CHILDREN WITH

COMMUNICATION
DISORDERS

October 28 & 30, 2024

COMMUNICATION

Communication is the interactive

exchange of information, ideas, feelings,
and desires. It involves encoding,
transmitting, and decoding messages.
ELEMENTS OF COMMUNICATION:
ELEMENTS OF COMMUNICATION:
 Message - a communication or statement
being conveyed.
 Sender - one who expresses the message.
 Receiver - one who responds to the
message.
INTRA-INDIVIDUAL COMMUNICATION

 Intra-individual Communication occurs

when the same person is both sender and
receiver of the message (e.g., when we talk
to ourselves or write a note to remind
ourselves to do something when we read it
later).
SEVERAL IMPORTANT FUNCTIONS
OF COMMUNICATION,
PARTICULARLY BETWEEN
TEACHERS AND STUDENTS
(Lindfoors, 1987; Owens, 2005)
NARRATING
 Narrating means to tell a story, often by reading
aloud from a text, or to describe events as they
happen.
 Children need to be able to tell (and follow the telling of) a
story that is a sequence of related events connected in an
orderly, clear, and interesting manner.
 Example: Five-year-old Cindy tells her teacher. "I had a
birthday party. I wore a funny hat. Daddy made a cake, and
Mommy took pictures." Fourteen-year-old Ian tells the class
about the events leading up to Christopher Columbus's first
voyage to America.
EXPLAINING/INFORMING
 Explaining/Informing entails sharing how something
works, how something came to be, or why something
happened.
 Teachers expect children to interpret the explanations of others in
speech and writing and to put what they understand into words so that
their listeners or readers will be able to understand it too.
 In a typical classroom, children must respond frequently to teachers'
questions: "Which number is larger?" "How do you suppose the story
will end?" "Why do you think George Washington was a great
president?”
 REQUESTING
 Requesting means asking for something
or asking someone to do something.
 Children are expected to communicate their wishes
and desires to others in socially appropriate ways. A
child who has learned to state requests clearly and
politely is more likely to get what she wants and less
likely to engage in inappropriate behavior as a way
to communicate her needs.
EXPRESSING
 Expressing means sharing your thoughts and feelings.
 It is important for children to express their personal
feelings and opinions and to respond to the feelings of
others. Speech and language can convey joy, fear, frustration, humor,
sympathy, anger.
 Example: A child writes, "I have just moved. And it is hard to find a
friend because I am shy. Another tells her classmates, "Guess what? I
have a new baby brother.” Through such communicative interactions,
children gradually develop a sense of self and an awareness of other
people.
 Both paralinguistic behaviors and nonlinguistic
cues play major roles in human communication.

