Category Archives: Structured Conversations

I have just qualified as a speech and language therapist, and attended the Lidcombe Program workshop, which I found really interesting. While I understand the principles behind structuring the child’s first sessions, why we do it and so forth, I am a little unconfident about exactly how to do this in the clinic. I wondered whether you could give me some tips about what to do? I know for example that ‘sentence completion’ is a good way to elicit shorter utterances, but could you give me some guidance about other ways of structuring a child’s sessions, and some equipment suggestions? I am hoping to start the Lidcombe Program with my first client in a couple of weeks and he seems to be quite severe, so any suggestions would be really helpful!

The choice of activity and language during a structured activity will be critical to how much stutter-free speech occurs during a structured conversation.

The type of activity being used during a conversation.

Some activities naturally elicit shorter utterances and these are more likely to be stutter-free. For example, playing a memory game or talking about a book with simple pictures allows for a high degree of structure, while playing with toy sets, like train sets or doll houses naturally lends itself to less structured conversation. Books, games, felt boards, puzzles, play dough, drawing/colouring, and magnetic boards are all useful. Many activities can be used for both high and low structure conversations, for example books may elicit very short verbal responses, or can be used to prompt conversations that are much more open ended, free flowing and natural. Books lend them selves to parent training and are the most readily available resource in the child’s home. Still, it is important for therapy to not revolve around only one activity and there should always be variety incorporated into the activity. Also, it is always important to consider the individual child’s preferences and responses: Some activities elicit fluent utterances for one child and not for another.

The linguistic elements of a conversation.

The language used during a conversation can be manipulated to elicit utterances that are of a length and complexity that is more likely to be fluent. Some examples of how a parent might manipulate linguistically are:

1. Modelling:
Children tend to use similar sentences while engaged in an activity to those being used by their parents for example if a parent says: “Look, I see a boy eating an ice cream”, the child might say a sentence of similar length and complexity, for example “yes, and there is a boy kicking a ball”,

2. Sentence completion:
Here a parent begins the sentence but leaves the ending for the child to say, for example, while looking at a book a parent might say, “Wow, that man is climbing….” To which the child may add “up the ladder”. Sentence completion can be used to gradually encourage longer sentences as the child’s fluency improves, for example the parents may say, “Over there is….” To which the child may respond “…a boy eating some popcorn”.

3. Binary choices:
Here a parent limits how much a child says by asking a question that contains two responses: An example is “Is that red or blue?”, Binary choice questions are suitable when a conversation needs a lot of structure, and when stuttering severity is higher.

4. Commenting
This refers to teaching the parent to point at a picture/something and say a word that directs the child’s attention and encourages them to comment, for example the parent might say “Look…” and wait for the child to make a comment.

5. Directing the conversation

6. As the child demonstrates increased fluency the amount of time the parent spends doing that can lessen. The aim of treatment during structured conversation is not to stay at the same level (for example, single word level, or sentence level) but to encourage parents to readily experiment to determine if they can elicit longer and more spontaneous responses from the child whilst continuing to be at a severity rating of 1 or 2, as soon as possible.