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Easy Does It® for Fluency Preschool/Primary
Ages: 2-6   Grades: Toddler-1

Use play-based activities with clear goals and techniques to shape fluency.  This program is adaptable to direct and indirect therapy and meets the needs and interests of young children. 

Outcomes

  • Shape fluency through motor, linguistic, and psychosocial changes
  • Use easy onsets, light contacts, and continuous phonation
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#31091
$51.95
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Experienced and beginning clinicians love the Easy Does It series for its:  

  • detailed explanation of therapy techniques
  • evidence-based therapy plans
  • clear goals and objectives
  • step-by-step progression of lessons
  • student practice activities and materials
  • take-home activities

Easy Does It for Fluency Preschool/Primary is based on the premise that much learning takes place through modeling.  Fluency is shaped through motor, linguistic, and psychosocial changes.  The activities are play-based and supplemented with materials from the 169 page Materials Book. 

The program is organized around five levels of progress: 

  • Experiencing Easy Speech: The child experiences fluency through the use of slow, easy speech using slightly exaggerated inflection patterns. (Inflection patterns and speaking rate are normalized as the child progresses.)
  • Establishing Easy Speech: The child imitates the use of easy speech in stereotyped and carrier sentences, and progresses to using easy speech in novel sentences.  Thirty-four play-based activities are outlined with instructions, materials, and home activities.  
  • Desensitizing to Fluency Disrupters: The child maintains the use of easy speech while tolerating pressures which may disrupt fluency.  Disruptors are presented in the form of people, noise, interruptions, new locations, contradictions, time pressures, emotional topics, and competition.
  • Transferring Fluency: The child uses easy speech in real-life situations.  Activities begin with semi-structured tasks and progress to spontaneous speaking tasks.  The response type becomes more conversational and the length of responses increases. 
  • Maintaining Fluency: Direct therapy contacts are reduced as the child maintains the use of easy speech for longer periods of time without therapy intervention. 

Copy the student activity pages or print them from the FREE CD.  The all-in-one program includes:

  • therapy manual with 188 activities
  • 169 page materials book
  • troubleshooting tips and suggestions for modifications
  • home activities
  • home and school letters
  • sample lesson plans

Copyright © 1998

Components
2-Book Set: 117-page therapy manual, 169-page materials book plus a CD of the reproducible pages
  • ASHA (1995) promotes use of a hierarchy going from single words to conversation fluently, role-playing social situations to desensitize a patient's reaction to stuttering, and implementing parent and teacher support for carryover of targeted fluency skills.
  • Fluent children between four and five years of age can distinguish between fluent and disfluent speech and usually assign a negative label to disfluent speech.  Children often reported they wanted to be friends with a child who showed fluent speech.  This has clinical implications of not only the rationale that very young children can identify disfluent speech, but also the negative social consequences if a young child does not improve with fluency strategies (Ezrati-Vinacour, Platzky, Yairi, 2001).
  • Preschool children who stutter were found to have quicker response times and more fluent speech during a picture description task after a priming sentence was provided versus when no priming sentence was provided (Anderson & Conture, 2004).  Use of imitation, carrier phrases, and speech modeling in this book all provide examples of priming as a fluency enhancing measure.
  • Young children who stutter showed more difficulty adapting to a new environment, showed greater attention span, and more variability in biological patterns, such as hunger and sleep, in comparison to children who do not stutter.  A therapy approach should take these results into account to provide effective fluency intervention (Anderson, Pellowski, Conture, & Kelly, 2003).
  • Use of fluent conversational skills, in various social situations relevant to the child, need to be directly addressed in therapy for successful transfer of targeted skills and discharge from speech therapy services (Weiss, 2004).

Easy Does It for Fluency Preschool/Primary incorporates these principles and is also based on expert professional practice.

References

American Speech-Language-Hearing Association (ASHA). (1995). Guidelines for practice in stuttering treatment. Retrieved September 9, 2009, from www.asha.org/policy

Anderson, J.D., & Conture, E.G. (2004). Sentence-structure priming in young children who do and do not stutter. Journal of Speech, Language, and Hearing Research, 47, 552-571.

Anderson, J.D., Pellowski, M.W., Conture, E.G., & Kelly, E.M. (2003). Tempermental characteristics of young children who stutter. Journal of Speech, Language, and Hearing Research, 46, 1221-1233.

