During Stage 2, the parent and child return for clinic visits aiming to maintain treatment targets for increasingly longer intervals: two visits 2 weeks apart, then two visits 4 weeks apart, then two visits 8 weeks apart, and finally two visits 16 weeks apart. The schedule normally takes a year or more. The importance of this procedure is shown by a report that half of children during Stage 2 fail to meet treatment targets at least once during Stage 2.
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Some of us have been taught to give the ratio of contingencies of a stutter-free speech to stuttered speech as 5:1. Is this ratio something that the Lidcombe Program has borrowed from operant conditioning theory generally or is it something that is specific to the Lidcombe Program? Do you ever advise different ratios?
The concept of reinforcing the behaviour that you want to increase and applying some contingencies to the behaviour that you want to decrease, is drawn from the field of applied behaviour analysis. When considering the ratio of contingencies it is important to relate this to the individual child. As outlined in the ‘The Lidcombe Program of Early Stuttering Intervention – A Clinician’s Guide’, contingencies need to be delivered safely and should not be intensive, invasive or intrusive.
The 5:1 ratio is not a prescription but rather a bare minimum safe guard. It is there to prompt clinicians to remember that the contingencies for stutter-free speech must be much more frequent than contingencies for stuttered speech. The speech-language pathologist and parent need to continually generic online pharmacy monitor how the child is receiving any contingencies and make adjustments accordingly. If a child is sensitive to contingencies for stuttering, then very few or no contingencies for stuttering may be recommended. Later this can be reviewed and more contingencies applied for stuttered speech, if they are being received well. If there is a temptation to deliver a ratio less than 5:1 in structured treatment it is likely that the treatment is structured at a level that is too difficult for the child. Overall the ratio of contingencies is quite variable as the parent and speech-language pathologist respond to what is happening with any individual child’s speech, but it should not go below the minimum of 5:1
