchy is simply a sequence of activities that become gradually more
difficult. For example, a hierarchy may include first the use of choral speech, then immediate imitation, then delayed
imitation, then elicited speech and
finally, spontaneous speech. Factors that contribute to fluency breakdown
can be similar across students, but I doubt there is a one-size-fits-all
hierarchy. So, I view a hierarchy as a
process, a sequence of talking tasks that changes week to week depending upon a
student’s goal, attempts to change and lessons learned from each attempt. The process considers: When and with whom is the child courageous
enough to attempt a small speech change? How can the experience help to design a
subsequent attempt at change? In what
ways can listeners be educated about and appreciated for supporting the child’s
hard work?
Research
on fluency offers some guidance. We know that “many variables – such as
language, motor, cognitive, emotional, and genetic factors – interact in
complex ways” in the development and appearance of disfluency.[2],
[3]
Gosh, this feels overwhelming. So let’s focus on language for now, because we
also know that “The importance of the interactions of… language and speech
motor processes, is supported by a wealth of data including behavioral findings
that increases in utterance length and/or syntactic complexity are associated
with the increased occurrence of disfluency.” [4] We know that language demand affects fluency.
Where can family and friends find activities to do with children that control
for language difficulty?
I
should let you know that there are many commercially packaged therapy programs
for stuttering therapy. [5] Most
of them probably include a step-by-step program that includes a hierarchy of speech/language
activities. One exception is Easy Talker[6] ,
which does such an excellent job of presenting an overview of fluency therapy that
I give it to my middle school students for free. I’ve spent a small fortune on
products published specifically for speech therapy. However, the most fun and
cost effective activities were those I created using books, games, and videos found
in the clearance sections of book stores and discount outlets.
One
day I found some simple story books called “Reading Rod Readers” for only one dollar
each. They were orphans of a packaged, patented reading program published by
ETA Cuisenaire. [7]
The illustrations were colorful, the literacy goals explicit and the price was
right so I scooped up about 15 of them. They became part of take-home lessons for
my younger students. I mention this as
one example of children’s literature that controls for linguistic difficulty
and therefore offers families an opportunity for carryover practice. Such books
provide language content at prescribed levels of difficulty. The Reading Rod Readers that I discovered have
short language exercises at the end of each story to review vocabulary,
grammar, comprehension, and writing skills. Such graduated reading programs[8],
including the English Language Arts workbooks children are already using in
school, may provide opportunities for fluency practice.
Some
resources for language arts standards across age levels include:
·
The American Speech Language Hearing
Association [9]
·
Resources for Understanding the Common
Core State Standards[10]
·
Massachusetts Early Learning Guidelines
for Infants and Toddlers[11]
·
Massachusetts Curriculum Frameworks for
English Language Arts and Literacy[12]
·
World Class Instructional Design and
Assessment WIDA[13]
·
Partnership for Assessment of Readiness
for College and Careers[14]
Let’s
look at some research on language and fluency.
A
recent study examined the oral motor coordination of children who stutter while
saying sentences of different length and complexity. Here are some of the
study’s conclusions. Note that the abbreviation CWS means ‘children who
stutter’ and CTD refers to children who are developing in a
typical way.[15]
·
“For syntactically simple sentences, CWS
had significantly more variable articulatory coordination than CTD
·
“…reduced coordinative stability within
the speech motor system is likely a significant component of developmental
stuttering…
·
“…even during perceptually fluent speech
production, the speech motor systems of some CWS are functioning with a reduced
level of coordinative stability
·
“Perhaps responses to sentence length
and syntactic complexity differ between children who will persist in stuttering
and children who will recover.”