Ezrati-Vinacour, R., Platzky, R., & Yairi, E. (2001). The young child's awareness of stuttering-like disfluency. Journal of Speech, Language, and Hearing Research, 44, 368-380.

Weiss, A.L. (2004). Why we should consider pragmatics when planning treatment for children who stutter. Language, Speech, and Hearing Services in Schools, 35, 34-45.

Author(s)

Barbara A. Roseman, Karin L. Johnson

Biography

Barbara A. Roseman, M.A., CCC-SLP, is an associate professor at Augustana College in Rock Island, IL.  She is also the director of the Augustana College Center for Communicative Disorders.  Barbara is the past president and fellow of the Illinois Speech and Hearing Association.

Karin L. Johnson, M.A., CCC-SLP, is an associate professor at Augustana College in Rock Island, IL.  She is also the director of the speech-language pathology program, the chair of the department of speech communications and theater arts, and the chair of the fine arts division at Augustana College.

Barbara and Karin have co-authored numerous publications in the areas of fluency disorders, motor speech disorders, narratives, birth-to-three intervention, and metalinguistics.  These longtime LinguiSystems' authors have also written The Fluency Companion and Easy Does It for Fluency Intermediate.

Introduction

Easy Does It for Fluency Preschool/Primary is an individualized, systematic therapy program for children ages two through six with stuttering disorders.  This program is systematically organized, but is not meant to be a "cookbook."  Carefully look at the progression of activities and tailor them to meet the needs of each child.

We have attempted to anticipate and address possible problems that may arise when you are working with a child. In addition, we have provided specific activities for parents/caregivers and daycare/preschool teachers.

 

Rationale
Easy Does It for Fluency Preschool/Primary is based on the principle that much learning takes place through modeling.  Because easy speech can be learned the same way, the use of modeling is an inherent component of this program.  Goals and objectives are set up in a hierarchy to enhance shaping and generalization of the easy speech.

This therapy program is an integrated approach that combines the flexibility of stuttering modification with the structure of fluency shaping.  It is systematically organized based on developmental norms, interest level, and author experience.

This program addresses three components usually theorized as potential causes of stuttering:

  • Motor
    This is addressed by modeling easy speech using slightly exaggerated inflection patterns and a slow speaking rate (usually about 90 to 110 words per minute).  As the program progresses, you will model normal inflection patterns and a speaking rate that matches a rate conducive to fluency for the child.  Typically, that rate is about 110 to 130 words per minute, a slower rate than is usually used by an adult.  Easy onsets, light contacts, and continuous phonation will also be modeled, but not directly taught.
  • Linguistic
    This component focuses on length of utterance.  As you introduce different tasks, the child produces one-word utterances.  The child's utterance length eventually increases to sentences and then to conversation.  Initially, the child will respond by imitating, and then progress to use of stereotyped and carrier sentences.  The complexity of the linguistic task increases with question-and-answer tasks. Finally, the child engages in conversation.

    Language appropriate for young children is used throughout this program.  Activities help to develop vocabulary and syntax as well as to introduce words that are often difficult for the child who is stuttering (e.g., I, what).  In addition, transfer tasks are organized around pragmatic functions of informing, controlling, ritualizing, expressing feelings, and imagining.
  • Psychosocial
    This is addressed by incorporating work on attitudes.  Since the people with whom a child has contact may impact therapy, activities involve the people most important in the life of a young child.  Similarly, since fluency can be affected by disruptions, a number of fluency disrupters are introduced to desensitize the child to their influence.

Basic Principles
Easy Does It for Fluency Preschool/Primary is divided into five steps for the child to work through to reach his goal of fluent speech.

  • Step 1 Experiencing Easy Speech: The child experiences fluency through the use of slow, easy speech.  During the activities in this section, model a slower speaking rate (120-130 syllables per minute or 90 to 110 words per minute).  Also use appropriate inflection, stress, and pausing patterns.
  • Step 2 Establishing Easy Speech: The child establishes fluency through use of easy speech.  We have found that modeling slightly exaggerated inflection patterns may be needed at the onset of this step.  Continue modeling a slower speaking rate.
  • Step 3 Desensitizing to Fluency Disrupters: The child maintains use of easy speech while tolerating pressures which may cause a disintegration of fluency.
  • Step 4 Transferring Fluency: The child transfers easy speech from structured activities to real-life speaking situations.
  • Step 5 Maintaining Fluency: The child maintains fluency while decreasing the frequency of direct therapy contacts.

