An easy, effective treatment for preschool stuttering.
Whether you frequently work with children who stutter or not, you’ve probably heard of using syllable-timed speech as a treatment approach. Before I began using it, I pictured a highly unnatural practice of speaking along to a metronome and thought, that can’t possibly generalize! I also remembered from grad school that in adults, syllable-timed speech can help establish fluent speech, but does not lead to long-term improvements in fluency.
Then I had a client who improved tremendously using the Lidcombe Program. He went from daily stuttering severity ratings of 7-8 down to severity ratings of 3-4. His confidence and relationships improved as well. It was amazing...but we simply could not move to the maintenance stage of the program because his progress plateaued. That’s when I did a little research on syllable-timed speech and found the Oakville Program. The Oakville Program combines syllable-timed speech with verbal contingencies similar to those used in the Lidcombe Program. It is specifically designed for children with more severe stuttering that has been resistant to previous treatment. Daily practice with syllable-timed speech in addition to the verbal contingencies we were already using has been the extra little push my client needed to become even more fluent. But syllable-timed speech can be used effectively with any children who stutter, not just children with more severe stuttering. So let’s get into what it is and how to use it.
How to Produce Syllable-Timed Speech
Syllable-timed speech is a rhythmic way of speaking in which each syllable is evenly stressed. Although some people use a metronome, I do not recommend this! You don't want the child to become reliant on using a metronome to produce syllable-timed speech, because this will not allow him/her to move in and out of syllable talking naturally throughout the day. I recommend listening to examples of syllable-timed speech and then practicing a lot yourself before presenting it to your clients and their families. The Australian Stuttering Research Centre has video demonstrations of syllable-timed speech here. You should use normal volume, pitch, and intonation, and the syllables should all flow together. Do not insert spaces between each syllable, which gives it a highly unnatural staccato sound.
When you first teach a child how to use syllable talking, use a slow rate. This should gradually increase, until you’ve achieved a speech rate that is very near a normal conversational rate. This takes practice! My advice is to speed up your rate early on, because if you’re speaking too slowly, preschool-aged children become impatient! I have found that a faster rate of syllable talking leads to much better compliance.
Teaching Syllable Talking to Preschoolers
In your first session using syllable-timed speech, you will introduce syllable talking to the child while demonstrating it for the parent. Tell your client, “I’m going to teach you a new way of talking called syllable talking. Imitate what I say and the way that I say it.” I use the term “syllable talking” instead of something like “robot talk” that might lead to highly unnatural speech. You can let the child name it anything he/she wants if that makes it more fun.
Start with imitation of short phrases and sentences. Gradually move to longer sentences, then begin asking questions. You can use books with a lot of things to describe like Wimmelbooks or I-Spy books. If those are too visually stimulating or distracting, switch to Spot the Difference books or simply use individual pictures of objects or actions.
If your client has difficulty maintaining syllable talking when you move to spontaneous speech, you can go back to the imitation level. Daily practice of syllable-timed speech can lead to improvement in spontaneous fluency even if only imitation is used.
Open communication with your client (yes, even a four year old) about what you’re doing and why is always encouraged. I explain to them that we don’t have to use syllable talking all the time, but practicing for a few minutes throughout the day will help make their speech more smooth all the time.
Giving Feedback and Praise
It is important to sprinkle praise for syllable talking throughout the session. I do this by saying, “Wow, that’s great syllable talking” and “Good syllables!” If my client is not talking in syllables, I gently encourage him/her to use syllable talking, and I keep using it myself during the entire session. If compliance is an issue, I break sessions up into 5 minute stretches of syllable talking, followed by 5-10 minutes of a reward activity. When we’re not using syllable talking, I tell my clients that if they feel bumpy speech coming, they can use syllable talking to smooth it out. In spontaneous speech, if I hear a client use syllable talking, I immediately praise, saying “I heard you smooth out a bumpy word using your syllable talking, great job!”
Parent Practice Sessions
The most important aspect of this treatment is parent involvement and daily practice sessions at home. Research has shown that preschool-aged children’s fluency improved by 96% with 4-6 short practice sessions per day provided by parents (Trajkovski et al., 2011). Once parents have demonstrated that they can produce syllable-timed speech in your clinical sessions, they should be encouraged to practice it with their child at home on a daily basis. Practice sessions can be special times that are set aside, but they can also be initiated spontaneously (e.g., while driving in the car or during daily routines).
I’ve created a FREE one-page Syllable-Timed Speech Parent Handout (above) that you can distribute to parents when you are first introducing this treatment. I also recommend that you record yourself doing syllable talking with your client and send it to the parent so they can listen to it periodically and make sure their rhythm and timing are accurate.
What You’ll Notice
Once you’ve been using syllable-timed speech for a while, you will begin to notice that the child’s spontaneous speech becomes more fluent. At first, you’ll notice this immediately following syllable talking practice, then eventually you’ll observe changes in overall fluency throughout the day. It is important to have parents give daily ratings of stuttering severity so you can monitor progress.
And finally, I’ll leave you with this note about goals of treatment. With preschool-aged children, I set goals that are objective and measurable. This means my goals specify improvements in daily stuttering severity ratings and a reduction in percentage of syllables stuttered. However, the most important goal when I provide stuttering treatment is that my client’s confidence grows as a communicator. If goals for stuttering severity and percentage of syllables stuttered are not quite reached, but the parent reports significant improvements in social skills, relationships, and confidence, then I view treatment as highly successful.
If you have questions about getting started with using syllable-timed speech, please email me at laura@lauragslp.com. I’d love to hear from you!
Resources
Westmead Program: This program uses syllable-timed speech and is best for young children with borderline or beginning stuttering. This website includes a treatment guide, activity guide, and video demonstrations of syllable-timed speech.
Oakville Program: This program uses syllable-timed speech and verbal contingencies and is best for older children, or young children with severe stuttering that has been resistant to prior treatment such as the Lidcombe Program. This website includes a treatment guide, activity guide, and video demonstrations of syllable-timed speech.
Trajkovski, Natasha, et al. “A Phase II Trial of the Westmead Program: Syllable-Timed Speech Treatment for Pre-School Children Who Stutter.” International Journal of Speech-Language Pathology, vol. 13, no. 6, 2011, pp. 500–509., https://doi.org/10.3109/17549507.2011.578660.