The Lidcombe Program: Where To Next?
About the presenter: Michelle Lincoln (PhD), is a senior lecturer in the School of Communication Sciences and Disorders, The University of Sydney, Australia. Michelle has published papers in the areas of early intervention for stuttering, treating school-age children who stutter, the social validity of stuttering treatments and anxiety and stuttering. Michelle is a lecturer, clinical educator and researcher in the area of stuttering.
The Lidcombe Program: Where to next?
by Michelle Lincoln
from Australia
The Lidcombe Program is a parent and clinician administered early intervention for preschool children who stutter. The Program was developed through the collaboration of staff from the Stuttering Unit, Bankstown Health Service, and researchers from the School of Communication Sciences and Disorders , and the Australian Stuttering Research Centre at the University of Sydney The program is based on weekly visits to the speech pathologist. The components of the Program are (1) training parents, (2) within clinic and beyond clinic speech measures, (3) praising and rewarding stutter-free speech and correcting stuttered speech, and (4) a performance-contingent maintenance program. The treatment manual for speech pathologists can be found at the following web site http://www.cchs.usyd.edu.au/Academic/ASRC/
The outcomes of the Lidcombe Program when used with preschool children are described in four publications (Onslow, Costa & Rue, 1990; Onslow, Andrews & Lincoln, 1994, Lincoln and Onslow, 1997, Lincoln, Onslow & Reed, 1997). Outcomes for a group of school-age stuttering children are described by Lincoln, Onslow, Lewis and Wilson (1996).
Onslow et al. (1990) reported outcomes of the Lidcombe Program with four preschool children. Pre treatment data were gathered in a variety of speaking situations for two months pre treatment and nine months post treatment. Stuttering was reduced to near zero levels in all four children post treatment after 5 to 8 clinical hours. Following this study Onslow et al. (1994) conducted another trial of the Lidcombe Program with 12 subjects. Pre treatment data were collected for 2 months and 12 months post treatment data were collected. The subjects achieved a median of 1.0%syllables stuttered (SS) for the entire 12-month post treatment period. Surveys were sent to the parents of the children after completion of maintenance. The five parents who responded to the survey reported an average stuttering severity rating of one or two on a ten-point severity rating. Parents also reported that they continued to give online feedback occasionally, i.e. daily , or monthly. The reported treatment benefits were achieved in 10.5 clinical hours.
Lincoln and Onslow (1997) reported the long-term outcome of treatment from the two studies previously discussed. This study provides outcome data on the children at 2 to 7 years post treatment. Additionally, data were collected 1 to 4 years post treatment on a comparable clinical population who received the same treatment. The subjects in this study were 43 children who had been treated for stuttering between 2 and 5 years of age. Parents were requested to make three 10-minute recordings of their child's speech each year for 3 years. Questionnaires were sent to the parents at the same time as the tapes. Near zero stuttering levels were achieved post treatment and were maintained long-term. These results suggest that preschool-age children treated for stuttering may not need to re-enter treatment for up to 7 years after their initial treatment.
Taken together the results of these three studies suggest that the Lidcombe Program is effective in reducing stuttering to near zero levels in the short and the long-term. This result was achieved for all the subjects who completed the program and were available for follow-up in the long-term. Of particular interest is the relatively short time required for treatment when compared with treatment times for adults who stutter. Also of interest are the reports by parents that they continued to provide on-line feedback in the long-term. Perhaps this suggests that for some children control of stuttering continued to be reliant on parents' feedback. Lincoln, Onslow and Reed (1997) compared the speech of children who received The Lidcombe Program with the speech of children of the same age and sex who have never stuttered. Part A compared the %SS of the two groups of children. The study found that both groups attracted similar measures of %SS. Part B compared the number of "stuttering" versus "not stuttering" judgments made by experienced clinicians and unsophisticated listeners on the same speech samples. Children who had never stuttered were identified as "stuttering" significantly more than the treated children. Lincoln et al (1997) concluded that the Lidcombe Program resulted in speech that was comparable with children of the same age who had never stuttered. These results are in contrast to the adult stuttering literature which contains consistent findings that the speech of adults who have been treated for stuttering can reliably be distinguished from normal speakers (for example see Metz, Schiavetti & Sacco, 1990). While the findings of this study are encouraging further investigation is required to determine why the normal speakers where identified as stuttering more frequently than the children who had received the Lidcombe Program. It is possible that some qualitative differences exist in the speech of the two groups which this study did not assess.
Research in progress and future directions
At the time of writing, there are several studies underway on the Lidcombe Program. My colleagues at The Stuttering Unit and the Australian Stuttering Research Centre are actively researching in the following areas (1) investigating the contribution of its various components of the Lidcombe Program (2) investigating effects of the Lidcombe Program on the language development of preschool-age stuttering children, (3) assessing the impact of the Lidcombe Program on the course of stuttering in preschool-age children, and (4) clinical trials of the Lidcombe Program in several overseas speech pathology clinics.
Currently underway are a series of studies aiming to develop an effective method of delivering the Lidcombe Program to stuttering children who live in rural areas of Australia, and consequently have limited access to speech pathology services. The project will develop a treatment 'package', and evaluate its effectiveness.
Also in progress is a study which aims to describe in detail the correction component of the Lidcombe Program. To date no attempt has been made to describe the actual behaviours that clinicians and parents use when asking a child to repair/correct stuttered speech. "Repair" is a linguistic concept which has long been used in speech pathology research but has not, however, been adapted to stuttering (Ferguson, 1998; Brinton, Fujiki, Loeb and Winkler, 1986). By analysing interactions between both the clinician and the child and the parent and the child, we aim to (1) describe the behaviours that are typically used to encourage children to repair stuttered speech and (2) identify those behaviours that are most effective in eliciting stutter free responses from the children during treatment.
References
Brinton, B., Fujiki, M., Loeb, D.F., & Winkler, E. (1986). Development of conversational repair strategies in response to requests for clarification. Journal of Speech and Hearing Research, 29, 75-81. Ferguson, A. (1998). Conversational turn-taking and repair in fluent aphasia. Aphasiology, 12 (11), 1007-1031.
Lincoln, M., Onslow, M., Lewis, C., & Wilson, L. (1996). A clinical trial of an operant treatment for school-age children who stutter. American Journal of Speech Language Pathology, 6, 77-84.
Lincoln, M. A., & Onslow, M. (1997). Long-term outcome of early intervention for stuttering. American Journal of Speech-Language Pathology, 6 (1), 51-58.
Lincoln, M., Onslow, M., & Reed, V. (1997). The social validity of treatment outcomes of an early intervention for stuttering. American Journal of Speech-Language Pathology , 6, 77-84..
Metz, D. E., Schiavetti, N., & Sacco, P. R. (1990). Acoustic and psychophysical dimensions of the perceived speech naturalness of nonstutterers and posttreatment stutterers. Journal of Speech and Hearing Disorders, 55, 516-525.
Onslow, M. (1996) Behavioral management of stuttering. San Diego, CA: Singular Publishing Group.
Onslow, M., Costa, L., & Rue, S. (1990). Direct early intervention with stuttering: Some preliminary data. Journal of Speech and Hearing Disorders, 55, 406-416.
Onslow, M., Andrews, C., & Lincoln, M. (1994). A control/experimental trial of an operant treatment for early stuttering. Journal of Speech and Hearing Research, 37, 1244-1259.
August 13, 1999
