ASSESSMENT

FLUENCY ASSESSMENT SUGGESTIONS

1. Rote Tasks:
a. Counting: 1 20
b. Reciting the days of the week
2. Sentence Repetition Task
a. The dog chased the cat.
b. I like chocolate ice cream.
c. Tom has lots of fun playing ball with his sister.
d. Bill has a large black and white spotted dog.
e. Summer is my favorite season.
f. We are going to buy some candy.
g. I dont like snakes.
h. Was the car followed by the police?
i. Betty has a pretty doll.
j. John is playing with his drum.
3. Picture Description Task
4. Story Retell (e.g., Cookie Theft)
5. Reading Sample (gr. 4 up)
6. Conversation Sample

STUTTER TYPES
Take note of which stutter types the client usually has:
Blocks (the word is stopped or interrupted, however briefly, before its completion;the word may
come out forcefully, accompanied with a sudden burst of air and/or articulatory tension)
Repetitions (a sound, part of a word, a whole word, or part of a sentence is repeated)
Sound repetition a single sound is repeated (usually the first sound in the word)
e.g., f-f-father
Part-word repetition a syllable is repeated
e.g., fa-fa-father
Whole-word repetition the entire word is repeated
e.g., father-father
Phrase repetition part of the sentence/the entire sentence is repeated
e.g., My father-my father is a teacher.
Prolongations (a sound is stretched for an abnormally long time)
Combination stutters (2 or more of the above occur at the same time)
Take note if the client usually stutters:
at the beginning of sentences
in the middle of sentences
Take note about duration of stuttering:
how long, in seconds, is the longest stuttered moment?

COMPUTING % SYLLABLES STUTTERED

To compute % syllables stuttered (% ss):
# of stutters___
total # of syllables

X 100

___ % ss

*in order to get a good representation of the childs speech, obtain a 3 to 5 minute conversational sample and if applicable,
an oral reading sample.

COMPUTING RATE
To compute syllables per minute (spm):
Total # of syllables
# of minutes

= syllables/minute (spm)

*the norm for children is 160 to 180 spm and for adults is 180 to 240 spm

FLUENCY CASE HISTORY

NAME OF CHILD:
GRADE:
SCHOOL:
PARENTS/GUARDIANS:
PHONE #:
ADDRESS:
DATE:
LANGUAGE SPOKEN IN THE HOME:
1. Describe your childs health. List any current medications your child is taking.
2. Has your child ever had surgery on his/her head, face, neck, or chest?
3. Has your child ever sustained an injury that may have caused trauma to his/her head, face, neck, or
chest?
4. When did your child start to stutter?
5. Who first noticed your childs stuttering?
6. What was the stuttering like when it was first noticed? (e.g., easy repetitions, lots of struggle)
7. What is the stuttering like now? (all that apply)
your child repeats sounds, syllables, or words
your child prolongs (hold onto) sounds
your child has difficulty getting sounds to come out
the stuttering cycles (gets better or worse daily, weekly, or monthly)
the stuttering has worsened since it began
the stuttering has improved since it began
Your childs stuttering today is:
representative or typical of his/her usual speech
better than usual
worse than usual
Rate your childs stuttering:
the stuttering is mild
the stuttering is moderate
the stuttering is severe
8. Does anyone else in the family stutter? yes/no
If yes, please provide the following information:

List the relatives who stutter on the fathers side. Please indicate if any of these relatives recovered
or if they still stutter.

List the relatives who stutter on the mothers side. Please indicate if any of these relatives
recovered or if they still stutter.

9. Is your child aware of his/her stuttering? yes/no

If yes, how does your child deal with the stuttering? (e.g., stop talking, become frustrated, cry, ask for
help)
10. List situations when your child appears to stutter more?
11. List situations when your child appears to stutter less?
12. Are there any sounds, or words that seem more difficult for your child? yes/no
If yes, does your child avoid any sounds or words?
13. List any tricks your child uses to get words out?
14. What do you do when your child stutters?
15. How do family and friends react to your childs speech?
16. Has your child ever been teased?
17. Has your child received previous therapy? yes/no
If yes,
when?
where?
for how long?
what did your child work on?
was previous therapy helpful?
18. Are you interested in therapy now? yes/no
19. What are your goals for your child in this therapy program?
20. What are your childs interests?
21. Are there any other problems your child is experiencing? (e.g., difficulties at home or school?)
22. List any questions you have about stuttering.

