About the presenter: Kristin A. Chmela M.A. CCC-SLP Board Recognized Specialist and Mentor-Fluency Disorders Central Reading & Speech Clinic Long Grove, Illinois Kchmelaslp@aol.com

You can post Questions/comments about the following paper to the author before October 22, 2006.

Self & Double Charting: A Self-Monitoring Strategy for School-Age Children Who Stutter

by Kristen Chmela
from Illinois, USA

Both stimulus and response generalization have been topics of interest in the field of stuttering therapy (Boberg, 1981; Culatta & Goldberg, 1995; Onslow & Packman, 1997; Ingham, 1993). In stuttering therapy, stimulus generalization occurs when the modified speech responses happen without being associated directly with identical stimulus conditions. Response generalization occurs when the situation remains the same and the child learns to combine one type of response with another type of response independently (Gregory, 2003). In order for successful generalization to occur, clients are encouraged from the very start to become their own therapists. Helping school-age children who stutter develop self-monitoring skills assists them in speaking more fluently and managing moments of stuttering in healthier ways. A core set of skills, including general communication, fluency shaping, stuttering modification, or a combination of those (Guitar, 1999) may also be improved upon by having the clinician create opportunities to use them in different situations with different levels of language context, discourse, and complexity. The following paper provides a short description of using a self-monitoring procedure in order to help children who stutter improve the three basic elements necessary for successful self-monitoring, and in fluency therapy, for successful management of the process of forward moving communication.

Three basic elements of self-monitoring were outlined by Bandura (1999) which included: 1) self observation or real-time tracking or scanning of beliefs and behavior output, 2) symbolization and judgment or comparing cognitive structures and behavior output to a desired target, and 3) self-reaction or applying self-reinforcement or another consequence. Self-efficacy, or the belief in the ability to perform a task successfully, may influence the operation of the elements of self-monitoring (Hillis & McHugh, 1998). Utilizing only evaluative praise for changes in the parameters of speech such as "that was great" or "nice easier beginning" as the sole measure of reinforcement may not assist the child in developing an independent awareness of what the targets were or how they felt and sounded. Furthermore, it may negatively impact the generalization of skills to other extra-clinical environments.

Utilizing self-reaction, one of the three self-monitoring subfunctions, has been shown to improve fluency when the client provided self-evaluation of stuttering occurrences (Ingham, 1982; Martin & Haroldson, 1982). In Ryanıs (1974) hierarchical GILCU format the computer asked the client every so often "Were you self-monitoring?" and Shames and Florance (1980) utilized a hand signal produced by the client for self-monitoring. A self-monitoring schedule, or having the client tally his or her own productions during a therapy activity, is another way to help build self-monitoring skills (Campbell, 2003) when working with school-age children who stutter. The following provides a description of a self-monitoring procedure which incorporates two different strategies that may be used within individual or group therapy sessions with children who stutter as well as with children who have other speech-language issues.

Self- charting involves a process whereby skills to be practiced are selected from a wide range of targets that may include general communication skills such as eye contact, delayed response, pausing and phrasing, as well as other fluency shaping and stuttering modification strategies appropriate for a particular child. Self-charting may be used initially when targeting one specific skill, although it may also be used to target several skills during the same activity. Once the goals are determined, the clinician and child create a note card for each skill. As the activity is executed, the clinician asks the child if he or she liked how the "skill" felt, sounded, etc. If in agreement, the child makes a tally mark on each appropriate note card. It is common for the child to be unsure at first, or for the clinician to ask the child to try a response again.

Double charting involves two or more individuals engaged in the activity. Each individual charts one other person or partner. As an example, if working with a group of four children, each would partner up and be responsible for charting their partnerıs target goal skills. Children are also taught ways to encourage each other to try a response again in a slightly different way. This kind of dialogue between the clinician and child or group of children makes talking about aspects of speech very "normal", which may help desensitize negative feelings associated with the communication problem (Murphy, 1999). The clinician may also engage in double charting with the child and model the responses that he or she chooses to practice.

If a child engages in an activity with either his or her classroom teacher or at home with another communicative partner, and utilizes the identical self-monitoring procedure developed in a therapy session, the procedure may serve as a stimulus to increase generalization of skills being targeted in the clinical environment. The mere sight of the self-monitoring procedure may become a stimulus for the child to monitor his speech production more closely. Utilizing a self-monitoring procedure that prompted for a skill such as eye contact and easier onset of phonation repeatedly may result in the use of increased eye contact when the goal is targeted for something else, or when the procedure was removed.