 Paralinguistic behaviors include speech modifications

(e.g., variations in pitch, intonation, rate of delivery,
pauses) and nonlanguage sounds (eg. “ohh,” laughter)
that change the form and meaning of the message.
 Nonlinguistic cues include body posture, facial
expressions, gestures, eye contact, head and body
movement, and physical proximity.
LANGUAGE
 Language is a formalized code used by a group of people to
communicate with one another.
 All languages consist of a set of abstract symbols–sounds, letters,
numbers, elements of sign language–and a system of rules for
combining those symbols into larger units (Hulit & Howard, 2002;
Owens, 2005).
 There are more than 6,000 languages spoken in the world (McLaughlin,
1998).
 Languages are not static, they grow and develop as tools for
communication as the cultures and communities of which they are part
change (Ovando, 2004).
FIVE DIMENSIONS OF LANGUAGE:
1. Phonology refers to the linguistic rules governing a language's sound
system. Phonological rules describe how sounds can be sequenced and
combined. The English language uses approximately 45 different sound
elements, called phonemes.
2. Morphology is concerned with the basic units of meaning and how those
units are combined into words.
 Morphemes - the smallest elements of language that carry
meaning, can be sounds, syllables, or whole words.
 Free morphemes - can stand alone (e.g., “fit”, “slow”)
 Bound morphemes - do not carry meaning by themselves; they are
grammatical markers that change the meaning of words when
attached to free morphemes (e.g., “unfit”, “slowly”).
FIVE DIMENSIONS OF LANGUAGE:
3. Syntax is the system of rules governing the
meaningful arrangement of words into sentences.
4. Semantics has to do with the meaning of words and
combinations of words.
5. Pragmatics is a set of rules governing how spoken
language is used to communicate.
KINDS OF PRAGMATICS SKILLS (ASHA, 2004A):
 Using language to achieve various communicative functions
and goals (e.g., greeting, informing, demanding, promising,
requesting);
 Adapting or changing language to the conversational context
(e.g., talking differently to a baby than to an adult, providing
background information for an unfamiliar listener); and
 Following rules for conversations or narrative (e.g., begining
and ending a conversation, taking turns, staying on the topic,
rephrasing when misunderstood, proper distance, facial
expressions, gestures).
SPEECH
 Speech is the oral production of language.
 Although it's not the only vehicle for expressing
language (e.g., gestures, manual signing, pictures,
and written symbols are also used), speech is the
fastest, most efficient method of communication by
language.
Speech sounds are the products of four separate but
related processes (Hulit & Howard, 2002):
1. Respiration - breathing provides the power supply for speech.
2. Phonation - the production of sound when the vocal folds of the larynx
are drawn together by the contraction of specific muscles, causing the
air to vibrate.
3. Resonation - the sound quality of the vibrating air, shaped as it passes
through the throat, mouth, and sometimes nasal cavities.
4. Articulation - the formation of specific, recognizable speech sounds by
the tongue, lips, teeth, and mouth.
According to Hulit and Howard (2002), speech is one of the most complex
and difficult human endeavors. They describe just some of what happens in
speaking a single word, “statistics.”
 NORMAL
DEVELOPMENT OF
SPEECH AND
LANGUAGE
BIRTH TO 6 MONTHS
 Infants first communicate by crying, which produces a
reliable consequence in the form of parental attention.
 Different types of crying develop–a parent can often
tell from the baby's cry whether she is wet, tired or
hungry.
 Comfort sounds–coos, gurgles, and sighs–contain some
vowels and consonants.
BIRTH TO 6 MONTHS
 Comfort sounds develop into babbling, sounds that in the
beginning are apparently made for the enjoyment of feeling
and hearing them.
 Vowel sounds, such as /i/ (pronounced "ee") and /e/
(pronounced "uh"), are produced earlier than consonants, such
as /m/, /b/, and/p/
 Infantdoes not attach meaning to words she hears from others
but may react differently to loud and soft voices.
 Infant turns eyes and head in the direction of a sound.
7 TO 12 MONTHS
 Babbling becomes differentiated before the end of the first