Brutten (revised)
1. Do you feel like you talk properly (right)?
2. Is it hard to ask the teacher a question when youre in class?
(Does it make you nervous?)
3. Do you sometimes feel like words might get stuck in your mouth
when you talk?
4. Do you think people worry about (or think about) the way you talk?
5. Do you feel like its harder for you to give a report in class (book
report, presentation, talk in front of the class) than it is for most of the
other kids in your class?
6. Do the other kids in your class think that you talk funny (differently)?
7. Do you like the way you talk?
8. Do people sometimes finish words for you?
9. Do you think that your parents like the way you talk?
10. Do you find it easy to talk to most people?
11. Do you feel like your speech is good most of the time?
12. Is it hard for you to talk to people?
13. Do you think that you talk like other children you know?
14. Do you worry about (or think about) the way you talk?
15. Do you find it easy to talk?
16. Do you think that your words come out easily?
17. Do you think its hard to talk to strangers (people who are safe to
talk to, but that you dont know very well)?
18. Do you think that other kids wish they could talk like (the same as)
you?
19. Do kids ever make fun of or tease you about the way you talk?
20. Would you say that talking is easy for you?
21. Is it hard for you to tell someone your name?
22. Do you find that some words are hard for you to say?
23. Do you speak well with almost everyone?
24. Do you think that you sometimes have trouble talking?
25. Would you rather talk about something than write about it?
26. Do you like to talk?
27. Do you think that you are a good talker/speaker?
28. Do you ever wish that you could talk/speak like other children you
know?
29. Do you ever feel afraid that the-your words wont come out when
you talk (that they are there, but that they are stuck)?
30. Do you think that you talk better than your friends?
31. Do you worry or think about talking on the phone?
32. Do you think that you talk better when you are with a friend?
33. Do you think that other people are bothered by the way you talk
(do they seem to mind)?
34. Do you ever let other people talk for you?
35. Would you say that reading out loud in class is an easy thing for you
to do?

Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N

Average for children who stutter = 16.7

Average for children who do not stutter = 8.7

Fluency Profile
Severity Rating:
Severity Rating
% Stuttered Syllables (3-minute conversational sample)
Speaking Rate:
Syllables per minute
Normal (children: 160-180 syllables/minute)
Fast
Slow
Short rushes of speech
Omission of syllables
Fast articulatory rate (movement from sound to sound)
Long phrases
Infrequent pauses
Dysfluent behavior is primarily characterized by:
Blocks
Repetitions (
initial-sound,
part-word/syllable,
Description:
Prolongations of sounds
Description:
Length of longest stuttering moment in seconds

whole-word,

part-phrase)

Breathing is characterized by:

Audible inhalations
Fast airflow on exhalation
Speaking on low air
Short, rapid inhalations (clavicular breathing)
Speaking on inhalation
Secondary struggle co-occurring with moments of stuttering:
Laryngeal tension
Eye closing
Lip pressing
Jaw posturing
Head movements (forward)
Tongue protrusion
Loss of eye contact in stuttering moments
Body movements (foot tapping)
Other: (eye-brow furrowing, nasal flaring)
Stuttering on the day of assessment was described as:
Typical
More fluent than usual
More dysfluent than usual
Awareness of dysfluencies:
Good
Fair
No awareness
Avoidance behaviors:
Word substitutions
Circumlocutions (talking around a word)
Starter words (e.g., um, uh, like, well)
Not speaking
Back ups (backing up to the beginning and starting over)
Changing voice:
Other: (changing rate of speech - slowing down, speeding up)

1 minute conversation sample

Student: Is it starting?
S-LP: Yup, I got it started. So can you tell me what you like to do for fun when youre not a
school?
Student: Yyoouu mean, you mean when Im at home?
(combo: prolongation/ppr)

Student: Uh I,I well I like geography so much and I dr,draw these maps.
(wwr)

(isr)

S-LP: Oh you do?

Student: I,I draw maps of Canada, Alberta, an,and the world.

(wwr)

(isr)

S-LP: Thats so cool.

