In response-contingent stuttering therapy, the speech-language pathologist trains the parent to do something after the child stutters or speaks fluently.
In the Lidcombe Program[ref]Yairi, E., & Ambrose, N.G. Early Childhood Stuttering for Clinicians by Clinicians. (2005, ISBN 89079-985-7), page 431-432.[/ref] parents are trained to verbally reward the child’s fluent speech, e.g., saying “good talking.” Children are sometimes asked for self-evaluation, e.g., “Was that smooth speech?” The parent also actively corrects the child’s disfluencies by repeating the child’s words fluently, and the child is asked to repeat the words fluently, sometimes several times.
At least eight published studies[ref]Bothe, A., Davidow, J., Bramlett, R., Franic, D., & Ingham, R. (2006). Stuttering treatment research 1970–2005: II. Systematic review incorporating trial quality assessment of pharmacological approaches. American Journal of Speech-Language Pathology, 15, 342-352; 1058-0360/06/1504-0342.[/ref][ref]Christine Lewis, Ann Packman, Mark Onslow, Judy M. Simpson, Mark Jones. (2008) A Phase II Trial of Telehealth Delivery of the Lidcombe Program of Early Stuttering Intervention. American Journal of Speech-Language Pathology, 17, 139–149, May 2008, 1058-0360/08/1702-0139[/ref][ref]Christina Lattermann, Harald A. Euler, Katrin Neumann. (2008) A randomized control trial to investigate the impact of the Lidcombe Program on early stuttering in German-speaking preschoolers. Journal of Fluency Disorders, 33, 1, March 2008, 52–65. http://dx.doi.org/10.1016/j.jfludis.2007.12.002[/ref][ref]Sarita Koushik, Rosalee Shenker, Mark Onslow. (2009) Follow-up of 6–10-year-old stuttering children after Lidcombe Program treatment: A Phase I trial. Journal of Fluency Disorders, Volume 34, Issue 4, December 2009, Pages 279–290. http://dx.doi.org/10.1016/j.jfludis.2009.11.001[/ref] have found that Lidcombe Program to be effective, with almost all children below 1% stuttered syllables, and many with zero stuttering, post-treatment.
However, long-term results of the Lidcombe Program are more difficult to assess. Two studies[ref]Jones M, Onslow M, Packman A, O’Brian S, Hearne A, Williams S, Ormond T, Schwarz I. (2008) Extended follow-up of a randomized controlled trial of the Lidcombe Program of Early Stuttering Intervention. Int J Lang Commun Disord. 2008 Nov-Dec;43(6):649-61. PMID: 18608610[/ref] [ref[vii] Barbara Miller, Barry Guitar (2009). Long-Term Outcome of the Lidcombe Program for Early Stuttering Intervention. American Journal of Speech-Language Pathology, 18, 42–49, February 2009, 1058-0360/09/1801-0042[/ref] suggested that about 15% of children relapse within five years.
One study found that Lidcombe Program resulted in improved social, emotional, and cognitive (SEC) measures, including anxiety, aggression, depression, withdrawal, and attachment to parents.
A 2013 JSLHR systematic review concluded that “there is clear support for only one intervention approach, the Lidcombe Program,” however, there may be other treatments just as effective as Lidcombe that have not been studied as carefully.[ref][viii] Nye, C., Vanryckeghem, M., Schwartz, J., Herder, C., Turner, H., & Howard, C. (2013) Behavioral Stuttering Interventions for Children and Adolescents: A Systematic Review and Meta-Analysis. Journal of Speech, Language, and Hearing Research. , page 28.[/ref]
Lidcombe for School-Age Children
One study found that the Lidcombe Program was successful with older children (ages 6 to 10).[ref]Sarita Koushik, Rosalee Shenker, Mark Onslow. Follow-up of 6–10-year-old stuttering children after Lidcombe Program treatment: A Phase I trial. Journal of Fluency Disorders, Volume 34, Issue 4, December 2009, Pages 279-290, https://doi.org/10.1016/j.jfludis.2009.11.001.[/ref]
What the Experts Think
The Lidcombe Program is widely practiced and discussed. However, many American experts disparage the Lidcombe Program and instead recommend Wendall Johnson’s Indirect Therapy.
If You Tried Lidcombe and Your Child Still Stutters
Lidcombe isn’t the only stuttering therapy for young children.
Lidcombe was designed to be so simple that parents can do it. A parent doing therapy every day with a child can be more effective than a SLP doing therapy once or twice a week. Simplicity is Lidcombe’s strength but could also be its weakness. The Australian Stuttering Research Centre, which developed Lidcombe, has a newer, more complex therapy called the Westmead Program.
The Westmead Program is a syllable-timed speech treatment, in which the child is trained to speak at a slower speaking rate. In a study of three pre-school children, the treatment was effective.[ref]Trajkovski N, Andrews C, Onslow M, O’Brian S, Packman A, & Menzies R. Using syllable-timed speech to treat preschool children who stutter: A multiple base-line experiment. Journal of Fluency Disorders, Volume 34, Issue 1, March 2009, Pages 1–10, http://dx.doi.org/10.1016/j.jfludis.2009.01.001[/ref] In a study of eight children (3 to 4.5 years old), pre-treatment stuttering was 6.0% stuttered syllables and at 12-months post-treatment stuttering had decreased to 0.2% stuttered syllables, representing a mean stuttering reduction of 96%.[ref]Trajkovski N, Andrews C, Onslow M, O’Brian S, Packman A, & Menzies R. A phase II trial of the Westmead Program: Syllable-timed speech treatment for pre-school children who stutter. Int J Speech Lang Pathol. 2011 Dec;13(6):500-9. PMID: 22070727[/ref]
Maybe you need to spend more time doing therapy practice with your child.
In the game “Turtle Talk,” the speech-language pathologist makes a turtle hand puppet walk slowly when the child uses slow, relaxed speech. When the child uses fast, tense speech, the turtle stops and crawls into his shell. The child has to use slow, relaxed speech to ask the turtle to come out of his shell. If you don’t have a turtle hand puppet, you can have a car slowly drive along a table, avoiding obstacles.
In the game “Say the Magic Word,” the clinician or parent says that he or she is thinking of a word, and if the child guesses the word, he will be rewarded with a peanut or will be allowed to ring a bell. They then look through a picture book or look out a window. This game is easy for a parent to play while driving with the child. When the child says a word fluently, the parent says that that was the magic word, and rewards the child. If the child stutters, he isn’t rewarded. The parent doesn’t think of any word, but rather listens for the child to say fluent words.
Submit your review