year and contains some of the same phonetic elements as the
meaningful speech of 2-year-olds.
 Baby develops inflection-her voice rises and falls.
 Shemay respond appropriately to "no," "bye-bye," or her own
name and may perform an action, such as clapping her hands,
when told to.
 She will repeat simple sounds and words, such as "mama.”
12 TO 18 MONTHS
 By 18 months, most children have learned to say several
words with appropriate meaning.
 Pronunciation is far from perfect; a baby may say "tup" when
you point to a cup or "goggie" when she sees a dog.
 She communicates by pointing and perhaps saying a word or
two.
 She responds to simple commands such as "Give me the cup"
and "Open your mouth.”
18 TO 24 MONTHS
 Most children go through a stage of echolalia, in which they repeat, or
echo, the speech they hear. Echolalia is a normal phase of language
development, and most children outgrow it by about the age of 2½.
 There is a great spurt in acquisition and use of speech; baby begins to
combine words into short sentences, such as "Daddy bye-bye" and
"Want cookie"
 Receptive vocabulary grows even more rapidly; at 2 years of age, she
may under- stand more than 1,000 words.
 Understands such concepts as "soon" and "later" and makes more subtle
distinctions between objects such as cats and dogs and knives, forks,
and spoons.
2 TO 3 YEARS
 The 2-year-old child talks, saying sentences such as "I won't
tell you” and asking questions such as "Where my daddy go?"
 She participates in conversations.
 Sheidentifies colors, uses plurals, and tells simple stories
about her experiences.
 She can follow compound commands such as "Pick up the
doll and bring it to me.”
 Sheuses most vowel sounds and some consonant sounds
correctly.
3 TO 4 YEARS
 The normal 3-year-old has lots to say, speaks rapidly, and
asks many questions. She may have an expressive vocabulary
of 900-1,000 different words, using sentences of three to four
words.
 Sentences are longer and more varied: "Cindy's playing in
water"; "Mommy went to work"; "The cat is hungry."
 She uses speech to request, protest, agree, and make jokes.
3 TO 4 YEARS
 Sheunderstands children's stories, grasps such concepts as
funny, bigger, and secret, and can complete simple analogies
such as "In the daytime it is light, at night it is...."
 Shesubstitutes certain sounds, perhaps saying "baf" for
"bath" or "yike" for "like”
 Many 3-year-olds repeat sounds or words (b-b-ball-little).
These repetitions and hesitations are normal and do not
indicate that the child will develop a habit of stuttering.
4 TO 5 YEARS
 Thechild has a vocabulary of more than 1,500-2,000 words
and uses sentences averaging five words in length.
 Shebegins to modify her speech for the listener, for example,
she uses longer and more complex sentences when talking to
her mother than when addressing a baby or a doll.
 Shecan define words such as "hat," "stove," and "policeman"
and can ask questions such as "How did you do that?" or
"Who made this?"
4 TO 5 YEARS
 Sheuses conjunctions such as "if," "when," and
"because."
 She recites poems and sings songs from memory.
 She may still have difficulty with consonant sounds
such as /r/, /s/, /z/ and // and with blends such as "tr."
"gl." "sk" and "str.”
AFTER 5 YEARS
● Language continues to develop steadily, although less
dramatically, after age 5.
● A typical 6-year-old uses most of the complex forms of adult
English and has an expressive vocabulary of 2,600 words and a
receptive understanding of more than 20,000 words.
● Most children achieve adult speech sound production by age 7.
● Grammar and speech patterns of a child in first grade usually
match those of her family, neighborhood, and region.
COMMUNICATION DISORDER
• The American Speech- Language- Hearing Association
(ASHA, 1993) defines a communication disorder as "an
impairment in the ability to receive, send, process, and
comprehend concepts of verbal, non- verbal and graphic symbol
systems.
• A communication disorder is any condition that affects an
individual's ability to effectively communicate with others,
encompassing both verbal and nonverbal communication styles.
These disorders can range from simple sound substitutions to the
inability to understand or use one's native language (Wikipedia).
When does a communication difference become a
communication disorder?