Student: I,I even m,ma,ma,make some on my computer.
(wwr)

(isr)

S-LP: Wow, thats amazing. So whats the last map that you drew? Can you tell me what it
looked like?
Student: Last map...hard to say.
Im,Im go,gonna draw w,way,way more and when Im maybe when Im sixteen years old Ill,Ill
(wwr)

(isyllr)

(combo: isr/wwr)

(wwr)

I wont draw maps anymore.

(block)

And I think Ill know what my last one is.

S-LP: Yeah...okay. Whats the one you did most recently? Like...
Student: You mean...

S-LP: Like not the very last one youll ever do in your life but the one maybe that you just
finished.
Student: Well I...uh...

Mom: Remember we drew a map the other day, last night on that scrapbook. You drew it for
me. You drew a map of what?
Student: Oh yeah, oh yeah, oh yeah.
Mom: Yeah what was it?
Student: I,it was Alberta.
(isr)

Mom: North America.

Student: No, no, no, no Alberta.
Mom: Okay.
S-LP: What did it look like? How did you draw it?
Student: Well I drew it like this. Thats,thats wwwhat our province looks like for real.
(wwr)

(prolongation)

S-LP: So what do you use when you make a map...like what kind of paper, pencils,
markers...what do you usually do?
Student: Oh, oh well I w,well I use markers, pens, n,not pencils.
(combo: ppr/isr)

(isr)

S-LP: Umhmm...okay...
Student: A,and I use this mmm -this paper with holes on the edges.
(isr)

(combo: block/wwr)

S-LP: Right, cool, okay...whats the biggest one you ever made?
Student: The biggest map oh...III dont know.
(prolongation)

Total # stuttered syllables = 20

Total # syllables =157
% ss = 12.74
Rate = 157 spm

Secondary struggle behaviours: reduced eye contact, ?eye blinking, ?jaw posturing
Breathing: mid-phrase audible inhalations (especially after initial repetition or word)
Stutter types: prolongations, isreps, wwreps, ppreps, blocks, combination stutters

FLUENCY TARGETS
Diaphragmatic Breathing (tummy breathing)
Many people who stutter may hold their breath before they start to speak. Sometimes they
hold their breath mid-phrase, when they are expecting to stutter on a particular word.
Another thing typical of stuttering is letting the air out in a rush as or before the first
sound is started (often this happens following a breath-hold). In order for the vocal cords to
work properly, slow, smooth, and continuous airflow is required. Breath-holds and fast rushes
of air can result in stuttering.
Because the diaphragm is the largest and most powerful muscle for breathing, it offers the
best control over the airflow. We teach clients to breathe from the diaphragm so the air
flows in and out slowly and smoothly (it isnt sucked in or pushed out).

Stretch
We teach clients to slow down their rate of speech so that they can monitor the other
fluency targets.

Pre-Voice Exhalation (puff of air)

Air is needed to make the vocal cords move. When the vocal cords move or vibrate they
create speech. The vocal cords should never be closed when we start to speak the air has
to begin to flow out of the lungs and through the vocal cords before the vocal cords can move
or vibrate. Many people who stutter try to speak before the vocal cords are open (when the
air is trapped under the vocal cords). We teach clients to breathe out for 1 second
(therefore opening up the vocal cords) before they talk.

Continuous Phonation (words holding hands)

Many people who stutter have the habit of using very choppy speech patterns, or very soft
volume with lots of breath and very little real vibration, resulting in mid-sentence stutters.
We teach clients to keep their voice on throughout each sentence. Continuous phonation
simply means that the vocal cords continue to vibrate from the very first sound of a phrase
to the very last sound of the phrase. This helps to prevent stutters from happening in the
middle of the sentence.

Pause & Plan (the 2 Ps)

This skill enhances the clients ability to use previously learned targets by encouraging
formulation of thoughts into words. The skill requires that the client take the time (pause)
to think (plan) of their next phrase(s) while continuing to practice the breathing target.
Once the idea is organized, the breathing is ready to support the phrase.

