Direct therapy for stuttering in young children Direct therapy typically involves behavior modification using operant conditioning techniques. Two programs that have shown some promise with young children are outlined below. Developed by Elaine Costello-Ingham, this program involves obtaining at least 10 consecutive fluent trials at each of the following stages of therapy. Token economy may also be used. The following activities are completed during each therapy session.
Token economy is used in which tokens are given for fluent trials.
The tokens are later exchanged for objects that the parents have agreed to provide. Picture identification may be phased out in later sessions. One nonstuttered word per trial Picture identification - one fluent word for each picture. Storybook activity - the child progressively fills in words beginning with only the last word of the sentence during session one and ending with the child telling the complete story in later sessions using fluent speech. Four brief consecutive utterances per trial 30 seconds of conversation per trial 45 seconds of conversation per trial 1 minute of conversation per trial 90 seconds of conversation per trial Language lotto - similar to snakes and ladder game in which the child takes turn asking and answering questions using fluent speech.