Thursday, July 25, 2013

Fluency Basics {1000 Likes Celebration Day 4}

Fluency is an area that some people never get to work with.  I was fortunate enough to have a fluency client in the fall.  I was blessed to have the opportunity with him because he taught me SO much about treating fluency and how important fluent speech is.  Today, I'm going to be talking about my experience with him for Day 4 of 1000 Likes Celebration Week!

Yesterday's winners- Natalie S. won Space Hero Social Skills and Alison L. won Building Conversation! Congrats to you both.  You will be emailed by the end of the week!

The number one thing I learned while working with this client is that PATIENCE IS THE KEY! I mean it.  Our field takes patience no matter what client we're working with.  I believe fluency requires a little extra.  It requires patience on the client's part because they get frustrated with lack of instant progress and get frustrated that they actually have to practice to become more fluent (shocker....).  It also requires patience on the clinician's part to work with the client.  I had to deal with the client not showing up or cancelling at the last minute.  I learned from my supervisors that stuttering clients aren't necessarily the most consistent.  It took me awhile to get him to buy into therapy.

That being said, be patient with them, because it will be fun and worthwhile if they stick with it!!

Another piece of advice I have is to make therapy activities somehow relate to their interests.  Obviously this is the goal all of the time with every client.  I tried to explain to my client that practice was necessary and that he wasn't going to become more fluent until he practiced and put effort into it.  Well he didn't buy that.  So what did I do?  Explain it to him in football terms.  The coach wants you to do a new play at Friday's game.  Do you just walk onto the field and expect it to happen? No. You practice it over and over and over and over and over and over...sometimes until you feel like you're going to fall over.  That's when he started to finally get it!  Make it relevant and fun.

Now, I want to make this as practical for you as possible.  Let's start with assessment.  A complete diagnostic for stuttering should include these elements:
1. Case history, including how long they have been stuttering and at what point it started
2. Speech testing- articulation, informal speech sample, rate, disfluencies
3. Language- receptive and expressive language, vocabulary, pragmatic skills
4. Voice
5. Prosody
6. Other fluency behaviors- primary and secondary
7. Hearing Screening
8. Oral Mech Exam
9. Cognition
10. Behavioral observations- any concomitants?

You will write up your report using the information from those assessments above.  You will also include types of stutters, strengths and weaknesses, secondary behaviors, level or stage of stuttering, risk factors, and temperament.

For treatment, I believe it's important to discuss the client's beliefs about stuttering.  What is stuttering in his/her own words? What fears do they have?  It's important for the client to be open and honest about it and for you, as a clinician, to be open and honest back.

Some treatment goals for you to consider:
1.  For fluency shaping- reduce the frequency of stuttering.  This would be carried out by increasing awareness of stuttering, modeling new speech behaviors, and using positive reinforcement.

2. For stuttering modification- reduce the abnormality of stuttering.  This would be carried out by encouraging the person to correct the stutter immediately, change it while it's happening, or teaching them how to start a word smoothly to begin with.

Ok those are the BASICS!  I am NOT an expert on this topic at all.  This is just what I have learned from one client I had this year.  For more information, please consult The Stuttering Foundation.

Today I have TWO amazing giveaways for you.  The first is from my friend Shannon over at Speechy Musings.  She created this huge packet just for fluency goals.  There are really cute graphics to use as visual aids too!  Check it out here.

Enter the rafflecopter here:
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The second giveaway is from my friend Lauren over at Busy Bee Speech!  She has another great fluency packet!!  This one is called Fluency Tools, which is another great visual aid for our fluency friends!! Check it out here.

Want this packet? Enter the rafflecopter below:

a Rafflecopter giveaway

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  1. I don't have any fluency clients yet, but I would love to have one! The products in the giveaway are great!!

  2. No clients that I know of yet. Just starting a new job this year.

  3. As a new CF, I don't yet know what my caseload consists of, but I do know that there aren't many resources available for fluency in my speech room. Either of these products would be such a great addition! :)

  4. I do have students working on fluency. We work on easy onset and stretching sounds along with other things.

  5. I am the fluency clinic supervisor at National Speech Language Therapy Center in Maryland, and as such the majority of my caseload are children and teens that stutter. I am always so happy to see other therapists put in the effort to learn more about stuttering therapy, as I have seen my fair share of therapists not qualify children stating "does not have academic impact." We all know stuttering most certainly impacts children academically, most notably in their participation! Thanks for sharing your experience in your blog! My only suggestion would be to always stress to your clients that although we want them to practice their speech tools, that speech tools will not always work and that is not their fault! Not only should progress be measured in their use of tools and increased fluency, but also in changing the way they stutter (less tension or getting on the sound in the case of a block) and also in change in attitudes about their speech! If you're interested, I have my own blog dedicated to educating parents and speech therapists on fluency disorders at

    1. Brooke- Thank you so much for sharing! That is great advice and information to share with client. So great to have a blog dedicated just to that. I will definitely be checking it out!


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