I am often asked about how to help children generalize their speaking strategies from the therapy room into real-world situations. Clinicians typically report that kids are good at using strategies in structured tasks like reading when they have a lot of clinician support but need reminders when using techniques in conversational speech.
Generalization in stuttering therapy is one of the most common challenges that speech-language pathologists (and their young clients) face. There are many reasons for this, not least is the simple fact that using speaking techniques is difficult. Imaging trying to change something about your speech and making that change consistently. Have you ever tried to change your own speaking rate (or use any other technique)?
For the rest of your life?!?
It’s a very difficult thing to do, and it is not surprising that kids have trouble doing it.
For me, then, the first step in working on generalization is recognizing and acknowledging just what we are asking from the child. It is not necessarily that the child isn’t motivated or that he isn’t trying hard enough; it’s just that what we’ve asked him to do is really hard. Every time a child uses a technique—every single time—it takes effort. Moreover, it makes his speech sound different from what he is accustomed to—and different from other children. Finally, we have to recognize that even when kids do use techniques, this isn’t a guarantee that they won’t still stutter.
So, we have presented the child with techniques that (a) take effort, (b) sound different from what they’re used to, (c) sound different from other kids, and (d) don’t always work. And we expect them to use them?!? It’s a tough sell… And, it’s not surprising to me that kids don’t always want to (or remember to…or even try to) use their techniques.
Still, we want to help them be as successful as they can be. So, in an attempt to find a true source for independent motivation, let’s look at *why* a child may want to use a technique. To clinicians (and parents), the reason may seem simple: so they won’t stutter as much. But, we have to ask, is this really that great a motivator? If a child is able to communicate without using a technique, then why on earth would he put in all that effort to use a technique?
Remember…when a child opens his mouth to speak, he is doing so in order to communicate. He is not speaking in order to “be fluent.” He is talking in order to express his thoughts. If he can express his thoughts without using a technique (even if that expression is disfluent), then why would he put in all the effort to use a technique. He has accomplished his goal: communicating. Fluency, in and of itself, is not the motivator that parents and others think it is. It is not enough of a reward for a child to be fluent if he can already achieve his goal (communicating) when he is disfluent.
Finally (for now...there is much, much more to say on this topic), even if a child is independently motivated to use techniques, we can think about some of the reasons that generalization fails. One of the most common reasons is that he has not been given sufficient support in moving from relatively easy situations (e.g., a reading task with clinician prompts) to harder situations (e.g., conversational speech). This would be akin to expecting a child in articulation therapy to move from using a corrected speech sound in isolation with a clinician’s model to spontaneous speech in a single jump. That wouldn’t be successful in articulation therapy, and it won’t be successful in stuttering therapy.
Instead, we can set up many intermediate steps to help the child move his use of the strategy gradually in the direction of conversational speech. For example, after he achieves success in reading with prompts, then we might want to see him achieve success in reading with fewer prompts and then with no prompts at all. Then, perhaps we’d want him to achieve success in a modeling task (instead of reminders, maybe a turn-taking task with cues in advance). Then, perhaps we’d want him to achieve success without those “preminders.” After that, perhaps moving to a turn-taking task not with the clinician but with another child from the therapy group. And, then, perhaps doing that but in some other setting than the therapy room. And, so on up the hierarchy from easier to harder situations. We can manipulate the various parameters that affect the difficulty of the task to help the child climb a ladder up from the highly structured reading task to the highly unstructured spontaneous speech task, ensuring his success at each step. Again, we do this routinely in articulation therapy; we can do the same in stuttering—keeping in mind that in stuttering therapy, it may well take more steps and more practice because of the inherent difficulty in using techniques.
All that said, we still have to remember that the child has very little reason to use strategies on his own. As I mentioned, fluency itself isn’t enough of a motivator, and that’s okay. I would hate to see a child get into a situation where he is so focused on fluency that his communication is negatively impacted.
Remember that the point of therapy is to foster good communication—and if a child can communicate effectively (even if he is disfluent, and even if he is not using the techniques that he’s been taught in therapy), then he is still being successful. It is not our job speech-language pathologists to eliminate all signs of stuttering in a school-age child’s speech; it is our job to help them communicate effectively. That can be accomplished with or without techiques.
There is obviously much, much more to say on the topic. That’s why my colleague Nina Reardon-Reeves and I wrote a book on it… And one of the main topics in the book is generalization! You can find info here:
Also, we have a FREE “Practical Tip” specifically focused on generalization.
Generalization is a difficult task, but approaches with understanding and structure, it can be overcome.