The distinction between a communication difference and

a communication disorder lies in the degree to which it
impacts an individual's ability to function effectively in
their daily life. A communication difference, also known
as a dialect or variation, is simply a variation in speech or
language that is specific to a particular region, social
group, or cultural background. This variation is not
considered a disorder because it does not impede the
individual's ability to communicate effectively within their
community (ASHA, 1993).
On the other hand, a communication disorder is
defined as an impairment in the ability to receive,
send, process, and comprehend concepts or verbal,
nonverbal, and graphic symbol systems. This
impairment can affect hearing, language, and/or
speech, and it can range in severity from mild to
profound. A communication disorder is considered
a disorder because it significantly impacts an
individual's ability to communicate effectively in
various settings, including social, academic, and
occupational environments (ASHA, 1993).
Haymes and Pindzola (2004) emphasize the impact that a
communication pattern has on one's life. A communication
difference would be considered a disability, they note, when any of
one these criteria is met:

 The transmission and/or perception of messages are

faulty.
 The person is placed at an economic disadvantage.
 The person is placed at a learning disadvantage.
 The person self- esteem or emotional growth is
negatively affected.
 The person causes physical damage or endangers the
health of a person.
The definition of speech or language
impairment in IDEA reads, "a
communication disorder such as stuttering,
impaired articulation, a language impairment,
or a voice impairment that adversely affects a
child's educational performance. (20 U.S.C.
1401 [3], Section 300. 7 [c] [11]).
SPEECH IMPAIRMENTS
A widely used definition considers speech to be impaired
"when it deviates so far from the speech of other other
people that it (1) calls attention to itself, (2) interferes with
communication, or (3) provokes distress in the speaker or
the listener". (Van Riper & Erickson, 1996, p. 110)

The three basic types of speech impairments are

articulation disorders (errors in the production of speech
sounds), fluency disorder (difficulties with the flow or the
rhythm of speech), and voice disorders (problems with the
quality or use of one's voice).
LANGUAGE IMPAIRMENTS

ASHA (1993) defines language disorder as

"impaired comprehension and/or use of spoken,
written, and/or other symbol systems. The disorder
may involve (1) the form of language (phonology,
morphology, and syntax), (2) the content of language
(semantics), and/or (3) the function of language in
communication (pragmatics) in any combination. (p.
40)
CHARACTERISTICS
Speech Sound Errors
There are four basic kinds of speech sound errors:
• Distortions. A speech sound is distorted when it sounds more like the
intended phoneme than another speech sound but is conspiciously
wrong.
• Substitutions. Children sometimes substitute one sound for another,
as in saying, "train" for "crane" or "doze " for "those".
• Omissions. Children may ommit certain sounds, as in saying, "cool"
for "school". They may drop consonants from the end of words, as in
"pos" for "post".
• Additions. The addition of extra sounds makes comprehension
difficult. For example, a child might say "buhrown" for "brown" or
"hamber" for "hammer".
ARTICULATION DISORDER

• Articulation refers to the movement of muscles

and speech organs necessary to produce various
speech sounds.

• An articulation disorder means that a child is at

present not able to produce a given sound physically,
the sound is not in his repertoire of sounds.
PHONOLOGICAL DISORDER

• A child is said to have a phonological disorder if she has

the ability to produce a given sound and does so correctly in
some instances but does not produce the sounds correctly at
all times.

• Children with expressive phonological disorders are apt to

experience problems in academic areas, and they are
especially at risk of difficulties in spelling (Clarke- Klein &
Hodson, 1995) and reading (Larivee & Catts, 1992).
FLUENCY DISORDER

ASHA (1993) defines a fluency disorder as an

"interruption in the flow of speaking characterized
by a typical rate, rhythm, and repetitions in sounds,
syllables, words, and phrases. They may be
accompanied by excessive tension, struggle
behavior, and secondary mannerisms" (p. 40).
• Stuttering. The best- known (and probably least understood) fluency
disorder is stuttering, a condition marked by rapid- fire repetitions of
consonant and vowel sounds, especially at the beginning of words,
prolongations, interjections, and complete verbal blocks (Ramig &
Shames, 2002).

• Developmental stuttering is considered a disorder of childhood. It

usually begins between the ages of 2 and 6, and 97% of case begin
before the age of 10 (Mahr & Leith, 1992).

• Cluttering. One type of fluency disorder is known as cluttering, a

condition in which speech is very rapid, with extra sounds or
mispronounce sounds. The clutterer's speech is garbled to the point of
intelligibility.
Hulit and Howard (2002) point out the differences
between stuttering and cluttering:

(1) the stutterer is usually acutely aware of his

fluency problems, while the clutterer may be
oblivious to his disorder,
(2) when a stutterer is asked to pay more attention to
his speech, he is likely to stutter more , but the
clutterer can often improve his fluency by
monitoring his speech.
BASIC TYPES OF VOICE DISORDER:

• Phonation disorder
It causes the voice to sound breathy, hoarse, or strained
most of the time. In severe cases, there is no voice at all. It
can have organic causes, such as growths or irritations on the
vocal chords.

