SLP738-1 Fluency Skills Lab Final Project Spring 2022

Stuttering Intervention Approaches

Treatment Approach: Fluency Rules Program

Author/s: Charles M. Runyan and Sara Elizabeth Runyan

Year Developed: 1993

Age Recommendations:

The Fluency Rule Program (FRP) is a stuttering intervention approach recommended for

school-aged children, specifically preschool or early elementary students (Runyan & Runyan,

1986).

Specific Recommendations for Use:

The program is designed for young school-aged children who stutter. The FRP aims to

address the overt characteristics of stuttering (i.e., observable disfluencies) and is not intended

to treat the affective or behavioral aspects of the disorder (Brundage et al., 2012). The program

can be used to treat both stuttered (e.g., blocks, prolongations, part-word repetitions) and non-

stuttered (e.g., phrase repetitions, revisions) disfluencies (Brundage et al., 2012). The FRP does

not specifically identify the suggested severity level of clients utilizing the program, however,

Runyan and Runyan (1986) administered the FRP to a group of children ranging from very mild

to severe stuttering according to the Stuttering Severity Instrument (Riley, 1972, as cited in

Runyan & Runyan, 1986).

Description of Treatment Approach:

The Fluency Rules Program is a therapy approach consisting of seven rules of fluency

that children are taught to follow as they communicate with their peers and other individuals

(Gottwald & Starkweather, 1995). According to Gottwald and Starkweather (1995), “the
SLP738-1 Fluency Skills Lab Final Project Spring 2022

concept of ‘rules’ was easily understood in the school setting” and therefore effective for

school-aged children (p. 124). Runyan and Runyan (1986) found that explicitly explaining,

modeling, and practicing the fluency rules resulted in a decrease in both the frequency and

severity of stuttering events in school-aged children who stutter. The rules are as follows:

1) Speak Slowly: Children enrolled in the Fluency Rules Program are encouraged to utilize a

slower rate of speech. It is believed that slower speech reduces the frequency of

stuttering disfluencies, allows for contemplation of the fluency rules learned, and

provides additional time a child might need to utilize self-monitoring skills (Runyan &

Runyan, 1986). This first rule is taught to students through timing and/or symbolic

materials. For example, a metronome may be used to slow a child’s speech. That is, the

metronome plays at a slower rate and the child is encouraged to speak on time with the

sounds. The administer of the program may model use of the metronome to aid the

child in following along with the tool. In addition, an individual might utilize a picture of

a tortoise to represent slowing one’s speech. Using a symbol such as this will remind a

child to implement a slower rate of speech and hopefully, will be visualized by the child

outside of the therapy room to promote generalization.

2) Use Speech Breathing: The second rule of the program is for children who stutter and

experience airflow difficulties (Sidavi & Fabus, 2010). The student will first learn the

difference between regular breathing and speech breathing and then be encouraged to

speak using exhaled air (Runyan & Runyan, 1986). The individual administering the

program can model and explain that speech requires a quick inhale and a gradual exhale

with speech, making sure to avoid holding one’s breath. This can be reinforced using a
SLP738-1 Fluency Skills Lab Final Project Spring 2022

visual graphic of the breathing cycle to remind the child how and when to breathe and

speak (Runyan & Runyan, 1986).

3) Touch the “Speech Helpers” Together Lightly: The purpose of the third rule is to increase

a child’s awareness and understanding of the speech mechanisms (i.e., the lips, teeth,

tongue, etc.). This rule is also important for children who stutter and have airflow

difficulties, such as halting breath while speaking. Children will be advised to “’touch the

speech-helpers lightly’ because if they close the articulators too tight, they will stop

speech breathing, and speech production will cease” (Runyan & Runyan, 2007, as cited

in Sidavi & Fabus, 2010, p. 20). This rule can be explained to the child through

demonstration of the lips being touch together tightly versus lightly by the clinician.

Runyan and Runyan (1986) stated that it may also be effective to utilize tactile cues such

as resting one’s hand on the student’s arm during their fluent speech and gently

squeezing the arm during tense productions. Both modeling and cueing are efficient

ways to introduce a student to this rule.