This program progresses in order from Step 1 through Step 5, but there is some overlap in completion.  For example, work on transferring fluency begins in a subtle manner during Step 2, and work on desensitization continues from Step 3 throughout Step 4.

It's difficult to determine a child's success rate in completion of each step, but experience has revealed that most children are able to complete Step 1 within one or two sessions.  Because most children are able to experience fluency using the activities in this step, it's helpful to review these activities at the beginning of subsequent sessions.  It's also helpful to use the activities to reestablish fluency when a child is having problems.  Many children are able to complete Step 2 more quickly than Steps 3, 4, and 5.

When beginning this program, daily therapy is ideal.  If daily therapy is not possible, schedule therapy for at least two half-hour sessions per week.  Individual therapy sessions are recommended throughout the program, with some group sessions when working on Steps 3 and 4.

 

Lesson Plans
Sample lesson plans are included to demonstrate how a number of objectives may be targeted within one session.  It's important to realize that the number of activities targeted within any objective as well as the number of different objectives targeted within any session will vary significantly depending on each child.  For example, one child might need to complete many activities targeting the same objective before mastery is achieved, while another may need to complete only one or two activities.  We suggest that you begin and end sessions with an activity that the child can accomplish fluently.

 

Assessing Progress
Easy Does It for Fluency Preschool/Primary is not a step-by-step approach, but rather a systematic therapy program individualized for each child.  Therefore, no criteria for completion have been established.  Instead, allow the child to experience a high degree of fluency before moving to the next objective.

In general, a child is ready for dismissal after:

  • demonstrating less than two part-word repetitions per 100 words and no struggle behaviors
  • demonstrating less than one prolongation per 100 words and no struggle behaviors
  • you and the child's family feel that the child's fluency is appropriate for his age

Integration of Phonological Therapy
Recent research has indicated that a large number of children with disfluencies also demonstrate phonological deficits.  Since it's possible to address both disorders simultaneously, suggestions on how to do so are included.

Indirect vs. Direct Therapy

  • Indirect: When working with many young children, you do not need to identify a child's stuttering behavior.  Instead, an indirect program is sufficient.  Modeling easy speech and encouraging the child to speak the same way often results in fluent speech for the child.

    When therapy is indirect, direct reinforcement is not needed, nor is it recommended.  Every effort should be made to prevent calling attention to the child's speech.  Use of direct reinforcement, such as saying "good talking," often defeats the purpose of indirect therapy.  It's recommended that indirect reinforcement be used with comments like "That was fun," or "We played that game well."
  • Direct: Some children may benefit from a more direct approach.  These children are often more severely involved.  They are usually aware of their problems with fluency and need direct suggestions on how to change their speech.  If needed, introduce the terms "hard talking" and "easy talking."  Tell the child that there are two ways to talk, "a hard, pushing" way and an "easy" way.  Model the easy way and encourage the child to "talk in the easy way."  The puppet EZ may help introduce the concept in a concrete way.  Use both concrete and verbal reinforcement in Step 2, Establishing Fluency.

Involvement of Support Providers
Before beginning therapy, talk to the child's parents/caregivers about the therapy program.  Explain the program, its objectives, and how it progresses from easy, structured tasks to harder, conversational tasks.  Explain how the length and complexity of responses is carefully controlled and that activities are designed to meet the interest level and the language level of the child.  Stress the importance of family involvement throughout the program.  Talk about the need for family members to participate in sessions and to implement suggestions at home.

Make sure to communicate with parents/caregivers routinely.  Letters are included for you to send home at the onset of each step.  Occasionally arrange a face-to-face meeting so you can answer questions or model activities to practice at home.

If the child is in a daycare or preschool setting, ask the parents/caregivers to sign a release so you may communicate with the personnel in those settings.  Once you have obtained the release, talk to daycare/school personnel at the onset of therapy.  Explain the program and its objectives, just as you described it to the child's parents/caregivers.  Make sure to communicate routinely to answer questions and receive input.  Invite personnel to observe and/or participate in therapy sessions.  Letters are also included in the Therapy Manual for you to send to daycare/preschool personnel at the onset of each step.

We hope you find this program to be as helpful in planning your therapy as we have.  Remember to use it as a guide when planning an individualized therapy program for each child.  Feel free to add your own creative touches!

Barbara and Karin