From Clinic to Real Life: Speech-Language Therapists' Perspectives on Extratherapy Generalization in Children With Cleft Palate.

Abstract

Purpose: Extratherapy generalization, defined as the transfer of sounds learned in the training environment to spontaneous speech outside the clinical setting, is a crucial yet underexplored facet of speech therapy in children with a cleft palate with or without a cleft lip (CP ± L). This study aimed to explore how speech-language pathologists (SLPs) experience and structure treatment activities to achieve extratherapy generalization in this population.

Method: Fourteen SLPs, aged between 29 and 49 years, were included. They all worked in a first-line health care setting and had their own private practice. Semistructured interviews were conducted to identify their experiences with extratherapy generalization in children with CP ± L. The data were analyzed using an inductive thematic approach. Researcher triangulation, negative case analysis, and member checking were performed to guarantee trustworthiness.

Results: Four major themes emerged: (a) Parental and Environmental Support, (b) The Child's Motivation, (c) Incorporating Therapy Into Everyday Life, and (d) The SLPs' Internal Feelings of Responsibility for Client Improvement. SLPs emphasized the importance of parental and environmental involvement in bridging the gap between therapy and real-life communication, while noting that negative social experiences could catalyze progress. Although external motivators (e.g., rewards) aided short-term compliance, long-term success was rooted in fostering intrinsic motivation and addressing challenges such as perfectionism. Integrating therapy into daily routines reduced the pressure of formal sessions, making learning more natural. SLPs expressed strong emotional investment in client success, often balancing clinical goals with the need to empower children to apply skills independently.

Conclusions: The findings suggest that a child-centered approach is more effective than a therapist-driven model. The study underscored the critical role of intrinsic motivation, emphasizing that while external reinforcement can facilitate short-term compliance, long-term success is best supported by fostering a growth mindset. By ensuring a balance between support and autonomy, SLPs can improve therapy outcomes.