Category Archives: Verbal Contingencies

I have been told recently that in some countries in Europe where ‘commenting’ on stuttering feels more problematic some clinicians have been moving towards only offering verbal contingencies for stutter-free speech, thereby omitting those for stuttered speech. Do you think there might be problems with this, what might they be and is there any evidence for what might happen if only contingencies for stutter-free speech are given?

It is still unclear which components of the Lidcombe Program make it effective. Is it the structured treatment times? Is it the verbal buy levitra in canada contingencies, and if so which ones? Or is it the combination of structured treatment and verbal contingencies? These questions still need to be answered, but what we do know from some preliminary research (Harrison et al, 2004) is that verbal contingencies for stuttered speech appear to be a functional component of the Lidcombe Program.

If there are no verbal contingencies for stuttered speech then not all components of Lidcombe Program are being implemented. There are cases though, such as with sensitive clients, where it might be appropriate only to provide verbal contingencies for stutter-free speech.  

References
Harrison, E, Onslow, M & Menzies, R (2004) ‘Dismantling the Lidcombe Program of early stuttering intervention: verbal contingencies for stuttering and clinical measurement’ International Journal of Communication Disorders, vol. 39, no. 2, pp. 257-267

I have read recently that it might be possible to think about the parental verbal contingencies in the Lidcombe Program in the form of a dose, like a medicine. Using this framework, do you have any recommendations about what ‘dose’ we should be giving or is this individualised as with other aspects of the program? Is asking about ‘dose’ or number of contingencies given something you would regularly do when discussing treatment with parents?

I find that some parents and clinicians find it helpful to think in terms of dosage of treatment. I do not use it for all clients but as I would with other analogies, it may be used to explain expectations to some parents.

As for recommendations, I would usually start with daily structured treatment for 15 minutes as per the Lidcombe Program Guide and introduce verbal contingencies throughout the day when there is some fluent speech. I would monitor severity ratings from beyond the clinic and in the clinic to determine whether more or less treatment is required. Sometimes I change the timing of the verbal contingencies as well as the amount and the style of delivery.

However, the amount/dose of treatment really does vary for each child and will depend on the stage of treatment that they are in. The “dosage” is determined by the child’s response to treatment reflected in severity ratings and the child’s reactions to contingencies. For this reason, you should ask parents how many verbal contingencies they are providing, in what buy lipitor no prescription treatment situations, and whether they are delivering them in patches or intermittently throughout the day. That information forms the basis for any changes in the “dosage” of treatment that you recommend.

Times when you might deliver more frequent verbal contingencies include at the start of treatment, especially if the stutter is severe; when the child is starting to experience periods of stutter free speech throughout the day; if you suspect that the child needs more contingencies throughout the day to make further progress.

Times that verbal contingencies will be reduced include if the child is achieving mostly stutter free speech and appears to be stable, if the child does not like attention, if you suspect that verbal contingencies are too intensive and therefore invasive for the child (clues are if the child reacts, e.g. “stop saying that”, or if you can see the parent providing a contingency on every utterance).
It should be noted that verbal contingencies for stutter free speech should always be rewarding, unpredictable, and not constant or invasive.