The Effectiveness of Rate Reduction on Speaking Fluency with Children Who Stutter (CWS)

Question

Parents and teachers are often advised to refrain from telling children who stutter to "slow down" or "take your time" when they speak. As clinicians, should we NOT talk to our students with fluency disorders about "slowing down"?

Answer

Great question and one doesn't have a simple answer. That said, research consistently indicates that rate reduction has a positive effect on speaking fluency although there are differences of opinion about why this occurs. On the other hand, children who stutter (CWS) are virtually unanimous in their negative reactions to reminders for reduced rate.

In response to this question, it is important to consider that clinicians hold a different position in the child's world than do parents, teachers or friends. From my perspective, clinicians seem to fall into the same category to children as dentists do to adults.

An adult goes to the dentist when he or she has an issue with dental health. The dentist makes a diagnosis and treats the condition. As an adult, I expect that. What I don't expect is to hear is my spouse, hairdresser or friends make comments in the local grocery store, "How's that dental problem? If you would just floss, you wouldn't have that problem. Are you using your dental hygiene techniques?" If that is irritating and embarrassing to an adult, we can assume that similar reminders for the use of fluency tools have the same negative impact on children.

When considering whether a clinician should prompt his or her clients to use a slower rate,
my response is "yes" if it is done in a way that promotes positive attitudes toward speaking and the therapy process. There is a difference between teaching valuable fluency enhancing techniques and speech "nagging"; sometimes that balance is not easy to achieve. Ethically, we are speech experts and our clients and their parents have come to us for help. It is our responsibility to promote practices that will benefit our clients. In my experience, it is important to do so in a way that is positive, encouraging and fun or it will seem like nagging and over-zealous correction.

Toward that goal, I have a few suggestions:

1. Model what you want the child to do. Altering anything about our speech is very challenging, even to adults. As a trained clinician, if we can't make these changes, how can we expect a child to do it?


2. To reduce negative experiences with speaking, help the child get relief from speech "nagging" in his environment. Encourage parents and teachers to model a reduced speaking rate and increased pausing in their own speech.


3. Demonstrate and practice rate reduction in motivating, upbeat ways. Cowboy Sam makes frequent appearances in our clinic. Cowboy Sam is slow walking and slow talking. My clients and I take turns playing the role of Cowboy Sam. We also can get speeding tickets from the Sherriff for speeding on the speech highway.


4. For children 10 and older, consider switching your focus away from speech rate and toward phrasing. Phrasing has the benefit of reducing conversational rate without concentrating on speaking rate. This process also teaches CWS to identify linguistic "chunks." Not only does this skill enhance fluency, it also supports competence in more complex language structures needed for advanced education. Phrasing provides as many benefits for the listener as it does for the speaker and improves the overall quality of communication.

Perhaps that is the long way to say, teaching reduction in the speed of communication is an important tool in enhancing fluency and in overall communication. As a clinician, you can not ignore the positive impact of this strategy as a part of your treatment plan. Consider your client's cognitive, linguistic and social/emotional status when designing your plan. Ask him what is helpful. It is a lot easier to prompt for reduced rate or phrasing in therapy if it is a skill that your client has determined is beneficial.

Free checklists to help children identify what practices are helpful/not helpful in his or her environment are available at www.therapyinprint.com.

This Ask the Expert was taken from the course entitled: Stuttering Therapy for the School-Aged Child: Phrasing Techniques presented by Kathy Swiney, CCC/SLP, BRS-FD, ASHA Board Recognized Specialist- Fluency Disorders.

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Kathy Swiney practices in both public schools and private practice in Houston, Texas. She is an ASHA Board Recognized Specialist in fluency disorders. Kathy is the co-author of "Sound Strategies for Sound Production: A Multisensory Approach for Improving Intelligibility" (Pro-Ed) and "Well Versed: Poetry Based Articulation, Language & Fluency Therapy" (Therapy in Print).