Category Archives: Additional speech and learning difficulties

I am working with a little boy who I am beginning to realise has a clutter as well as a stutter. In your experience have you found the Lidcombe Program to be as effective when a child has both disorders present, and can I expect him to go down to 1s and 2s in the same way as a child with just a stutter ?

To my knowledge there has been no research about treating children who clutter using the Lidcombe Program. In fact, cluttering is often not diagnosed until a child is beyond the preschool years (St. Louis et al 2007). For these reasons much of what I say here is based on clinical observations rather than on published evidence.

If a child has a clutter as well as a stutter there may be a variety of impacting factors to consider including language or learning disorder, a fast speech rate, compromised intelligibility, and poor self evaluation. I would suggest treating the stuttering first, as you would with the Lidcombe Program, but ensure that verbal contingencies are only applied to effortless, stutter-free and intelligible speech. If the stutter is successfully treated but the cluttering behaviours remain, they may need to be treated separately.

It is difficult to predict what will happen in the case of this little boy. The most logical course to undertake would be to treat this child as a single case study. Take very careful measurements prior to and during treatment. Base your clinical decisions on these measures. Seek supervision opportunities and problem-solve this unusual case with senior staff or mentors.

Finally, consider writing up this case study for others to learn from your experience of treating a preschool age child who clutters.

St. Louis, K. O., Myers, F. L., Bakker, K. & Raphael L. J. (2007). Understanding and treating cluttering. In Conture E. G. & Curlee R. F. (Eds.), Stuttering and related disorders of fluency (3rd ed.) (pp. 297-322). New York: Thieme.

Do you use the Lidcombe Program with children with Down’s Syndrome ? If so, do you take into account the developmental age rather than the chronological age when considering timing of treatment?

You can use the LP with children with Down’s Syndrome. However, it is important to remember that much of the research on the Lidcombe Program has been based on children without concomitant disorders. Hence it is difficult to apply the reported outcomes to this population.

When treating children with Down’s Syndrome it is therefore important to ensure that you have valid and reliable measurements so that you can determine that progress is occurring.

In terms of deciding on the timing of intervention, if their developmental age is such that they would not be able to participate adequately in the treatment, then you may consider waiting for a time. Otherwise you should consider the same issues that you would for other children. These are overviewed below:

  • time since stuttering onset (the chances of natural recovery occurring is reduced over time whether the child is normally developing or has a concomitant disorder)
  • pattern of severity of stuttering over time
  • when the child will be starting school
  • if the child or parent or peers are reacting negatively to the stuttering
  • Family history of stuttering

See Onslow, Harrison and Packman (2003). The Lidcombe Program – A Clinician’s Guide: Chapters 4 for more information about the Timing of Intervention.