Non-English Speaking Families

Can a child be treated with the Lidcombe Program when the parents do not speak the same language as the speech-language pathologist?

Yes it is possible to successfully treat a child with the Lidcombe Program when the parents and the speech-language pathologist do not speak the same language. Interpreters can be used effectively to help communicate with the family. However, this situation does present a clinical challenge for the speech-language pathologist.

What information is available about parents’ experiences of the Lidcombe Program?

The Lidcombe Program Treatment Guide contains details of two comprehensive reports about parent experiences of the Lidcombe Program. These are well worth reading.

Suitability of the Lidcombe Program for all Children

Are there any children for whom the Lidcombe Program is not suitable?

There has been no research that has explored this. Clinical trials have excluded children with comorbid conditions such as ADHD and intellectual impairment. 

Prompting & Praise

I have heard the term ’prompting’ used by speech-language pathologists who use the Lidcombe Program, but it is not in the Lidcombe Program Treatment Guide. What does it mean?

In the context of the Lidcombe Program, prompting means alerting a child to attempt to be stutter-free in a forthcoming speaking situation. For example, prior to a visit to a friend, the parent might remind the child where they are about to go, and prompt the child to use stutter-free speech. Normally the parent would be careful to follow this up with verbal contingencies. 

What are the age limits for children for whom the Lidcombe Program is suitable?

The Lidcombe Program was developed for children younger than 6 years. Children as young as 2 years have participated in clinical trials. One clinical trial showed that the Lidcombe Program can be effective with children in age range 7–12 years.

Severity Ratings

How do I learn to be accurate with the severity rating scale?

The only way to do this is to consult with colleagues, because the scale pertains to the clinical population of stuttering children. For example, if you think a child’s stuttering warrants a severity rating of 7, then you might check that colleagues agree with you.

Can the parent give more than one severity rating per day?

Typically a severity rating for each day is used to measure progress. However, speech-language pathologists can use variations. Examples of variations are provided in the Lidcombe Program Treatment Guide. What is important is that the speech-language pathologist is clear about how the parent is giving the ratings so the information that the parent provides can be interpreted properly. It is important that the ratings are used in a way that is consistent and meaningful.

Verbal Contingencies

What kinds of activities are suitable for giving verbal contingencies during practice sessions?

Memory games, books, games, felt boards, puzzles, play dough, drawing and colouring, train sets, doll houses and magnetic boards are all useful. Books lend themselves to parent training and are often the most readily available resource in the child’s home.

The Lidcombe Program Treatment Guide specifies that the clinician watches the parent giving verbal contingences during each clinic visit and gives the parent feedback. Are there any exceptions to that routine?

It is a general rule to watch the parent giving verbal contingencies during each clinic visit. However, towards the end of Stage 1, the speech-language pathologist may judge it to be more useful to spend the time during a clinic visit discussing the treatment and problem solving. However recommended that the speech-language pathologist does allow two weeks to lapse without watching the parent give verbal contingencies during two consecutive visits.

What do you do if when collecting a severity rating or %SS sample a child uses a lot of rote speech? For example, the child who insists on counting everything, or saying nursery rhymes, or, when putting things away, says ...."and that one in there....and that one in there...and that

If a child does this a few times in one conversation, and it is not the habitual way that of talking in the clinic, then it is not a problem and there is no need to do anything about it. On the other hand, if this happens often, subtly intervene. The aim is to gently move the child on to talking about something different, so that a more representative sample of speech is heard. For example, try to move the "Counting Kid" on to talking about functions, and the "Nursery Rhyme Kid" on to playing a matching game. Then you are more likely to obtain a baseline speech measure that is valid.

The Lidcombe Program Treatment Guide states that percent syllables stuttered is no longer essential. What measures are used now to determine whether a child is ready for Stage 2.

The treatment guide describes how a child is admitted to Stage 2 if parent and clinician severity ratings meet specified targets.  

Is self-monitoring essential in the Lidcombe Program?

required from children. Of course, though, it is a positive thing if a child is spontaneously self monitoring to control stuttering.  

Why do clinical trials show that the Lidcombe Program is efficacious?

At present it is unknown why the Lidcombe Program appears to be efficacious.

Stage 2

When a child is in Stage 2 of the Lidcombe Program what is the usual schedule of visits?

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.

Who Conducts the Treatment at Home

Can a parent who does not attend the clinic visits give verbal contingencies to the child?

No, only parents who have attended some clinic visits should give the verbal contingencies. To ensure that the Lidcombe Program works properly, the speech-language pathologist needs to train every parent who will give verbal contingencies.

Stage 1

What is the expected number of visits to end Stage 1 and begin Stage 2?

According to publications up until June 2015, a median of 16 visits is required for children to attain Stage 2 criteria and there is around one-third reduction of median parent severity rating scores after four weeks of treatment. Severity of stuttering is a predicting factor with, children who have more severe stuttering typically taking longer to reach Stage 2 than children with mild stuttering.

Treatment times for individual speech-language pathologists will vary; the range of medians in the publications above is 11–23. It is recommended that these figures be used as broad guidelines for number of Stage 1 visits rather than being used as professional benchmarks. They may be useful guidelines to alert speech-language pathologist when a child’s progress may not be typical of Lidcombe Program caseloads. Such situations commonly prompt speech-language pathologist to consult with colleagues.

Child’s Awareness of Stuttering

Do children need to be aware of their stuttering for the Lidcombe Program to be suitable?

It is not a requirement of the Lidcombe Program that children are aware of their stuttering. However, as treatment progresses, they do become aware of if, particularly when parents begin to present verbal contingencies for unambiguous stuttering.

Attending a Lidcombe Program Workshop

I am a student and have been learning about the Lidcombe Program on my undergraduate course. Is it possible to train in the program while I am still a student or is it only for qualified speech-language therapists?

The Consortium Lidcombe Program workshop has been developed for practising speech-language pathologists. However, speech-language pathology students in their final semester of a professional degree program can attend the workshop. For a list of forthcoming Lidcombe Program Workshop click here.

Hand-outs for Parents

Are brochures available about the Lidcombe Program for parents?

Yes, a brochure is available here. It is a useful introduction to the treatment for parents. Another document that is widely available is the Lidcombe Program Treatment Guide. Some speech-language pathologists may find it helpful to direct parents to the Guide once they have commenced treatment.