8 Fluency Shaping Techniques & Stuttering Modification Strategies

This is a guide to fluency shaping techniques and stuttering modification strategies for adults.

In this article, you’ll learn:

• What makes stuttering treatment work
• 3 fluency shaping techniques
• 5 stuttering modification strategies

Each strategy comes with a video, so you can see them in action!

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What Stuttering Treatment Works?

A study of adults whose stuttering treatment worked (vs those who didn’t) found core traits of successful stuttering treatment.

Successful patients had:

• Adequate stuttering treatment (more on this below)
• Support
• Behavioral and cognitive change 
• Self-acceptance and fear reduction
• High personal motivation
• Optimism and a sense of freedom
• Continued management after treatment (Plexico et al., 2005)

This shows that stuttering exercises alone aren’t enough.

For treatment to succeed, a patient also needs the right support and mindset.

Prioritize building a trusting therapeutic relationship. Take the time to understand their experience with stuttering so you can choose treatments that not only reduce stuttering symptoms but also help them build the mindset and support they need (ASHA, 2024).

Types of Stuttering Treatment

Stuttering treatment falls into 5 categories:

• Speech modification strategies (aka fluency shaping techniques or speech restructuring)
• Stuttering modification strategies
• Reducing negative reactions
• Reducing word avoidance
• Increasing participation

Let’s learn more about each.

Stuttering Modification vs. Fluency Shaping

What’s the difference between stuttering modification strategies and fluency shaping techniques?

Stuttering modification strategies target the stutter itself, with the goal of reducing tension and struggle (Van Riper, 1973).

The patient learns to become aware of both their stuttering behaviors and secondary behaviors (e.g. blinking, throat clearing). Then learns how to change these behaviors. 

Stuttering modifications help patients:

1. Identify their core stuttering behaviors
2. Recognize physical behaviors that happen when they stutter
3. Locate the point of physical tension and struggle when they stutter
4. Reduce that physical tension (American Speech-Language-Association, n.d.)

Fluency shaping techniques are also known as speech modification or speech restructuring. This approach changes speech patterns as a whole, not just the stutter. It aims to make overall speech more smooth.

Fluency shaping techniques reduce stuttering by 50–57 %, but they can be hard to use (Brignell et al., 2020). Some patients complain that it makes their speech sound unnatural (Ingham & Onslow, 1985; Martin et al., 1984).

This is where that good relationship with your patient comes in! Help them find an acceptable balance between stuttering control and natural-sounding speech.

Check out the Camperdown Program for an evidence-based fluency shaping program.

Stuttering Modification Strategies

Teach patients how to reduce physical tension and struggle when they stutter. 

When teaching a strategy, remember the process of stuttering modification treatment:

1. Patients identify their core stuttering behaviors
2. They become aware of what physical behaviors happen before, during, and after stuttering
3. They locate where in their body they have physical tension and struggle when they stutter
4. They reduce that physical tension using these strategies

1. Cancellation For Stuttering

Cancellation helps a patient say the sound they’re stuttering on in a relaxed and smooth way.

Steps to Cancellation

• A patient starts to stutter on a sound/word
• Pause and relax
• Start again with less tension

Cancellation can also be done by stopping, imitating the stutter, and then relaxing the sound to improve fluency.

2. Pull Out Stuttering Technique

Also known as ‘sliding.’ The pullout fluency technique involves stretching out the sound or word during the stutter.

Steps to Pull Out

• A patient stutters on a sound or word
• They pull (or slide) out of the sound by stretching out the sound

3. Preparatory Set

A preparatory set is when the patient ‘prepares’ in anticipation of a stutter.

To use it, they must first be aware of the sound they usually stutter on. Then they use a technique like easy onset or prolonged speech (described below) in anticipation of the stutter.

Steps to Preparatory Set

• A patient knows the word they will likely stutter on
• They prolong or ease into that sound

Fluency Shaping Techniques

Teach patients to change the timing and tension of their overall speech with these fluency shaping techniques. 

