Fostering generalization and maintenance in school settings.

One of the most challenging aspects of therapy for school-age children who stutter is generalizing the skills learned in the therapy room to other settings such as the classroom, lunchroom, playground, or home. An additional challenge is seen in maintaining gains over the long term. This article reviews common roadblocks to generalization and maintenance, including the goals of therapy, the nature of the treatment strategies that require generalization, the scheduling and implementation of generalization activities within the overall therapy process, and the child's understanding of the treatment goals. Specific strategies for overcoming these roadblocks include: desensitizing children to both stuttering and treatment strategies designed to improve fluency, using hierarchies as a way of structuring treatment and moving children toward success in their daily activities, integrating the child's real world and clinical settings, and using structured practice activities to help children solidify all of the lessons they learn in treatment. This article highlights the importance of taking a broad-based view of stuttering to help children improve their overall communication across a variety of settings and over time.