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

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.

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

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)

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

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.”

Video Examples

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)

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”

Video Examples

Lidcombe Program Stage 1 (treatment) Stage 2 (maintenance) 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

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

Social Validity Woods et al., 2002 Lincoln et al., 1997 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

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

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

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

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.