TEACHING FLUENCY TARGETS

(HELPFUL HINTS)
Diaphragmatic Breathing (tummy breathing)
-adequate breath support is an essential prerequisite for smooth, continuous voicing.
-many children who stutter do not appear to use their air efficiently. You may observe them
taking little gasping breaths, speaking on inhaled air, or speaking on low air. You may hear
air flowing out quickly on the exhalation (fast airflow) or you may notice upper respiratory
breathing (movement of the chest and shoulders).
-talk about upper respiratory (chest & shoulder) breathing. Demonstrate the difference.
Use the toothpaste tube analogy. If you squeeze a tube of toothpaste near the top (like the
chest and shoulder muscles around the lungs) lots of toothpaste comes out and it comes out
fast. If you squeeze a tube of toothpaste near the bottom (like the diaphragm underneath
the lungs), the toothpaste comes out slowly and smoothly more control!
-use picture symbols to help the child remember what to do when tummy breathing:
chair sit up straight
hand one hand on tummy to feel the tummy move & one hand on chest to feel that
there is no movement
mouth slightly open
ear should not hear any breathing
tummy with balloon string tummy is like a balloon when air goes in it gets big, and
when air goes out it gets small
wheel tummy should keep movingit should not stop
breathing hill in 2 out 2, 3, 4
-it is easiest to learn tummy breathing while lying down. Gravity helps to isolate the chest
and shoulder movements. Once the child has established breathing on the floor, move to a
chair. Use a mirror to watch the chest and shoulders.
-lots of kids are REVERSE breathers. That means their tummies go in when they breathe in
and their tummies go out when they breathe out. Talk about how the tummy is like a balloon.
When you put air inside, it gets big. When you let the air out, it gets small.
-it may help to put a kleenex box or book on the tummy so they can see and feel the direction
the tummy is moving.

-it may help to put your hand on top of their hand gently press down when they should
breathe out and release the pressure when they should breathe in.
-instead of counting, in 2, out 2, 3, 4 you can try, breathe breathe, blow, blow, blow, blow.
Smaller kids may have difficulty breathing out to 4, so you may need to reduce the count to
3.
-use a kleenex place it in front of the childs mouth so they can watch the airflow move the
kleenex.
-put your hand in front of the childs mouth so you can feel the air coming out.
-check to feel/watch that the child does not hold his/her breath at the peak of the
inhalation or at the bottom of the exhalation.
-always practice consecutive breaths (this reinforces continuous breathing and reduces
breath-holding).
-mouth should be slightly open when breathing in and lips should be slightly pursed when
breathing out. Pursed lips help to slow the airflow out.
-you should not hear the breathing (in or out) if you can hear it, the air it too fast! Say,
shh or I can hear you!
-make breathing FUN! Play games.
-when its your turn to breathe, make mistakes and see if the child can tell you what you are
doing wrong:
breathe loudly
keep your mouth closed
slump down or stretch out in your chair
place your hands in incorrect positions
move your chest and shoulders when you breathe
hold your breath (make sure your tummy stops moving)
-use gestures as a gentle reminder to use tummy breathing:
tap your tummy to cue the child to use tummy breathing
place your finger up to your mouth to cue the child to keep the breathing quiet

Target
Tummy Breathing

Stimulus
Material

Teaching Aid

Game Ideas

Homework Goals

Balloon
Kleenex box
Kleenex
Book on tummy
Picture symbols
Gestural cues
Mirror

Crocodile Dentist
Dont Wake Daddy
Jumping Frogs
Kerplunk
Games to Go
Dont Break the Ice
Buckaroo
Connect 4

Child:
learns to breathe from the tummy
consistently
learns how to count in his/her head
Parent:
counts out loud for child.
watches for chest/shoulder
involvement
matches count with childs breathing

STRETCH
-use a picture of an elastic band to symbolize this target
-talk about syllables (beats in a word). Practice tapping out 1, 2, 3, and 4 syllable words. Ask
kids to guess how many syllables are in your names.
-talk about stretching. Use an elastic band to show how it becomes longer when it is
stretched. Indicate that the word sounds slower when it is stretched.
-we really want to stretch out each syllable for about 1 second so that the kids can learn how
to slow down. Slowing down the speech rate gives them a chance to learn how to coordinate
tummy breathing with speech.
-when you stretch, you are stretching the vowel part of each syllable
e.g., baaat, paaaperrr
-start with vowels, 1, 2, and 3 syllable words, and then on to short phrases.
-once the child gets to short phrases, you dont need to stretch so much. Decrease the
stretch to approximately 1/3 of a second per syllable.
-be sure to practice tummy breathing while practicing stretch
e.g., In 2 out buuuterrrflyyy
-watch that kids maintain natural sounding voices. Many kids turn into robots and may can
also sound sing-songy!
-use gestures to gently remind the child to use stretch when he/she is talking:
pretend to stretch out an elastic band in the air