• Resonance disorder
A voice with a resonance disorder suffers from either too
many sounds coming at through the air passages of the nose
(hypernasality) or, conversely, noy enough resonance of the
nasal passages (hypernasality).
 LANGUAGE
IMPAIREMENT
LANGUAGE IMPAIRMENT
Involves problems in one or more of the five
dimensions of language: morphology, phonology,
syntax, semantics and pragmatics.

2 TYPES:
• Recessive Language Impairment
• Expressive Language Impairment
LANGUAGE LEARNING DISABILITIES (LLD)

used to refer to children with significant receptive or

expressive language disorders
PREVALENCE
The prevalence of communication disorders in children
vary widely. It is estimated that approximately 50% of
children who receive special education services
because of another primary disability (e.g. mental
retardation, learning disabilities, hearing impairments)
also have communication disorders. (Hall et al., 2001)
CAUSES

A speech or language impairment may be organic,

that is, attribute to damage, dysfunction, or
malformation of a specific organ or part of the body.
However, most communication disorders are not
considered organic, but rather functional. Functional
communication disorder derive mainly from
environmental influences.
CAUSES OF SPEECH IMPAIREMENTS:

- cleft palate
- paralysis of speech muscles
- absence of teeth
- craniofacial abnormalities
- enlarged adenoids
- traumatic brain injury
DYSARTHRIA

Refers to a group of speech disorders

caused by neuromuscular impairments in
respiration, phonation, resonation, and
articulation.
An organic speech impairment may be a
child’s primary disability, or it may be
secondary to other disabilities, such as
mental retardation or cerebral palsy.
CAUSES OF LANGUAGE DISORDERS:

Factors that can contribute to language

disorders in children include cognitive
limitations or mental retardation, hearing
impairments, behavioral disorders, structural
abnormalities of the speech mechanism and
environmental deprivation (Hall et al., 2001)
Language is so important to academic
performance that it can be impossible to
differentiate a learning disability from a
language disorder (Siliman and Diehl, 2002)
APHASIA

Described as the loss of the ability to process and use

language. It is the most prevalent causes of language
disorders in adults, most often occurring after
cardiovascular event (stroke). While head injury can
be the cause of aphasia in children.
Research indicates that genetics may contribute
to communication disorders. Scientist in Britain
have discovered an area that affects speech, and
other researchers have reported genetic links to
phonological disorders and stuttering.
A child who has little stimulation at home and a
few chances to speak, listen, explore and
interact will probably have little to no
motivation for communication and may well
experience delays in language development
(Ratner, 2004)
IDENTIFICATION AND ASSESSMENT

To avoid the consequences or untreated speech

language impairments, it is especially important
for children to receive professional assessment
and evaluation services (Hall et al., 2001)
SCREENING AND TEACHER EVALUATIONS

In some school districts, screen-language

pathologists screen the spoken language
abilities of children. These screenings might
involve norm-referenced tests, informal
assessment developed by SLP, And
questionnaires or checklist for parents and
teachers.
EVALUATION COMPONENTS

Testing procedures vary according to the

suspected type of disorder. Most examiners will
use a variety of assessment devices and and
approaches in an effort to obtain as much
relevant information as possible to inform
diagnostic decisions and treatment plans.
 CASE HISTORY  ARTICULATION
AND PHYSICAL TEST
EXAMINATION
Speech errors by the child are
The parents may be asked when assessed. A record is kept of
the child first crawled, walked, the sounds that are defective,
an uttered words. Social skills,
how they are mispronounced,
such as playing with others may
also be considered. The specialist and the number of errors.
will also examine the mouth.
 AUDITORY
HEARING



DISCRIMINATION
TEST TEST

Hearing is usually tested The test is given to determine whether

the child is hearing sounds correctly.
to determine whether a If unable to recognize the specific
hearing problem is characteristics of a given sound, the
child will be given a good model to
causing the suspected imitate. The Test of Auditory
communication disorder. Discrimination is frequently used.

