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I love everything about treating preschoolers who stutter: I love the collaboration with parents and caregivers, I love the crazy amount of progress my clients make in a short amount of time, and I love watching their confidence grow as communicating becomes easier. What I don’t love are plateaus. And for a while, I was seeing a lot of them. If you treat preschoolers who stutter, you know it is very common to observe plateaus or regression during treatment. For a while when we would reach a point where progress slowed, I tried to focus on the positives and remind parents about all the improvement we had already made. But I decided that I needed to do more digging in each case, and figure out if there was something we could change or focus on in order to see more improvement.
I noticed that often, fluency was very good during our speech sessions, but was not generalizing to all scenarios. And then I realized, my sessions and activities were TOO structured. I had been so focused on manipulating our activities to ensure my clients' success, that when it came to less structured activities (i.e., real life), we were still seeing a lot of stuttering. I noticed that when clients were trying to describe events to me or use their imagination to come up with ideas during play, they were more disfluent. This is not uncommon. We often see that during more complex language activities such as narratives, children who stutter are less fluent. I needed to focus more on narrative language when I provided therapy for stuttering. But wasn’t I already doing that? I usually included a book in every session!
With regular books, I was keeping the activity pretty structured. When you read a book with a 3-4 year old, it is easy to elicit short, fluent utterances by asking questions. I wanted my clients to move toward more complex narrative skills so fluency could be practiced during language-loaded utterances. I found that wordless picture books were perfect, and here’s why:
The images are vibrant and thought-provoking.
Because there are no words, you often have to make inferences or guesses about what the characters are thinking, feeling, or saying.
There are lots of opportunities for discussion. I find that my clients frequently have a different view of what is happening in the story from my own.
When I get started with a wordless picture book, I tell my client “This book doesn’t have any words, so we have to come up with the story.” I still ask questions on each page about what is happening, how characters are feeling, etc. But I really let my client do the talking and tell the story.
So where does the treatment come in? Well, that’s the other thing I love about treating preschool stuttering. The treatment can be done during absolutely any activity. When I see a new fun toy or game, I can almost always incorporate it into a session. When I’m using a direct approach to treating preschool stuttering, I use the Lidcombe Program. You may not be trained in the Lidcombe Program, but can still use a response-contingency approach to treating stuttering. This means that praise or acknowledgement of stutter-free speech is provided, along with requests for correction or acknowledgement of stuttering. In the Lidcombe Program, this feedback is referred to as “Verbal Contingencies.” In the approach I use, there are always a significantly higher amount of verbal contingencies for stutter free speech than there are for stuttering. That is, I’m providing lots and lots of praise and asking for corrections here and there. If I’m at the stage where I’m worrying about narratives and generalization, my client is fluent most of the time, and only stutters on a few utterances.
I use the same wordless books multiple times with the same client. Once the child is already familiar with the book, he/she can independently tell me the story, leaving me to focus more on providing feedback for speech fluency.
So what are some great wordless picture books to use with preschoolers? Here are my favorites:
Fly! by Mark Teague: This book has beautiful illustrations, lots of humor, and many opportunities to make inferences and describe.
Goodnight Gorilla by Peggy Rathman: My preschoolers love describing this cheeky gorilla’s antics! As a zookeeper closes up for the night, the gorilla steals his keys and begins letting all the other animals out. It’s a cute and funny story perfect for preschool-aged kids!
Frog Goes to Dinner by Mercer Mayer: I use “Frog Where Are You” in all my preschool assessments when I collect a language sample, but the other boy and frog books by Mercer Mayer are wonderful for treatment sessions! This story is exciting and fun, and you can find a script for completing a story retell task here.
Hank Finds an Egg by Rebecca Dudley: In this sweet story, a little bear finds an egg that has fallen from a nest. He does everything he can to return it, eventually teaming up with the mama bird to get the egg back to the nest. This book is not illustrated, it was created using photographs of gorgeous dioramas created by the author. It may be my top wordless book!
Journey by Aaron Becker: This book is about a lonely girl who creates an entire fantasy world to explore using a red marker. Each page is filled with things to describe and my young clients have fun guessing what might happen next!
Chalk by Bill Thomson: In this story, three children find a bag of magic chalk at a park. As they use the chalk, their drawings come to life. It’s magical and exciting (but sometimes a little scary for little ones).
Narrative tasks can be tricky to address when you’re working on improving fluency in preschoolers. Wordless picture books have helped my clients, and I hope they help you in your practice too!