Target

Stimulus
Material

Teaching Aid

Game Ideas

Homework Goals

Syllable Stretch

Vowels
1-syllable words
2-syllable words
3-syllable words
is verbing
phrases

Elastic band

BINGO
Hangman
Blues Clues
Memory
Tic-Tac-Toe
Battleship
Quicktionary
Silly Sentences
Snakes &
Ladders
Trouble
Outburst

Child:
learns to combine tummy breathing with
speaking
learns to use consecutive breaths when
speaking
Parent:
learns to cue child to breathe by providing
breathing count
learns to watch where the child is in their
breathing cycle

PRE-VOICE EXHALATION (PUFF OF AIR)

Air is needed to make the vocal cords move. When the vocal cords move or vibrate they
create speech. The vocal cords should never be closed when we start to speak the air has
to begin to flow out of the lungs and through the vocal cords before the vocal cords can move
or vibrate. Many people who stutter try to speak before the vocal cords are open (when the
air is trapped under the vocal cords). We teach clients to breathe out for approx. 1 second
(therefore opening up the vocal cords) before they talk. This target is especially helpful for
children who block or use starters at the beginning of phrases.
Here are some tips:
-talk about the vocal cords. Talk about how the vocal cords vibrate together, like clapping
hands, to make noise. Have the child feel his/her vocal cords while saying, ahhhh. Tell the
child that the air they breathe out is used to make their vocal cords clap.
-use the door analogy to explain this difficult concept to the kids:
1. point to a closed door and say, lets pretend that door is just like your vocal cords
2. say, Im going to try and go out that door the way it is (walk into the door)
3. ask the child, Why cant I get out?
4. say, So, if I open the door first, I can get outyour vocal cords are just like a door
they need to be in the open position before air can get through to make them clap
togethera puff of air will help to open them up
-use picture symbols to help the child remember this target:
door
cloud (puff of air)
-it is very important to keep a hand on the tummy so the timing of the breathing can be
monitored. Draw the childs attention to the fact that the tummy should move in for 1
second before talking. **Watch for a sudden extra inhalation before the child starts to
talk.
-kids should start to talk on the count of 2
e.g., In 2 Out 2, 3, 4

cat
-start with vowels, 1, 2, 3 syllables words, and move on to short phrases.
1

-watch that the exhalation is CONTROLLED again, you shouldnt hear the breathing. Also,
watch that any remaining air after the target response is released gently and not blown out.
-try for consecutive practice attempts to facilitate continuous breathing.
-you may also wish to introduce light touch/ gentle touch at this point (if child continues to
block when initiating speech).

Target**

Stimulus
Material

Teaching Aid

Game Ideas

Homework Goals

Pre-Voice
Exhalation
(Puff of Air)

Vowels
1-syllable words
2-syllable words
3-syllable words
Phrases
Y/N Qs
(requiring short
responses)
Sentence
completion tasks

Door
Picture symbols

BINGO
Hangman
Blues Clues
Memory
Uniset
Folder Fun
Tic-Tac-Toe
4 In a Row
Battleship
Quicktionary
Okay Card Game
Tribond
Silly Sentences
Games to Go
Snakes &
Ladders
Trouble
Outburst

Child:
learns to feel their tummy move in for 1
second before speaking

**taught to older
children (grade 2
and up)

Parent:
watches for a sudden extra inhalation right
before child begins to speak
cues child to let out a little, quiet breath of
air before speaking
monitors sufficient supply of air for speaking
(watches for vocal tension or change & if
needed, asks, Did you have enough air to say
your sentence?)

WHAT TO TRY WITH A CHILD WHO HAS SEVERE BLOCKS

The following skills are typically very difficult for young children (kindergarten & grade one)
to learn. However, if the child is evidencing severe blocks, it may be necessary to teach
him/her the following skills:

Pre-Voice Exhalation (puff of air)

See above.

