Evidence-based practice in stuttering: The Lidcombe Program

1. Evidence-based practice in stuttering: The Lidcombe Program Kimberly Farinella-Bocian May 6, 2006

2. Learner Objectives • The participant will be able to outline the major components of the Lidcombe program. • The participant will be able to outline the key studies supporting the effectiveness of the Lidcombe program.

3. Lidcombe program • What is it? • A parent-administered behavioral intervention designed for young children who stutter • Direct intervention approach • (Onslow, Costa, & Rue, 1990)

4. Lidcombe Program Origins • Response-contingent stimulation (RCS) procedures • (Onslow et al., 1990) • RCS procedures treat stuttering in an operant paradigm • Association between the behavior and the stimulus that follows (consequence) is established • Parents deliver verbal contingencies for stutter-free speech and stuttered speech in the child’s everyday environment • (Onslow, Packman, & Harrison, 2002)

5. What’s Involved? • Positive reinforcement for stutter-free speech • Correction (“punishment”) of unambiguous stuttering behaviors • Ratio of 5:1 • (Onslow, Andrews, & Lincoln, 1994)

6. Lidcombe Program Components • When the child produces stutter-free speech, the parent offers positive reinforcement • Verbally (“good talking”) • Tangible reinforcers (stickers or stamps) • For children older than 4 years of age • When an unambiguous stuttering behavior occurs, the child is asked by his/her parent to repeat the utterance again without stuttering • “Stop, I heard a bumpy word; say [stuttered word] for me again.”

7. Video Examples

8. Lidcombe Program • Initially, verbal contingencies are delivered by parents in structured conversations for 10-15 minutes per day • Once parent has mastered necessary skills for successful implementation, he/she is encouraged to deliver the verbal contingencies to the child in everyday, unstructured speaking situations • (Onslow, Packman, & Harrison, 2002)

9. Role of the SLP • SLP measures percent syllables stuttered (%SS) at the start of each clinic visit • Based on conversational speech sample that is a minimum of 300 syllables or 10 minutes in duration • Parent is trained by the SLP to rate the severity of the child’s stuttering each day in everyday speaking situations • 10-point severity rating scale where 1 = “no stuttering” and 10 = “extremely severe stuttering”

11. Video Examples

12. Lidcombe Program • Stage 1 (treatment) • Parent and child attend the speech clinic 1X/week • Treatment conducted by the parent everyday • Structured 10-15 minute conversations • Unstructured conversations throughout the day • Stage 2 (maintenance) • Criteria • %SS less than 1.0 in the clinic • Severity rating scores of 1 or 2 for the previous week, with at least four of those being 1 • Treatment conducted by parent less frequently • Less frequent visits to the speech clinic

13. Evidence-based Treatment • Lincoln & Onslow, 1997 • Lidcombe program highly effective in decreasing stuttering to zero, or near-zero levels • Post-treatment stuttering levels were maintained for up to 7 years in 43 children who participated in a long-term outcome study • No case of relapse reported

14. Social Validity • Woods et al., 2002 • Treatment was found to have no ill-psychological consequences on children • Lincoln et al., 1997 • Speech of children following treatment was not distinguishable from fluent controls based on listener judgment

15. Natural Recovery? • Lincoln, Onslow, Wilson, & Lewis, 1996 • Similar results obtained in school-age children who are unlikely to experience natural recovery from stuttering • Harris et al., 2002; Kingston et al., 2003 • Short-term reductions in stuttering that occur with the Lidcombe program have been shown to be greater than those seen with natural recovery

16. Conclusion • Lidcombe is a safe and highly effective treatment approach for use with young children

17. Lidcombe Program: On-line Manual • http://www3.fhs.usyd.edu.au/asrcwww/treatment/lidcombe.htm

18. References • Harris, V., Onslow, M., Packman, A., Harrison, E., & Menzies, R. (????). An experimental investigation of the impact of the Lidcombe Program on early stuttering. Journal of Fluency Disorders • Harrison, E., & Onslow, M. (1999). Early intervention for stuttering: The Lidcombe Program. In R.F. Curlee (Ed.), Stuttering and related disorders of fluency (2nd Ed.) New York, NY: Thieme. • Lincoln, M., & Onslow, M. (1997). Long-term outcome of an early intervention for stuttering. American Journal of Speech-Language Pathology, 6, 51-58. • Lincoln, M., Onslow, M., & Reed, V. (1997). Social validity of an early intervention for stuttering: The Lidcombe Program. American Journal of Speech-Language Pathology, 6, 77-84. • Lincoln, M., Onslow, M., Wilson, L., & Lewis, C. (1996). A clinical trial of an operant treatment for school-age stuttering children. American Journal of Speech-Language Pathology, 5, 73-85. • Onslow, M., & Packman, A. (1999). The Lidcombe Program and natural recovery: Potential choices of initial management strategies for early stuttering. Advances in Speech Language Pathology, 1, 113-121. • Onslow, M., & Packman, A. (2001). The Lidcombe Program of early stuttering intervention: Awaiting the results of a randomized controlled trial. Asia Pacific Journal of Speech, Language, and Hearing, 6, 85-89. • 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. • Onslow, M., Costa, L., & Rue, S. (1990). Direct early intervention with stuttering: Some preliminary data. Journal of Speech and Hearing Disorders, 55, 405-416. • Onslow, M., Hewat, S., McLeod, S., & Packman, A. (2002). Speech segment timing in children after the Lidcombe Program of early stuttering intervention. Clinical Linguistics and Phonetics, 16, 21-33. • Onslow, M., Menzies, R., & Packman, A. (2001). The Lidcombe Program: Development of a parent-conducted operant early intervention for stuttering. Behavior Modification, 25, 116-139. • Onslow, M., Pakcman, A., & Harrison, E. (2004). The Lidcombe Program of early stuttering intervention: A clinician’s guide. Austin, TX: Pro-Ed. • Woods, S., Shearsby, J., Onslow, M., & Burnham, D. (2002). The psychological impact of the Lidcombe Program of early stuttering intervention: Eight cases studies. International Journal of Language and Communication Disorders.