Goal: Improve Fluency Through Use of Indirect Strategies and Parent Training

Young children often go through completely normal periods of dysfluency. We call this developmental dysfluency. When evaluating a young child who stutters. We look at a list of common “red flags.” If the child has a lot of red flags, we will want to move into direct therapy as soon as possible to address the problem, as the child is less likely to resolve that kind of stuttering on his own. However, if a child does not have many red flags, then we may want to do some indirect therapy for a time to see if the child is able to resolve the issue on his own. This type of therapy is more about changing the child’s environment than bringing attention to his stuttering directly. This guide will help you understand how to do that.

This plan is broken out into two phases.  Phase one involves changing the child’s environment through parent training and indirect strategies used in the therapy room.  If the client’s fluency issues don’t resolve with these strategies, you can move to teaching bumpy/smooth and fast/slow as more aggressive indirect strategies.  These will help the child learn to modify his/her speech without actually addressing the stuttering.

Sample Goal:

Phase 1: Environmental Modifications and Parent Training: 

Client will participate in at least 10 minutes of conversation with a therapist or parent/caregiver using a variety of indirect fluency strategies (such as slow speech, stretchy speech, indirect statements, and undivided attention).

Phase 2:

Client will independently demonstrate bumpy or smooth speech in their own speech during structured speech activities with at least 80% accuracy.

Download the No-Prep Therapy Kit:

We have a start-to-finish therapy kit that will give you everything you need to practice this skill in therapy and send home homework.  Click the packet below to open it.  Then, print it out and place it in the child’s notebook or binder.

Therapy Phases:

Phase 1: Indirect and Parent Training

  1. Parent Training: Parent/caregiver will demonstrate understanding of the nature of stuttering and potential risk factors and will list 5 changes that can be made at home to reduce stuttering (such as, slowing self-rate of speech, not interrupting or filling in words, reducing daily tasks/demands, providing time to connect 1:1, and establishing routines).
  2. Slow Speech: Client will participate in at least 10 minutes of conversation with a therapist or parent/caregiver who is speaking using a slow rate of speech (an indirect strategy aimed at improving fluency).
  3. Stretchy Speech: Client will participate in at least 10 minutes of conversation with a therapist or parent/caregiver who is speaking using smooth, stretchy speech (an indirect strategy aimed at improving fluency).
  4. Indirect Statements: Client will participate in at least 10 minutes of conversation with a therapist or parent/caregiver who is speaking using indirect statements (like “I wonder what you had for lunch”, instead of “what did you have for lunch”) and adding appropriate pauses (indirect strategies aimed at improving fluency).
  5. Undivided Attention: Client will participate in at least 10 minutes of conversation with a therapist or parent/caregiver who is speaking using undivided attention and uninterrupted listening (not interrupting the child or finishing sentences for him/her; these are indirect strategies aimed at improving fluency).
 
Phase 2: Teaching Fast/Slow, Bumpy/Smooth

 

  1. Fast/Slow Identification in Others’ Speech: Client will independently identify if the therapist is using fast or slow speech with at least 80% accuracy.
  2. Fast/Slow in Own Speech: Client will independently demonstrate fast speech or slow speech in their own speech during structured speech activities with at least 80% accuracy.
  3. Slowing on Command: Client will slow his/her own rate of speech when prompted by a therapist or parent/caregiver during speaking tasks on 4 of 5 opportunities.
  4. Bumpy/Smooth Identification in Others’ Speech: Client will independently identify if the therapist is using bumpy or smooth speech with at least 80% accuracy.
  5. Bumpy/Smooth in Own Speech: Client will independently demonstrate bumpy or smooth speech in their own speech during structured speech activities with at least 80% accuracy.
 

What’s Next?

Supplemental Materials

Here are some other resources that may help you when working on this skill:

Fast vs. Slow Activity Worksheet

Start with fast/slow first as that one will be easier to understand.  Say something very quickly and then stop to comment on it.  Say “Wow, that was fast.  I was speaking too quickly.  I need to slow down.  Let me try again.”  Then say it very slowly.  Say “That was slow”.

Bumpy vs. Smooth Worksheet

For this one, you’ll do the same but you don’t necessarily need to say things like “I need to make it smooth”.  We want to convey the idea that bumpy speech is ok and smooth speech is ok, they’re just different.  This will reduce the stress and anxiety about stuttering. 

No-Prep Pacing Board Worksheet

During the indirect phase of therapy, we’re not talking about the child’s speech at all. Instead, we’re addressing the concepts of fast speech/slow speech and bumpy speech/smooth speech in order to indirectly target communication.

Goal: Improve Breath Control and Function to Improve Fluency and Voice

Resources and no-prep kit for improving breath control and function in children.

Training Videos:

Need some extra help on treating this skill?  Check out these related training videos:

Webinar Recordings:

If you need some in-depth information related to this skill, check out our related webinar recording(s):

Resources, Tools, and Training for Speech-Language Professionals

*** The SLP Solution is for informational and educational purposes only and does not provide medical or psychological advice.  We provide general resources but cannot tell you exactly what should be done for a specific client.  Every client is different and your clinical judgement should be used when making decisions about specific individuals.

 

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