Light Touch/Gentle Touch

Sometimes, when starting a word, the lips, tongue, jaw, and teeth press so hard that the
word wont come out. This usually happens on words starting with consonants, especially the
p, b, t, d, k, and g sounds. It may also happen with other consonant sounds, such as f, s, sh,
ch, j, h, and th. When the articulators come together too hard, this causes the airflow to
stop and the voice isnt able to turn on. To help get these sounds out, they must be made
more gently. Here are some tips:
-use a picture symbol of a pillow to help the child remember this target.
-practice touching the index finger to the thumb in 2 ways: hard and then light/gently (just
barely touching) so the child gets a sense of hard vs. light.
-press the lips together hard and then light/gently (just barely touching).
-press the tongue to the alveolar ridge hard and then light/gently (just barely touching).
-demonstrate hard vs. light/gentle contacts on various consonant soundsask the child, did
that sound hard or light?
-model light contacts in words beginning with consonant sounds and ask the child to imitate
you. Instruct the child to barely touch the articulators required to make each beginning
consonant sound.
-dont let the child break the flow of phonation or articulation between the sounds.
-when a blend occurs, the light touch technique is used on both sounds (e.g., stop)

-ensure that the child does not eliminate the fricatives or plosives entirely in an effort to
reduce the pressure.
-move from words to short phrases, and then to sentences.
-use gestures to gently remind the child to start lightly/gently:
place your index finger to your thumb
-once the child has mastered this skill, you may also wish to introduce the block correction
technique, cancellation (see page 26).

Target
Light Touch/Gentle
Touch

Stimulus
Material

Teaching Aid

Consonants
Picture symbols
Words beginning Gestural cues
with consonants:
1-syllable words
2-syllable words
3-syllable words
Sentences
beginning with
consonant
initiates

Game Ideas
Yahtzee
Creatures & Critters
BINGO
Go Fish
Battleship
Crazy 8s
Slamwich
Hiss
Memory

CONTINUOUS PHONATION (words holding hands/words linked)

-this target is most effective in controlling mid-phrase dysfluencies.

-continuous phonation or vibration of the vocal cords prevents closure of the vocal cords and
thus eliminates the need to re-start mid-phrase.
-if working with smaller kids, refer to this target as words holding hands or words linked.
-use picture symbols to help the child remember this target:
hands holding together
chain
different chains linked and broken
-discuss and demonstrate continuous vs. non-continuous voicing. Ask the child to feel the
vibration at the site of the vocal cords:
say,ahhhhh and then say, ah-ah-ah-ah.
practice phrases/sentences to feel the difference between continuous and noncontinuous voicing
e.g., MynameisMary vs. My name is Mary.
-demonstrate phrases/sentences with and without continuous voicing and ask the child to tell
you if the words were holding hands/linked.
- talk about how you want to keep all of the words holding hands or linked so that there
arent any cracks between the words. If there is a crack, a stutter could jump in.
-practice with phrases and short sentences.
-be sure to encourage use of previously taught targets. This is also a GREAT time to provide
positive reinforcement for SPONTANEOUS use of targets.
-use gestures to gently remind the child to link/connect his/her words during talking:
connect your hands
link your fingers like links on a chain
-teach pause & plan with this target

Target
Continuous
Phonation
(words holding
hands/words linked)

Stimulus
Material
Qs requiring
short responses
(i.e., sentence)
Sentences

Teaching Aid

Game Ideas

Homework Goals

Picture symbols
Gestural cues

Guess Who?
Yahtzee
Creatures & Critters
Barrier Games
BINGO (longer
sentences)
Go Fish
Tribond
20 Questions
I Spy
Crazy 8s
Riddles
Slamwich
Chipper Chat (Super

Child:
pauses & plans and then focuses on
keeping voice on
uses slightly stretched (1/3 of a
second), natural-sounding speech
Parent:
encourages child to think before
he/she speaks
provides feedback about whether the
child sounds natural

Duper)

Who/What/Where/
When/Why? Question
& Answer Card (Super
Duper)

PAUSE & PLAN (stop & think)

