The complexity of stuttering has been acknowledged numerous times and in copious amount research throughout the years. It is not surprise that treatment would be just as complicated. Speech Language Pathologists facilitate effective speech and language skills via four basic steps; evaluation, education/counseling, therapeutic treatment, and generalization. Because of the complexity of deficits, Speech language pathologists are presented with challenges in every step of therapy.
However, generalization is the step that Speech Language Pathologists struggle with more than any. In this the generalization and maintenance step, effectiveness of treatment is truly assessed. Unfortunately it is not only difficult to achieve generalization, but to assess generalization in fluency disorders as well. The fist challenge regarding the effectiveness of treatment it the fact that we do not completely understand the etiology of the disorder. There have been various theories as the why individuals demonstrate persistent stuttering.
If Speech Language Pathologists do not have an accurate etiological foundation of stuttering, it is difficult to measure change. More, so there is limited evidence to support the efficacy of a treatment because assessment of effectiveness is more subjective (Booth,2004). This is more so due to the fact that stuttering most likely has present with a stutter experience an individualized combination of these various factors, making it difficult to determine how a clinician may determine a scale for generalization and maintenance.
Many clinicians utilize the percent syllables stuttered to determine this. The individualization of each person with a stutter makes it extremely difficult to determine if the skills and strategies learned in therapy are generalized and maintained outside of the clinical environment. To truly assess a person’s generalization of a skill, he must be assessed in various contexts. Not only is this difficult for a clinician to assess due to limited time with the person with a stutter, but also because a true representation will take into varying context difficulty (Packman et. al , 2004).
For example some people find they stutter more when on the phone, while other present with more dysfluencies when talking in front of a crowd. Because of the individualization necessary for assessment of generalization, it is important that the person with a stutter is involved in this assessment as well, via both self-reports in everyday contexts, but in choosing contexts that are more difficult to maintain fluency in (Packman et. al , 2004). As imagined many people will automatically avoid more difficult situations on a daily basis, but to truly assess generalization, theses contexts are necessary.
After it is determined that a person with a stutter is generalizing his skills, it is important to determine if these skills are being maintained over time. To determine this a person with a stutter must be assessed in theses various contexts periodically for a minimum of a year but preferably over numerous years (Packman et. al , 2004). This can be extremely difficult as once a client is discharged from therapy it follow up is often challenging for both the client and the clinician. As mentioned, stuttering is a complex disorder with various parts that need to be assessed.
One of the two primary components that need to be assessed is the individual’s attitudes and beliefs regarding his dysfluencies. This component makes generalization and maintenance extremely difficult for a client, even with sufficient support, strategies, and therapeutic techniques. Attitudes of an individual with a stutter regarding his disfluencies can change from week to week or even day to day (Guitar &Bass, 1978). As negative attitudes decrease, self esteem decreases, leading to a decrease in generalization and maintenance.
For this reason counseling and education is an imperative part of the therapy processes. As mentioned various times it is important that Speech Language Pathologists to determine an accurate criteria to assess effectiveness and maintenance of therapy. The two primary ways clinician’s have assessed this is via percent syllables stuttered (%SS) and self-report. Based on the attitudes of a person with a stutter the %SS can show less dysfleucnies despite the client feeling there is no change.
Inversely there is research that has determined the person with a stutter felt there fluency had increased dramatically but these results were not reflected in the %SS. For this reason it is important that the clinician utilize both assessments but keep in mind how the client defines success (Pollard, et al, 2008). Speech Language pathologists are consistently facilitating generalization and maintenance of specific skills for their clients. This component of the therapy process is utilized to assess the efficacy of treatment and client progress. This is easier for some populations an harder for others.
Due to the lack of knowledge regarding etiology, individualism of the disorder, and determining effective ways to measure outcomes, Stuttering is a complex disorder to assess generalization and maintenance for. Although there are many obstacles when assessing the efficacy of a treatment program for people with a stutter, it is more than possible with enough time an effort on the clinician and client’s part. More, so determining the efficacy of treatment via generalization and maintenance of the skills can further help the client be a more productive and effective communicator with a higher self esteem overall.