4) Use Only the Speech Helpers to Talk: The fourth rule in the FRP addresses some of the

secondary characteristics that often accompany speech disfluencies such as body

movements, jaw jerking, irregular blinking, etc. (Runyan & Runyan, 1986). Students are

taught that fluent speech is produced using only the speech mechanisms (helpers) and

other bodily movements are unnecessary. It is helpful for a clinician to utilize a mirror

when explaining this rule, allowing the child to watch themselves speak and making

them aware of their secondary characteristics. This method has shown to be effective in

eliminating movements that are not speech related (Runyan & Runyan, 1986).
SLP738-1 Fluency Skills Lab Final Project Spring 2022

5) Keep Your Speech Helpers Moving: This rule teaches a student who stutters to recognize

the difference between “long” and “short” sounds to decrease the use of prolongations

in speech (Runyan & Runyan, 1986). An individual should explain to the child that fluent

speech is characterized by “’short’ sounds that are connected together to form words

and sentences” (Runyan & Runyan, 1986, p. 17). The rule can be adequately explained

by having the student mimic a prolongation as they run their fingers across a long piece

of textured material (e.g., velco, burlap, velvet). The child will then run their fingers

across a shorter piece of the same textured material as they practice speaking in short

sounds. The goal of this tactile cue is to illustrate the difference between prolongations

and typical speech sounds, encouraging the student who stutters to self-monitor the

feeling of producing both (Runyan & Runyan, 1986).

6) Keep “Mr. Voice Box” Running Smoothly: The sixth rule of the Fluency Rules Program

addresses the laryngeal difficulties children who stutter may exhibit. The rule instructs

the student to practice an easy onset of speech, keeping their vocal folds vibrating

smoothly as they begin a sound to decrease initial sound repetitions or blocks (Runyan

& Runyan, 1986). To explain the rule, clinicians may use a cartoon drawing or simple

illustration of the larynx and vocal folds to help the child visualize where the fluency

breakdown is occurring during uneasy starts of speech. Clinicians may also model and

prompt the child to hum with their hand on their neck (tactile cue), increasing their

understanding of vocal fold vibration. Runyan and Runyan (1986) encourage clinicians to

explain to the child that “it is very important that when the voice box starts running, it is

done very smoothly with an easy or gentle onset of vocal fold vibration” (p. 278).
SLP738-1 Fluency Skills Lab Final Project Spring 2022

7) Say a Word Only Once: The last fluency rule of the program was designed to decrease

the use of whole-word, part-word, and syllable repetitions in children who stutter.

Runyan and Runyan (1986) explained an effective method of introducing a student to

this rule by stating, “Rule 7 involved two railroad trains. The first train contained

different cars [only one type of each train car] and represented fluent speech. The

second train had a number of repeated cars in a row and represented speech that

contained repetitions” (p. 279). It was emphasized that a train runs smoothly when it

doesn’t contain duplicated train cars (i.e., repetitions) and that the duplicates were

unnecessary, similar to repeated sounds in speech.

In order to correctly administer the FRP, clinicians must first determine which speech

disfluencies their client exhibits through a diagnostic evaluation prior to implementation of the

therapy approach (Runyan & Runyan, 1986). This might consist of an informal observation or

conversation sample, as well as standardized assessments of observable characteristics (e.g.,

the Stuttering Severity Instrument). Once a child’s disfluencies are identified, the clinician

chooses which rules are applicable to the child’s needs. Sidavi and Fabus (2010) explain that it is

not always necessary for a child who stutters to learn all seven rules. For example, if a child who

stutters does not exhibit any secondary characteristics during their disfluencies, the clinician

may decide to eliminate Rule 4: Use Only the Speech Helpers to Talk, as it does not apply to the

child’s speech. Once the appropriate rules have been chosen, they should each be explained

and/or modeled as described above.

An important aspect of the Fluency Rules Program is the three-step self-monitoring portion

of the approach. Initially, following a description of each of the rules, the clinician will
SLP738-1 Fluency Skills Lab Final Project Spring 2022

pseudostutter and imitate “breaking” each of the rules, requiring students to identify when

these behaviors occur. Once a student has mastered identifying broken fluency rules in the

clinician’s speech, they will be asked to recognize those behaviors in their own speech, most

effectively through recorded samples (Runyan & Runyan, 1986). Lastly, following repeated

success in the previous task, students are asked to identify when each of the fluency rules are

broken in their own conversational speech as it is spoken. The program is intensively practiced

to ensure continued use of the fluency rules and to promote generalization of fluent speech

outside of the therapy room.