-most parents report that this target appears to be most useful in facilitating fluency
beyond structured speaking activities.
-formulating prior to speaking allows the child to maintain phonation throughout the
sentence.
-use picture symbols:
stop sign & a person thinking
-if we dont think about what to say first, it is very difficult to:
keep our breathing going
keep our words linked
maintain fluent speech
-point out that it is important to keep the tummy breathing going when thinking about what
to say. Lots of people hold their breath when they think! Once the idea is organized, the
breathing is ready to support the phrase.
-use gestures to gently remind the child to stop and think:
try tapping your finger on your head
put your hand up as if to stop the child

Target
Pause & Plan
(at this point you
are integrating of all
the targets)

Stimulus
Material
Short answer
Qs
Qs requiring
formulation
Conversation
Description
tasks
Transfer
practice

Teaching Aid

Game Ideas

Homework Goals

Picture symbols
Gestural cues

Pictionary
Barrier Games
Suitcase Game
Headbanz
Creatures & Critters
(longer sentences)
Scavenger Hunt
Describing Fun with
Cats & Dogs
Story Starters
Whats Wrong
Pictures
Show & Tell

Child:
formulates thoughts prior to speaking
in structured and semi-structured
activities
Parent:
encourages child to pause and plan
while inhaling
cues child to keep tummy breathing
if more thinking time is required

CANCELLATION (stutter buster)

-there are 2 objectives:
1. the stutter is stopped immediately so that further tension does not build up
2. targets are used specifically on the difficult word to facilitate fluency
-the child must have an awareness of when he/she is stuttering to be able to apply this
technique. Talk about bumpy speech or stutters. Ask the child if he/she feels when a
bump or stutter occurs.
-introduce this skill as the STUTTER BUSTER
-introduce the steps required to BUST the stutter:
1. you stutter
2. as soon as you feel the stutter, STOP talking
3. let out your air/let out a sigh
4. take a new breath (in 2 out)
5. try the difficult word again gently and then keep going
e.g., I have a pet c-1 (stop2)
(air out3)
(in 2 out4)

cat5.

-remind the child to start again at the difficult word. Most individuals try to re-start at the
beginning of the sentence which isnt typically effective. Demonstrate how starting at the
beginning of the sentence can sound like a broken record. (e.g., I have a pet c-, I have a pet
c-, I have a pet c-)
-ask the child to generate a sentence. Then, ask the child to choose a word in the sentence
to have a fake stutter on. Demonstrate how to use the stutter buster on the word.
Instruct the child to practice the fake stutter followed by the STUTTER BUSTER.
-remind the child to let it go or bust that stutter"

INTEGRATION OF TARGETS
-you have introduced all of the targets and the child is successful in using them in words,
phrases, sentences, and during structured gamesnow what?
-give the child practice in using ALL of the targets (or the ones that are most helpful) during
less structured activitiesremind parents to set up a regular practice time. It is also
important to remind parents not to expect that their child should use the targets all the
time.
-play games and conduct TRANSFER activities. Start with easy tasks and move on to more
challenging tasks.
-this may be a good time to talk about AVOIDANCES. Ask the child if he/she has any
fearful sounds, words, or speaking situations. Include these in your transfer hierarchy (start
with easy tasks and move on to more difficult tasks)
-this may also be a good time to talk about TEASING/BULLYING. Ask the child if this is
occurring. The child will need to learn effective ways to deal with teasing/bullying. Be sure
to discuss concerns with the childs parents and classroom teacher. You may be able to
access resources from the school.

Target
Integration
(all targets)

Stimulus
Material
Qs requiring
short responses
(i.e., sentence)
Conversation
Description
Tasks
Transfer
practice

Teaching Aid

Game Ideas

Homework Goals

Gestural cues

Pictionary
Suitcase Game
Scavenger Hunt
Barrier Games
Headbanz
Tribond
Show & Tell
Riddles
Goosebumps
3 for Me
Walk n Talk
Interviews
Conversation
Starters
Child brings own game
from home and
explains rules to group
storytelling
Phrase-marked
reading

Child:
uses all targets in less-structured
speaking activities, transfer to new
situations (e.g., ordering at a
restaurant).
more responsible for self-evaluation,
rather than relying on parent feedback
Parent:
provides praise for childs use of
targets
begins use of a non-verbal cueing
system throughout childs day
understands that it is not realistic for
the child to use targets all the time

WAYS TO PRAISE YOUR CHILD

Praising smooth speech:
No bumps there!
Great job!
That was really smooth!
Nice talking!
That sounded great!