Another
recent study reviewed 170 different reports on the language skills of children
who stutter. Through a rigorous selection process, 22 studies were chosen that adhered
to specific research standards. Note
that these findings are described by the abbreviation CWS for ‘children who
stutter’ and CWNS for ‘children who do not stutter.’[16]
·
“…findings suggest that CWNS differ from
CWS on several language abilities…CWNS outperformed CWS on seven of the 10
comparisons of language abilities
·
“…findings, however, do not necessarily
mean that, on average, the language development of CWS is ‘disordered’…but
rather…CWS exhibit relatively consistent but subtle differences in language
abilities when compared to their normally fluent peers
·
“There is some question whether the
aforementioned between-group differences in language abilities contribute to
actual instances of stuttering…Be that as it may, one could speculate that when
planning/formulating sentences, CWS may experience subtle but important
difficulties in quickly and efficiently encoding and retrieving lexical items
·
“…comprehensive speech-language
assessment…may uncover concomitant speech-language concerns that need to be
considered in the development of a comprehensive treatment plan for the
child…assessment may indicate that CWS’s language abilities are subtly below
those of CWNS even though they fall within the broad range of normal
limits…coupled with environmental factors that can impede fluency…may constitute
a ‘tipping point’ (Gladwell, 2000) where normally fluent speech becomes
stuttered speech…”
The
relationship between language and fluency is not straightforward. I am not
recommending the purchase the Reading Rod Readers or any other specific program.
E very student has unique needs.
My idea to adapt language arts programs and children’s literature is
because of ease of access, portability, affordability, a global interest in
literacy, and the findings of recent research that link language demand with
speech fluency. Books can be shared with siblings, care givers,
extended family and friends as a consistent homework resource. Books transport
easily to anywhere the child visits socially or needs to spend time waiting at
siblings’ activities, restaurants or stores. Favorite books become family memorabilia
shared across generations. [17] Digital natives may like to browse for apps[18]
to supplement the book experience. Families with special interests may enjoy
finding books on favorite topics. Those lucky enough to live near a library can
ask librarians for age- and grade-level literature. Ask your speech language
pathologist what specific goal you and your child could generalize through the
use of children’s literature.
Happy reading!
[1] For example,
Carrie Clark explains a traditional, hierarchical approach to articulation
therapy in her excellent blog series at Podcast 5: Step by Step Guide for Teaching
Your Child a New Sound, Speech and
Language Kids, http://www.speechandlanguagekids.com/slk5-teach-a-new-sound/
[2] An example of
multiple goals relevant to fluency therapy, including a brief linguistic
hierarchy can be found in “Using the CALMS Model as a Thematic Approach to
Fluency Therapy” by Elise Kaufman (2005) http://www.mnsu.edu/comdis/isad8/papers/kaufman8.html
[3] My own graphic
of therapy is at (broken link)
[4] Megan K.
MacPherson and Anne Smith (2013) Influences of Sentence Length and Syntactic
Complexity on the Speech Motor Control of Children Who Stutter, Journal of
Speech, Language, and Hearing Research, Vol. 56, 89-102, p. 89.
[5] pro-ed (broken link) ; Super Duper Publications http://www.superduperinc.com/search/search.aspx
[6] Easy Talker: A
Fluency Workbook for School-Age Children (13554) ISBN: 9781416404729
Barr
guitar, PhD, Julie Reville, c 1997 now distributed by pro-ed
[7] This company now
has a new name and new products: broken link
[8] For example, Flash Kids, A Division of Barnes & Noble,
NY, NY; and, Spectrum Reading,
Greensboro, NC. ; and, the Scholastic Store http://store.scholastic.com/webapp/wcs/stores/servlet/HomeView?storeId=10052&catalogId=10051
[15] Megan K.
MacPherson and Anne Smith (2013), pp. 98-99.
[16] Ntourou, K.,
Conture, E.G., Lipsey, M.W (2011) Language Abilities of Children Who Stutter: A
Meta-Analytical Review, American Journal of Speech-Language Pathology, Vol. 20,
163-179, quotes are taken from pp. 173-175.
[17] “Memories of a
Bedtime Book Club: personal reflection on reading aloud and some book
recommendations, by Dwight Garner, NY Times, April 24, 2013,
[18] APPS for
Children with Special Needs broken link;Speech
Techie http://www.speechtechie.com/
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