Positive Aspects:

Several researchers state that the Fluency Rules Program has yielded positive results,

suggestive of its effectiveness in reducing the amount and severity of speech disfluencies

exhibited by young school-aged children. During its pilot study, the authors of the program

found that, even after one to two years post treatment, each of their clients showed an

increase in fluency (through records of increased speech rate) following enrollment in the

program (Runyan & Runyan, 1986). In addition, the FRP is a customizable therapy approach that

can be personalized to individual students. Not only can a clinician eliminate rules that are not

applicable to their client, but they can also create new methods of demonstrating the rules

based on their student’s interests and likes. For example, as opposed to using textured

materials outlined in Rule 5: Keep Your Speech Helpers Moving, a clinician can utilize toy cars on

long and short roads for a student interested in that stimulus. Lastly, the FRP can be reinforced

in environments outside of the therapy room, such as in the classroom or at home. It is

relatively simple to explain to teachers and parents, and external reminders (e.g., stickers or
SLP738-1 Fluency Skills Lab Final Project Spring 2022

magnets) can be introduced in different settings to support extended use of fluent speech

(Runyan & Runyan, 1986).

Limitations:

Many of the outlined methods of implementing the program may not be appropriate for

certain users. Squeezing a child’s arm (Rule 3: Touch the “Speech Helpers” Together Lightly), for

example, may act as a trigger for students who have been abused or are uncomfortable with

physical touch. Also, using cartoons (Rule 6: Keep “Mr. Voice Box” Running Smoothly) may not

be effective for autistic children who tend to learn more effectively from realistic pictures.

Although these methods can be customized to fit a particular individual, as previously stated in

“Positive Aspects,” alternative ways of explaining the fluency rules are not explicitly outlined for

clinicians and high levels of creativity may be required, posing problems when implementing

the FRP. Furthermore, the FRP does not address the unobservable characteristics of stuttering;

the psychological symptoms that often accompany the disorder and can affect a child’s social

and emotional health. Recent research in stuttering intervention emphasizes the importance of

a therapy approach implementing both stuttering management and emotional and cognitive

treatment (Rankin, 2019). Even in young children, focusing solely on decreasing stuttering

behaviors is not as effective as addressing the totality of the stuttering disorder. Finally, the

pilot study of the Fluency Rules Program did not utilize a standardized assessment to evaluate

the participants’ fluency following treatment as they had prior to treatment. Without both a

baseline and progress score on the Stuttering Severity Instrument, one cannot sufficiently

determine that the program was successful in decreasing speech disfluencies in school-aged

children as the authors suggest. Further testing is required to establish the program’s efficiency.
SLP738-1 Fluency Skills Lab Final Project Spring 2022

Resources:

Brundage, S. B., Whelan, C. J., & Burgess, C. M. (2012). Brief report: Treating stuttering in an

adult with autism spectrum disorder. Journal of Autism and Developmental Disorders,

43(2), 483–489. https://doi.org/10.1007/s10803-012-1596-7

Gottwald, S. R., & Starkweather, C. W. (1995). Fluency intervention for preschoolers and their

families in the public schools. Language, Speech, and Hearing Services in Schools, 26(2),

117–126. https://doi.org/10.1044/0161-1461.2602.117

Rankin, C. M., "Script Training for Adults who Stutter" (2019). Graduate Theses and

Dissertations. https://scholarcommons.usf.edu/etd/7899 

Runyan, C. M., & Runyan, S. E. (1986). A fluency rules therapy program for young children in the

public schools. Language, Speech, and Hearing Services in Schools, 17(4), 276–284.

https://doi.org/10.1044/0161-1461.1704.276

Sidavi, A., & Fabus, R. (2010). A review of Stuttering Intervention Approaches for preschool-age

and elementary school-Age children. Contemporary Issues in Communication Science and

Disorders, 37(Spring), 14–26. https://doi.org/10.1044/cicsd_37_s_14

Submitted By: Camree Nelson