Praising good targets:

Wow, great breathing!
Nice stretch!
Great, you remembered your puff of air!
I liked how your words were all linked!
Good work; I could tell you remembered to stop and think!

WHAT TO SAY & DO WHEN YOUR CHILD STUTTERS

Pat your tummy to remind him/her to use targets.
You can say, Try that bumpy word again, in 2 out
Say, Lets try that again with words holding hands.
Say, Woops, lets try to stop and think first.
Say, Oops, that was a bit bumpy, lets try that again.
Give your child lots of time to speak - dont interrupt or finish your childs
sentences.
Show your child that you are listening maintain eye-contact and get down to
your childs level.
Try to eliminate other disruptions (background noise, siblings interrupting,
etc.).
Slow down your message this will encourage your child to do the same.
Limit asking questions that put pressure on your child to speak.
If your child becomes upset or says, I cant say it or It wont come out, be
accepting and comment, That was hard for you to say or That was a tough
word.

TRANSFER IDEAS
The following suggestions are just to get you started. If you have your own ideas, try them
out!
Use targets while:
Having a conversation:
Talk to mom or dad tell them about your day.
Talk to the speech-language pathologist while walking.
Talking to strangers:
Order some food at a restaurant.
Go to the library & inquire about a book or ask the librarian how to locate a specific book.
Go to a department store and ask the store clerk for a specific item.
Stop a person & ask for the time.
Talking on the phone: (be sure to work on scripting and rehearsing)
Call a friend & talk for 1 minute.
Call a relative & talk for 1 minute.
Call mom or dad from a friends home.
Answer the phone at home.
Call the bus company & ask about costs or about routes to a particular place.
Call the pet store & ask about particular breeds of dogs/cats/birds, cost of food,
accessories.
Call the video rental store & ask about particular videos or memberships.
Call a book store and ask about specific books; do they carry magazines?
Call a toy store and ask about a game or toy.
Call a museum or gallery & ask about hours, ticket prices, special exhibits.
Call a music store & ask if they have a particular CD.
Call a pizza place & ask about their specials.
Call a computer shop & ask about specific software or a game.
(you can also find lots of ideas from Fluency At Your Fingertips)
Talking to family:
Ask a brother or sister a question.
Talk to mom or dad while riding in the car.
Talk to mom or dad while watching t.v.

Asking survey questions:

Survey staff, students, family, or friends (about holiday plans, favorites, ect.; the S-LP can
help come up with survey ideas and questions)
Giving speeches:
Give a speech to a small group.
Give a speech to a large group.
(the S-LP may wish to talk to the teacher about upcoming classroom/school presentations)
Talking to friends:
Tell someone a riddle, explain how to play a game.
Tell a friend about a favorite t.v. show.
Talk to a friend at a friends home for 1 minute.
Play a game with a friend.
Reading out loud:
Read a story to
.
Read out loud to a small group.
Read out loud to a large group.
(the S-LP may want to talk to the teacher about upcoming reading activities within the
classroom/during school presentations)
Telling stories:
Use story starters (individual, small group or large group)
e.g., If I were King for a day

MAINTENANCE
-did you know that maintenance is the most important phase of therapy? Many parents and
children think that therapy is no longer needed because the child is so fluent. Our
most successful clients have continued to attend therapy sessions for 12 to 18 months
after learning their skills.
-continue to challenge the child. Start sessions off with a review of the targets, practice
some structured speaking activities, and then practice using targets in more difficult
speaking situations. Therapy sessions wont be as frequent but periodic follow-up is
NECESSARY.
-parents should continue to review the targets on a periodic basis.
-parents should continue to encourage 2-5 minutes of breathing practice and use of skills
every day. Encourage them to set aside time each day for a special time to talk with
their child.
-be sure to discuss REALISTIC EXPECTATIONS. It is not realistic to expect kids to use
their targets all day. Most kids feel comfortable stuttering at home its a SAFE
ENVIRONMENT. Parents should not push for 100% use of skills at home. This,
however, does not make the child EXEMPT from daily practice. Tell parents/children
that their ability to use targets to control moments of stuttering will deteriorate if
they dont continue to practice.