Audiometry is done.

PHONOLOGICAL 
VOCABULARY AND
AWARENESS AND OVERALL LANGUAGE
PROCESSING DEVELOPMENT TEST

Children without phonological Frequently used tests for vocabulary

awareness and processing skills not include the Peabody Picture Vocabulary
only have problems with receptive and Test III and the Comprehensive Receptive
expressive language but also have and Expressive Vocabulary Test. While
great difficulties in learning to read. in overall language development test, the
Phonological processing measure Test Language Development and the
include the test of Phonological Clinical Evaluation of Language
Fundamentals are used.
Awareness and and the Comprehensive
Test of Phonological Processing.
  OBSERVATION
LANGUAGE
IN NATURAL
SAMPLE
SETTINGS

A parent-child observation is
Some speech- frequently arranged for young
language pathologists children. The specialist provides
appropriate toys and activities
use structures tasks to and requests the parents to
evoke samples. interact normally with the child.
EDUCATIONAL APPROACHES

Various approaches are employed in the treatment of

children with communication disorders. SLP or the
Speech Language-Pathologist is the term used for
professionals with primary responsibilities for
identifying, evaluating, and providing therapeutic
services to children with communication disorders
(ASHA, 2001e).
TREATING SPECIAL SOUND DISORDER

A general goal of specialists in communication

disorders is to help the child speak as clearly and
pleasantly as possible so that the listener will
focus on the child's message rather than how he
says it.
1. ARTICULATION ERRORS

The goals of therapy for articulation problems are the

acquisition of the correct speech sounds,
generalization of the sounds to all speaking settings
and contexts and maintenance of the correct sounds
after the therapy has ended.
2. DISCRIMINATION ACTIVITIES

Are designed to improve the child's ability to listen

carefully and detect the difference between similar
sounds and to differentiate between correct and
distorted speech sounds.
3. PRODUCTION

The SLP may have the child carefully watch

how sounds are produced and then use a mirror
to monitor his own speech production. Children
are expected to accurately produce problematic
sounds in syllables, words, sentences , and
stories.
PHONOLOGICAL ERRORS
• When a child’s spoken language problem includes
one or more phonological errors, the goal of therapy is
to help the child identify the error pattern(s) and
gradually produce more linguistically appropriate
sound patterns (Barlow, 2001).

• For example, a child who frequently omits final

consonants might be taught to recognize the difference
between minimally contrastive words–perhaps using a
set of cards with the words “sea,” “seed,” “seal,”
“seam,” and “seat” (Hall et al., 2001).
TREATING FLUENCY
DISORDERS
• Throughout history, people who stutter has been
subjected to countless treatments. Some of them
unusual, to say the least.

• Past treatments included holding pebbles in the

mouth, sucking fingers into a light socket, talking out
of one side of the mouth, eating raw oysters, speaking
with the teeth clenched, taking alternative hot and
cold baths, and speaking on shed nether than exhaled
air (Ham, 1986; Hulit & Howard, 2002)
• Application of behavioral principles has strongly
influenced recent practices in the treatment of fluency
disorders (Ingrham, 2003) A therapist using this
methodology regards stuttering as learned behavior
and seeks to eliminate it by establishing and
encouraging fluent speech.

• For example, one stuttering treatment program

called the Lidcombe Program trains parents to
positively reinforce their child’s fluent utterances in
the home.
• Children often learn to control their stuttering and produce
increasingly fluent speech as they mature. No single method
of treatment has been recognized as most effective. Stuttering
frequently decreases when children reach adolescence,
regardless what of which treatment method was used.

• 65% to 80% of children diagnosed with stuttering recover

without formal intervention.