The self-monitoring procedure can also become a quick assignment completed by the child and classroom teacher as well as with important communication partners in the home and other environments. Before these assignments are given, the practicing partners must be aware of the various speech tools being targeted by the child. For example, a short communication exercise may be written on the chart card such as "John will name 5 science words with Mrs. Abrams at her desk using easier beginnings". At the end of each quick assignment, the practice partner merely asks the child how he or she thought it went. Then, the child makes his or her own tally. Upon daily completion for one week, the child returns the card to speech therapy. My clinical experience has shown daily use of these quick assignments positively fosters generalization and maintenance of skills being targeted in speech therapy into extra-clinical environments.

The following example introduces and demonstrates single self-charting in a therapy session with an eleven year old child who has been attending therapy for several months:

Clinician: "What is it that you think would be helpful to work on today?"
Child: Eye contact and easier beginnings
Clinician: "O.K. Why do you think you want to work on those strategies?"
Child: "Iım having trouble starting some words."
Clinician: "So when you try and start a word what happens?"
Child: "I get stuck and it wonıt come out. I want to practice making it smooth at the start."
Clinician: "Brilliant. You know what feels best in your speech machine. Letıs make a note card for each of those skills. Write each one or draw a picture representing each one on top of each note card. When we do this activity, I want you to make a tally on each card after your turn if you like how it felt and/or sounded. Try to make a sentence with the word /summer/ and start with an easier beginning with eye contact."
Child: "In the summer I play baseball."
Clinician: "O.K. How did you like your easier beginning?"
Child: "I liked it and my eye contact, too."
Clinician: "I liked how you paid attention to your speech. Make your marks."
Clinician: "Now try a sentence with the word /homework/."
Child: "H-H-Homework is the worst part of school."
Clinician: "How did you like your eye contact?"
Child: "Good but I got stuck."
Clinician: "Oh. Try it again."
Child: "Homework is the worst part of school."
Child: "That time I got it."
Clinician: "I like how you are feeling when you start a word with no tension. Make your marks."
Utilizing a procedure such as self or double charting may improve overall generalization of various skills targeted in stuttering therapy. The purpose of the procedure is for the child to learn how to pay attention to various aspects of communication as he or she is working on managing stuttering in more effective ways, but it does not take the place of a progress record being completed by the clinician. As an added benefit, it helps keep children paying attention to their target goals when they are in a speech session.

Selected Bibliography

Bandura, A. (1991). Social cognitive theory of self-regulation. Organizational Behavior and Human Decision Processes, 50, 248-287.

Boberg, E. (1981). Maintenance of fluency. New York: Elsevier.

Campbell, J. H. (2003). Therapy for elementary school-age children who stutter. In H.H. Gregory (Ed.), Stuttering therapy: rationale and procedures, (pp.217-262). Boston: Allyn & Bacon

Culatta, R., & Goldberg, S. A. (1995). Stuttering therapy: An integrated approach to theory and practice. Needham Heights, MA: Allyn & Bacon.

Gregory, H.H. (2003). Stuttering therapy: Rationale and procedures. Boston, MA: Allyn & Bacon.

Hillis, J. W. & McHugh, M. S. (1998). Theoretical and pragmatic considerations for extraclinical generalization. In A. K. Cordes and R. J. Ingham (Ed.), Treatment efficacy for stuttering: a search for empirical bases, (pp. 243-292). San Diego, CA: Singular Publishing Group, Inc.

Ingham, R. J. (1982). The effects of self-evaluation training on maintenance and generalization during stuttering treatment. Journal of Speech and Hearing Disorders, 47, 271-280.

Ingham, R. J. (1993). Transfer and maintenance of treatment gains of chronic stutterers. In R. F. Curlee (Ed.), Stuttering and related disorders of fluency, (pp. 166-178). New York Thieme Medical Publishers, Inc. 1993b

Martin, R. R. & Haroldson, S. K. (1982). Contingent self-stimulation for stuttering. Journal of Speech and Hearing Disorders, 47, 407-413.

Murphy, W. (1999). A preliminary look at shame, guilt and stuttering. In N. Bernstein Ratner & E.C. Healey (Eds.), Stuttering research and practice, (pp. 131-144). Mahwah, NJ: Lawrence Erlbaum Associates.

Onslow, M., & Packman, A. (1997). Designing and implementing a strategy to control stuttered speech in adults. In R. F. Curlee & G. M. Siegel (Eds.), Nature and treatment of stuttering: New directions (2nd ed., pp. 364-365). Needham Heights, MA: Allyn & Bacon.

Ryan, B. P. (1974). Programmed therapy for children and adults. Springfield, IL: Charles C. Thomas.

Shames, G. H. & Florance, C. L. (1980). Stutter-free speech: A goal for therapy. Columbus, OH: Charles E. Merill.

You can post Questions/comments about the above paper to the author before October 22, 2006.

September 1, 2006
Return to the opening page of the conference