|About the presenter: David A. Daly, Ed.D. (Penn State University) is an ASHA FELLOW and holds Specialty Certification in Fluency Disorders. David has worked as an SLP in the Michigan public schools, University of Alabama in Birmingham Medical School, and for 25 years as professor at the University of Michigan where he directed the Speech Clinic and Shady Trails Camp for stutterers. He has written three books on treating stutterers. In 2003, David received the Frank Kleffner Lifetime Clinical Service Award for his research and clinical contributions. Currently David operates a private practice specializing in stuttering and cluttering.|
After several unsuccessful attempts to help clients who clutter slow down their rate of speech, I began to look for other ways to help them communicate more effectively. Our research (Daly and Cantrell, 2006) indicated that other than rapid rate and poor self-monitoring skills, two additional features of cluttering held promise for remediation. Sixty expert fluency specialists from around the world ranked lack of pauses (run-on sentences) and imprecise articulation as prominent characteristics of cluttering that interfered with communication.
Van Riper (1992) suggested that clinicians focus on the clutterer's pauses. Specifically, he wrote, "Adequate pausing will slow down his speech more than any exhortation to talk slowly" (p. viii). Inasmuch as cluttering clients tend to be intolerant of interruptions, clinicians must be direct and firm in insisting that clients practice the pause behaviors the therapists model. Manning (1991; 2010) suggested that the clinician should demonstrate exactly the behaviors she expects the client to perform. With repeated practice reading specific material (see the end of the paper for directions and examples) some success in pausing is typically achieved. We recommend that initially clinicians use written material to teach clients to pause at all commas and periods. Not only can they hear our instructions, but they can see examples in print.
After success with reading, the clinician asks the client simple sentences such as his name, address, or phone number. The clinician signals the client how many seconds to pause before answering the questions by holding up one, two, or three fingers. Any improvement in pausing as well as signs of self-monitoring are immediately rewarded.
Remember, clinicians who work with cluttering and/or cluttering-stuttering clients must be strict task-masters. Some clients will resist our best efforts and as Van Riper (1992) purports they may even try to sabotage the therapy. Be firm, be demanding, and be persistent in sticking to the task. The end goal is not for pausing to become a forced act. The goal is for pausing to become a habit.
Occasional pausing usually does not permanently slow down the clutterer's speech rate. Diligent practice with frequent reminders to pause and encouragement for doing so are necessary. Many researchers (Daly, 1992; St. Louis et al, 2007; Ward, 2006) have noted that clutterers' rate of speech increases and speech intelligibility suffers as they produce longer sentences. Teaching the pause response on statements of increasing length and complexity is necessary. In our treatment program (Daly, 1996; 2008) we see such substantial benefits to focusing on pausing that we refer to it as the "Power of the Pause."
We also have noted that self-monitoring of pausing is enhanced through goal setting. Daly and Burnett (1999) recommended stating the goal and rationale for pausing three times in one treatment session; once at the beginning, once in the middle, and then once more at the end. Whenever possible we ask the client to tell us the goal and its rationale. Only with repetition and reinforcement for correct self-evaluations of their responses will the client's self-awareness and self-monitoring be heightened.
For clearer articulation, improved intelligibility, and reduced speech rate we recommend trying the pause strategy. What have you got to loose?
INSTRUCTIONS: Use a SMOOTH EASY START to initiate the first word (underlined) of each sentence. At the comma (indicated by a / ) PAUSE and count silently to two. Then complete the sentence using another Smooth Easy Start on the underlined word.
Daly, D. A., Helping the clutterer: Therapy considerations, In F. L. Myers and K. O. St. Louis (Eds.), Cluttering: A Clinical Perspective, 1992, San Diego: Singular Press.
Daly, D.A., The Source for Stuttering and Cluttering, 1996, East Moline, IL: LinguiSystems, Inc.
Daly, D.A., Strategies for identifying and working with difficult-to-treat cluttering clients. Paper presented at the Oxford, England Dysfluency Conference. (July 4, 2008).
Daly, D.A. and Burnett, M.L., Cluttering: Traditional views and new perspectives, In R. F. Curlee (Ed.) Stuttering and Related Disorders of Fluency, 1999, 2nd edition, New York: Thieme Medical Publishers, Inc.
Daly, D.A. and Cantrell, R.P., Cluttering: Characteristics identified as diagnostically significant by 60 fluency experts. Paper presented at the International Fluency Congress, Dublin, Ireland, (July 27, 2006).
Manning, W.H., (2010), Clinical Decision Making in Fluency Disorders (3rd ed.), Clifton Park, New York: Delmar.
Manning, W.H. (1991) Sports analogies in the treatment of stuttering: Taking the field with your client. Public School Caucus, 10(2), 1, 10-11.
St. Louis, K.O., Myers, F.L., Bakker, K., and Raphael, L.J. (2007). "Understanding and treating cluttering." In Conture, E. and R. Curlee , Stuttering and Related Disorders of Fluency, (3rd edition), New York: Thieme Medical Publishers, Inc.
Van Riper, C. (1992), Foreword in Myers, F. and St. Louis, K.O. (Eds.), Cluttering: A Clinical Perspective, San Diego, CA: Singular Press.
Ward, D., (2006), Stuttering and Cluttering, New York: Psychology Press.
SUBMITTED: February 15, 2010
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