• Early intervention by speech-language pathologists (SPLs)

recommended when parents notice signs of stuttering, as it
can prevent more severe issues later on.
TREATING FLUENCY DISORDERS

• Treating for language disorders is diverse, with

many programs emphasizing communication
activities that encourage exploration. These activities
foster the development of both receptive and
expressive language, recognizing that children need a
motivation to communicate and learn through
engaging experiences.
 PROVIDE A GOOD SPEECH MODEL
• Reduce your rate of speech - Young children often imitate the speech rate of their
parents and other significant adults. This rate may be inappropriately fast for the
child’s motoric and linguistic competencies.

• Create silence in your interactions - Pauses placed at appropriate places in

conversation help create a relaxed communication environment, slower rate of speech,
and more natural speech cadence.

• Model simple vocabulary and grammatical forms - Stuttering is more likely to occur
in longer words, words that are used less frequently, and more grammatically complex
sentences.

• Model normal non-fluencies - You may need to make a conscious effort to use
normal non-fluencies, such as interjections “um” or “ah” or an occasional whole-word
repetition, phrase repetition, or pause.
IMPROVE THE CHILD’S SELF ESTEEM
• Disregard moments of non-fluency- Reinforce occurrences of fluency and ignore
non-fluencies. Do not give instructions such as “slow down” or “stop and start over”
which imply that the child is not doing enough.

• Show acceptance of what the child expresses rather that how it is said- Ask the child
to repeat only the parts of the utterance that were not understood rather than those that
were non fluent.
• Treat the child who stutters like any other child in the class - Do not reduce your
expectations because of the non-fluencies.

• Acknowledge non-fluencies without labeling them - Do not refer to the problem of

stuttering. Instead, use words that the child uses to describe her speech, such as
“bumpy” or “hard”.

• Have the child feel in control of speech - Follow the child’s lead in conversation.
Speech will more likely be fluent if the child can talk about areas of interest.

• Accept non-fluencies - Try not to be overly concerned about normal non-fluencies

because you see the child as a stutter. Maintain eye contact and remain patient.
• Treat the child who stutters like any other child in the class - Do not
reduce your expectations because of the non-fluencies.

• Acknowledge non-fluencies without labeling them - Do not refer to

the problem of stuttering. Instead, use words that the child uses to
describe her speech, such as “bumpy” or “hard”.

• Have the child feel in control of speech - Follow the child’s lead in
conversation. Speech will more likely be fluent if the child can talk
about areas of interest.

• Accept non-fluencies - Try not to be overly concerned about normal

non-fluencies because you see the child as a stutter. Maintain eye
contact and remain patient.
CREATE A GOOD SPEECH ENVIRONMENT

• Establish good conversational rules - Interruptions may distract the child and
increase non-fluencies.

• Listen attentively - Active listening lets the child know that content is important. Use
naturalistic comments (e.g., “yes, johnny, that is a large blue truck”) in place of
absent-minded “uh-huh” and generic statements (e.g., “good talking”).

• Suggest that the child cease other activities while speaking - It is sometimes difficult
to perform two different motoric acts, such as coloring and talking, simultaneously.
• Prepare the child for upcoming events - The emotionality of birthdays, holidays,
field trips, and changes in the daily schedule may cause apprehension and increase
stuttering.

• It is important for the teacher or specialist to talk clearly, use correct inflections, and
provide a rich variety of words and sentences.
• Speech-language pathologists are increasingly employing naturalistic
interventions to help children develop and use language skills.

• Naturalistic approaches were developed as an alternative to didactive

language interventions because children often experienced difficulties
in generalizing new skills from structured teaching settings to everyday
contexts.

• Naturalistic approaches occur in the context of normal conversational

interchanges that follow the child’s “attentional lead”.
Kaiser and Grim (2006) make the following
recommendations about naturalistic interventions,
which are also known as milieu teaching strategies:

• Teach when the child is interested.

• Teach what is functional for the student at the
moment.
• Stop while both the student and the teacher are still

enjoying the interaction.