1. Reduced Speech Rate

Reduced speech rate is learning to speak much slower. 

One way to do this is by pacing one syllable at a time as they speak. A pacing board can be helpful.

2. Prolonged Speech

Prolonged speech prolongs each syllable slightly longer than normal speech. It’s also known as ‘smooth speech.’

Steps to Prolonged Speech

• Stretch out each syllable as they speak to control the stutter
• Gradually work towards more natural-sounding speech

See the Camperdown Program for a comprehensive stuttering treatment program.

3. Easy Onset

Easy onset speech is the slow initiation of vocal fold vibration (Max & Caruso, 1997). It’s also known as ‘gentle onset.’

Gradually turning on the vocal folds reduces vocal tension (which can contribute to stuttering).

Steps to Easy Onset

• Exhale
• Gradually turn on the voice on the exhale
• Start with easy onset vowels and words. Then move on to using it with longer phrases and sentences

4. Light Articulatory Contact

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Light articulatory contact (also known as soft contacts) is using light tongue and lip movements during speech. The goal is to reduce the tension in the tongue and lips when speaking. 

5. Continuous Voicing and Air Flow

Continuous voicing is a strategy that attempts to keep the vocal folds continuously vibrating when speaking, which can reduce stuttering. 

The goal is for the voice to be on the whole time as they speak. 

Steps to Continous Voicing

• The patient places their fingers on their throat
• Take a deep breath
• Say the word or phrase while keeping the voice ‘on’. If they succeed, they’ll feel vibrations under their fingers the entire time they speak

Other Stuttering Treatments

Decreasing Negative Reactions

These treatments address the negative reactions that come with stuttering. 

Evidence-based strategies/treatments for decreasing negative reactions in people who stutter include:

• Self-acceptance
• Acceptance and Commitment Therapy
• Cognitive Behavioral Therapy
• Self-disclosure
• Pseudostuttering
• Voluntary stuttering
• Mindfulness

Reducing Word Avoidance 

Some patients don’t say certain words to avoid stuttering. Help them reduce word avoidance so they can fully express themselves.

Coach them to use the ‘decrease negative reactions’ strategies, like self-acceptance or voluntary stuttering, to speak with more ease.

Increase Participation

These stuttering treatments help the patient become a more active participant in their lives. This includes speaking up more often and overcoming barriers to participation in different settings.

Ideally, all of your treatments will lead to increased participation. As your patients build skill and confidence, you can practice stuttering strategies on the phone, in the community, and to support specific goals like a work presentation.

The National Stuttering Association (NSA) offers social groups and practical support, like interview practice and career webinars. Here are links to their local chapters and events (online and live).

More Stuttering Resources

References

• American Speech-Language-Hearing Association (n.d.). Fluency Disorders (Practice Portal). Retrieved September 2024, from www.asha.org/practice-portal/clinical-topics/fluency-disorders
• Amster, B. J., & Klein, E. R. (2018). More than fluency: The social, emotional, and cognitive dimensions of stuttering. Plural.
• Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
• Plexico, L. W., Manning, W. H., & DiLollo, A. (2005). A phenomenological understanding of successful stuttering management. Journal of Fluency Disorders, 30(1), 1–22. https://doi.org/10.1016/j.jfludis.2004.12.001
• Ingham RJ, Onslow M. Measurement and modification of speech naturalness during stuttering therapy. J Speech Hear Disord. 1985 Aug;50(3):261-81. doi: 10.1044/jshd.5003.261. PMID: 4021454.
• Max, L. & Caruso, A. J. (1997). Contemporary techniques for establishing fluency in the treatment of adults who stutter. ​Contemporary Issues in Communication Science and Disorders, 24, 45-52
• Van Riper, C. (1973). The treatment of stuttering [by] Charles Van Riper. Prentice-Hall.