The Lidcombe Program is a parent-conducted behavioural treatment that targets stuttered speech in children, without changing the child’s usual speech pattern or environment. This program is widely-researched and has demonstrated effectiveness in reducing stutter among preschool age children (younger than 6 years). This program does not negatively interfere with child’s language development, psychological state or parent-child relationships, and is centred around parent verbal contingencies (verbal feedback), which are important in eliminating or significantly reducing stutter. Treatment length is largely dependent on child’s stutter severity.
The program comprises 2 stages. The aim of Stage 1 is for the child to have no or close to no stutters in conversation. This focuses on short periods of practice in structured and natural tasks, where an adult praises stutter-free speech or acknowledges when a stutter has occurred. Complexity is increased as tasks become less structured and the cognitive demands increase. A child progresses to Stage 2, after no stutters or close to no stutters were observed over three weekly treatment sessions. The frequency of therapy now reduces, over the course of a year, as long child continues to not stutter for extended periods of time.
Stuttering
Stuttering is an involuntary disorder of fluency which presents itself in 3 main speech behaviours: repeated movements (e.g. part word “a-a-again”, whole word “but-but-but”), fixed postures (e.g. with audible airflow by dragging the first sound in a word ‘sssnake’, without audible airflow like ‘blocks’ where the child might struggle to get the word out), and superfluous behaviours (e.g. verbal or nonverbal tics/tensions).
Stuttering most often appears among 2-3 years of age, with research reporting that it can begin as early as 12 months and may present at any stage across the lifespan. Stuttering can come on suddenly or gradually. A stuttering profile may vary over time, it may be continuously present and it may disappear, only to return again.
While, there’s no known cause of stuttering, there is established evidence suggesting that genetics does play a role in determining the recovery of stuttering. Psychological factors (e.g. stress, anxiety) can worsen the severity of stuttering, however stuttering is likely thought to be a neurodevelopmental disorder which affects areas in the brain that produce speech due to linguistic, cognitive or emotional demands placed on the child.
Research has found a small clinical window of opportunity for natural recovery during preschool years, however also found a low probability of recovery stuttering if treatment is delayed, especially 12 months after the onset of stuttering. Persistent stuttering behaviours could negative consequences impacting self-identity and having to manage negative reactions from peers. This could interfere with child’s ability to play to communicate with peers and others, thus affecting the development of healthy peer relationships.
Awareness of own stuttering has been observed to increase with age. It is also related to severity of stuttering and duration of stuttering. This awareness can stem from negative peer reactions such as interruption, mocking or ignoring what the child was trying to say. It is therefore imperative to identify early transient signs of distress among children who stutter.
References
Ambrose, N. G., Cox, N. J., & Yairi, E. (1997). The genetic basis of persistence and recovery in stuttering. Journal of Speech, Language, and Hearing Research, 40(3), 567-580. https://doi.org/10.1044/jslhr.4003.567
Boey, R. A., Van de Heyning, P. H., Wuyts, F. L., Heylen, L., Stoop, R., & De Bodt, M. S. (2009). Awareness and reactions of young stuttering children aged 2-7 years old towards their speech disfluency. Journal of Communication Disorders, 42(5), 334-346. doi:10.1016/j.jcomdis.2009.03.002
Connery, A., McCurtin, A., & Robinson, K. (2020). The lived experience of stuttering: a synthesis of qualitative studies with implications for rehabilitation. Disability and Rehabilitation, 42(16), 2232-2242. doi: 10.1080/09638288.2018.1555623
Jones, M., Onslow, M., Packman, A., Williams, S., Ormond, T., Schwarz, I., & Gebski, V. (2005). Randomised controlled trial of the lidcombe programme of early stuttering intervention. British Medical Journal, 331, 659-663. doi: 10.1136/bmj.38520.451840.E0
Kraft, S. J., & Yairi, E. (2012). Genetic bases of stuttering: The state of the art, 2011. Folia Phoniatr Logop, 64, 34-47. doi: 10.1159/000331073
Langevin, M., Packman, A., & Onslow, M. (2010). Parent perceptions of the impact of stuttering on their pre-schoolers and themselves. Journal of Communication Disorders, 43, 407-423. doi: 10.1016/j.jcomdis.2010.05.003
Lidcombe Program Trainers Consortium (2018). Retrieved from http://www.lidcombeprogram.org
Reilly, S., Bavin, E. L., Bretherton, L., Conway, L. J., Eadie, P., Cini, E., Prior, M., Ukoumunne, O. C., & Wake, M. (2009). The early language in victoria study (elvs): A prospective, longitudinal study of communication skills and expressive vocabulary development at 8, 12 and 24 months. International Journal of Speech-Language Pathology, 11(5), 344-357. doi: 10.1080/17549500903147560
