Learning a new way of speaking is a learning process. That means it would be helpful to know about how people learn new behaviors. This blog is driven by my observation that some children learn and then carryover new speech skills more easily than others. While we do acknowledge the inherent worth and dignity of each and every speaker by saying "It's ok to stutter," students attend speech therapy to change how they think about, feel about, and actually produce speech. Children, teens, and adults come to speech therapy to become more fluent speakers. So let's take some time to review theories about learning.

SLPs who are members of ASHA will find an overview of learning processes in the article Constructivist Strategies in Phonological Intervention: Facilitating Self-Regulation for Carryover by Ertmer & Ertmer (Language, Speech, and Hearing Services in Schools (1998) Vol 29, 67-75). The topic here is learning new speech sounds, but the issues are the same as we find in learning more fluent speech sounds: "The relatiely slow attainment of carryover by some children suggests that specialized instruction is needed." (p.67) Anyone familiar with and honest about speech therapy for stuttering will tell you that changing speech in the clinic room is much, much simplier than changing speech in daily living. Yet, I've seen it happen. I've seen it happen when clients and I build hierarchies together as they discover how to adopt new fluency skills successfully one small step at a time, one speaking situation at a time.

Now I'd like to know how those success stories happen, because I'm stymied by the students that do not enjoy this progress, not even the luxury of moving 4 steps forward for every 2 steps back. One clue to this mystery is called self-regulation. Wikipedia defines self-regulation with respect to a variety of disciplines. The Social Cognitive Perspective looked most appropriate to my needs as an SLP. The 3 characteristics listed in Wikipedia appear in SLP research literature:

1. self-observation (monitoring one's activities)
2. self-judgement (self-evaluation of one's performance)
3. self-reactions (reactions to performance outcomes).

These 3 processes underlie Kristen Chmela's article Self & Double Charting: A Self-Monitoring Strategy for School-Age Children Who Stutter http://www.mnsu.edu/comdis/isad9/papers/chmela9.html . I really like this article, but, when week-after-week, an individual client is not showing enough progress for his efforts, then what? I've attended too many National Stuttering Association meetings in which I've heard adults complain in pain that their SLP accused them of not trying hard enough and of somehow personally falling short in the speech therapy process, that I must help us all - SLP & PWS alike - remove this yoke of blame and move forward toward success.

Ertmer & Ertmer review 3 learning theories and suggest when to apply each.

1. Behavioral approaches are based on stimulus-response-reinforcement principles. Simply put, the client is trained in the new behavior, e.g., 'easy onset', and then earns a reward every time he produces this new behavior. An obvious analogy is gambling. A slot machine provides tokens for the player and it does so just often enough to keep the player playing. In time, gambling becomes a new habit that can be exceedingly expensive and difficult to change.

2. Cognitive-linguistic learning theories rely on "active mental processing and problem-solving principles." (p.68) To my mind, this teaching technique gives us credit for being thinking human beings! Yes, we live in bodies that respond to motor practice and emotional cues, but we can also think, self-talk, and share ideas with others to benefit ourselves and society. In speech therapy, we learn about how personal and environmental influences affect speech. We build hierarchies, join support groups, read self-help literature, and write personal journals. We can think our way to good judgements and healthy lifestyles.

"Behavioral and cognitive instructional techniques are widely accepted methods for establishing correct targets and for transferring speech skills to a variety of linguistic contexts within the therapy setting." (p.68)

3. Constructivist approaches "allow children to create their own understanding of how to use speech skills in linguistically and socially complex situations." (p.69) This is the missing link I was looking for. It is the constructivist approach that is going to help us shift locus of control (personal responsibility) from the clincian to the student. I cannot continue to provide the structure, the feedback, and the reward and assume my clients will carryover new ways of talking into their own lives. While I have always known this, I see it now with new understanding. When a client returns with increased levels of stuttering, I've focused on retraining skills and rebuilding hierarchies. Now, there will be time in speech therapy "to facilitate discovery of the concept of generalization." (p.70) This is a shift to emphasize the development of self-regulated carryover.

Self-regulation is diagramed in a way that most clients will understand on pages 70 & 71 of Ertmer & Ertmer's article. Reflection is an important concept in this teaching technique. The SLP acts "to facilitate understanding ... by asking guiding questions, supplying needed information, directing activity, challenging answers, requiring logical evidence for conclusions, and most important, emphasizing the process of thinking, learning, and problem solving rather than the products (answers)." (p.71) I suppose this happens incidentally anyway in most speech therapy sessions. But perhaps it is time to include constructivist learning theory with more diliberateness as clients take their success in the clinic and experiment with it in the real world.

SLPs can find more information in What Are Executive Functions and Self-Regulation and What Do They Have to Do With Language-Learning Disorders? (LSHSS, Vol 30, 265-273, July 1999) and Self-Regulation and the Management of Stuttering (Facing the Challenge of Treating Stuttering in the Schools, Part 2. Seminars in Speech and Language, Vol 24, No. 1, 2003).


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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.