Investigating the effect of the therapeutic method of gradually increasing the length and complexity of speech (GILCU) on reducing the speech disorder of primary school children aged 6-11 with stuttering

Master's Thesis

Speech Therapy

1 Introduction

Speech and language are the most efficient means of communication between humans. This method of communication can play its role effectively if it has special features. Each of these features may be damaged to different degrees separately or together for various reasons and disrupt the human communication path. One of the most common disorders is stuttering (1). Any disturbance in continuity, speed, ease of production, planning, speech rhythm or a combination of these factors will cause a phenomenon called dyspraxia or stuttering. In other words, any disruption and disturbance of the natural flow of speech leads to stuttering (2). Van-Ripper (1982) [1] believes that stuttering occurs when a sudden and unnatural interruption occurs in the natural flow of speech due to repetition, stretching, interposition, and locking of the mouth at any level of sound, syllable, word, and even phrases, and sometimes it is accompanied by "dependent behaviors [2]" (3). Stuttering is a common disorder in childhood. This disorder worries and challenges most speech therapists who work in the field of children. Statistics show that out of every hundred children who go to school, one child stutters (4). One of the things that have occupied the minds of researchers is the relationship between linguistic factors and the occurrence of stuttering, which is at the phonological and phonological, syntactic and semantic levels. In other words, it is assumed that the characteristics of words and the length of utterances can increase the probability of stuttering(5). The variable degree of speech disorder due to changes in the characteristics of words has an important role and effect in the treatment of stuttering (6). Since stuttering is a neurodevelopmental disorder[3], the younger children are treated, the better they respond to treatment. It is also vital for the group of elementary school children to receive the most effective treatment before their stuttering becomes stable (7). Children who continue to stutter as they grow up have to deal with injuries such as involuntary speech disruption and accompanying issues such as distress, failure, shame, worry and social avoidance. One of the big concerns in recent research is that thousands of children are at risk of these issues. Many children who stutter will weaken psychologically and socially over time. For these reasons, it is necessary to organize effective treatments for elementary school children to reduce the effect of any possible damage(1). Behavioral approaches have been increasingly common and accepted for years, and this can be because the techniques used are mainly directly rooted in the known principles of human behavior and are more accurately supported by laboratory evidence and field experiments (8). One of the direct treatment methods used to treat stuttering in primary school children is the approach of gradually increasing the length and complexity of speech (GILCU). This approach includes 54 steps that are very carefully controlled and coherent during the three stages of creation[4], transfer[5] and stabilization[6]. Ryan [7] considers speech as an active activity [8] and therefore, from his point of view, disordered speech is best treated in the form of agent conditioning. In other words, this method is based on agent conditioning (9). In this research, the effectiveness of the GILCU program on reducing the speech disorder of primary school children who stutter 6-11 years old has been examined. speech [10]. The therapeutic goal of the psychological stuttering perspective is to deal with the person's attitude towards stuttering and the emotional problems of stuttering people as an underlying problem, but in the psychological speech perspective, the therapeutic goal is to achieve fluent speech. In other words, from the point of view of fluent speech, it is believed that stuttering consists of a series of symptoms of speech disorder such as repetition, stuttering, stretching, interruptions, and these symptoms cause other behaviors such as fear, struggle, anxiety, etc. It should be established that by removing the symptoms of stuttering, all these symptoms will also be removed and there is no need to work on the behaviors caused by stuttering.It should be established that by removing the symptoms of stuttering, all these symptoms will also be removed and there is no need to work on the behaviors caused by stuttering. A number of fluent speech therapy methods include timed speech, extended speech, agent conditioning (10). The GILCU treatment method that is going to be investigated in this research is a type of operant conditioning method [11]. This type of treatment is very carefully controlled and coherent, which is carried out in 54 steps in the three stages of creation, transfer and stabilization. Here, it is necessary to briefly describe the path of the emergence of this treatment method. Shine [12] (1980) for the first time described stuttering as a lack of coordination of the speech muscle and language coding systems, so that the innervation of the speech muscle is very slow compared to the language idea that the child wants to express. According to his findings, the treatment starts with easy answers and gradually moves to more complex answers, which helps the child in pre-organization[13] of drawing-motor strategies[14]. In the same year, Stocker [15] (1980) found that speech disorder in children increases with the increase in communication demands. Following this finding, he developed a treatment and diagnostic method. After that, Riley [16] (1983) proved that children who stutter increase their stuttering as their sentences become longer and more complicated. Costello [17] (1983) developed the conditional therapy method based on increasing the length of expression [18]. Ryan (1984) developed a cognitive program called GILCU based on gradually increasing the length and complexity of utterances, during which Ryan reported that this method was associated with a high success rate for elementary school children. Following that, Perkins (1992) [19] reported that people who stutter are likely to use simple and short expressions that are more fluent. After that, Stark and Regions (1997) [20] also reported that speech fluency is created by controlling the length and complexity of utterances and their gradual increase during treatment (11). Based on the research and studies conducted, no study has been conducted on the effect of GILCU treatment method in increasing the fluency of speech in the group of elementary school children with stuttering in Iranian society. Therefore, the researcher has investigated and analyzed the effectiveness of the GILCU treatment method on this group of children. It should be noted that due to the time-consuming nature of this method in the time domain of 22 months during the 3 stages of creation, transfer and consolidation, the researcher has only limited himself to the implementation of the creation stage. 1-3 Importance and Necessity Mental disorders of speech are controversial issues that, despite many years of research, are still among the most complex from the point of view of many speech and language pathologists. It is a disorder and it is presented as a multidimensional disorder. This disorder is not unique to a specific culture, language, and dialect, and according to various statistics, one percent of the world's population stutters. The rate of occurrence of this disorder in childhood is several times its prevalence in adulthood. Some studies in 2002 calculated the prevalence of stuttering in the age range of 5-18 years as 0.9% (12). Stuttering is affected by many factors, so that its quality differs greatly in children and adults, and as the child grows older, the probability of its continuation increases. When stuttering becomes chronic, it has a negative effect on the child's emotional-social and academic development. Some children become anxious when stuttering severely and may have difficulty in communicating with others (13). These factors make the need for effective intervention in primary school children with stuttering more prominent and important. Therefore, the necessity of conducting this research is as follows:

1. Non-availability of necessary scientific research in the field of treatment of primary school children with stuttering

2. Absence of a coherent program for the treatment of children with stuttering in primary school age in Iran

3. Fixing stuttering in elementary school children in the absence of an effective therapy program

Abstract

Objectives

Gradual Increase Length and Complexity of Utterance (GILCU) therapy method is a form of operant conditioning. This type of treatment is very precise and controlled that is done in 54 steps in 3 speech situations consisting of monologue, reading and conversation.