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From: Judy
Date: 03 Oct 2012
Time: 09:15:51 -0500
Remote Name: 173.76.249.43
Elizabeth, How to go about generalization is THE challenge in speech therapy for stuttering, isn't it?! I treat stuttering using the CALMS Model perspective [see Elise Kaufman's article in the 2005 ISAD conference.] When this perspective is combined with the expectation that progress may require many small steps along a continuum of difficulty as defined in discussions between the SLP and client [see Marybeth Allens' article in the 2010 ISAD conference], then the next steps in a Window Shopping activity will probably provide many choices. It may involve changing the language task. A.C. and I agreed to begin each session with very simple speaking tasks such as naming objects. This seemed to help A.C. reestablish a more fluent way of speaking before moving on to longer and more complex utterances. Perhaps progress could be a gradual fading of this speech/language warm-up time. Much of our time was spent gradually increasing short monologues about objects. The specific goal for each monologue would change, again, upon mutual agreement. So, a monologue about wood stains might involve reducing moments of oral motor tension in real time (freezing, pull-out)at one session, increasing speech rate and naturalness at another session, and perhaps braving voluntary dysfluency at another session. This is progress. Sometimes the goal was to work on conversation. So again, we are talking about wood stains, as we have session after session, but this time I am interrupting A.C. to ask him for clarification, compliment him on his knowledge, share a personal experience, or raise a larger issue related to cost,environmental impact,advertizing, etc. This is progress. Notice how we are using familiarity with a task and topic to our advantage. We visited several stores and eventually chose to stay with only one of them because it provided the most meaningful products and elicited the most fluency. A.C. wanted to find the feeling of fluency and I wanted him to experience as much of that as well,so remaining at one store worked for us at this time. Of course, it is also important to include other aspects of therapy [see Tim Koch & Katie Dauer's article in the 2011 ISAD] but I personally find this difficult to do with most children. I take a back door approach to affective issues by raising them casually in conversation - oh - which reminds me of a VERY important point!! A.C. did not work on speech change for the entire 2-hour session. We had many conversations that were simply sharing of ideas about speech, school, extra-curricular interests, and the store products. This promoted desensitization to dysfluency, self-expression, and discussion of therapy goals. So, perhaps progress would be the ability to maintain focus on greater fluency for increasing lengths of time. Parents place a huge amount of trust in me by allowing me to walk around a store with their child without them. They sometimes check in by glancing our way from another store isle or simply walking up to us and saying hello. I hope it is understood that the SLP NEVER leaves the child at any time during this activity. This is an activity I have only done with a few students, middle and high school age, with whom I had a strong working relationship. This brief explanation is preface to my response to your question about talking with other customers and store personnel. No, I choose not to ask my students to talk with strangers. Thank you so much for giving me the chance to talk about the complicated issues of generalization. Best of luck to you! Judy