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 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) Stage 2 (maintenance)
Parent and child attend the speech clinic 1X/week
Treatment conducted by the parent everyday
Structured 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 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

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

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,
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,
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,
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,
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,
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,
Onslow, M., Costa, L., & Rue, S. (1990). Direct early intervention with stuttering: Some preliminary data. Journal of Speech and Hearing Disorders, 55,
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,
Onslow, M., Menzies, R., & Packman, A. (2001). The Lidcombe Program: Development of a parent-conducted operant early intervention for stuttering. Behavior Modification, 25,
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.