Stuttering

316 Section III • Treatment of Stuttering

where it can be done many days a week. It also appears e ec tive if natural uency is elicited at rst in highly structured situations, systematically reinforced, and then carefully transferred to more and more real-life situations in which stuttering has been occurring. Speech Behaviors Targeted for Therapy Usually, intervention for beginning stuttering focuses on u ency, with the expectation that children at this stage are likely to respond well to techniques with that focus. Sometimes, however, when the child is beginning to experience fewer repetitions and an increasing number of very e ortful stut ters, the focus may expand to include not just uency but also methods of modifying dis uencies so that they are less e ort ful. Despite these goals as major targets for therapy, however, creating a context that is playful and therefore fun is also seen as crucial. Fluency Goals Almost all children who are treated with e ective therapy for beginning stuttering will gain or regain spontaneous, typical uency. In most cases, a year or two a er treatment ends, the children will have little or no recollection of having stuttered and will not have to monitor their speech or work at being uent. Some who are stuttering more severely at the beginning of treat ment may have mild stutters remaining that are hardly notice able and which do not interfere with communication. In rare instances, children with beginning stuttering may continue to stutter in ways that are noticeable. ese children (and their par ents) can learn to accept the remaining stuttering and develop attitudes that allow the children to communicate e ectively. Feelings and Attitudes As noted earlier, a child with beginning stuttering has occa sional frustration and intermittent concern about talking. ey have only mildly conditioned fears or avoidances of stuttering. us, it is typically unnecessary to focus directly on feelings and attitudes in therapy—in most cases—for a child with beginning stuttering. I do, however, work on feel ings if the child seems frustrated or ashamed of their stutter ing, as you’ll see in the later sections of this chapter where I talk about speci c techniques. e feelings and attitudes of these children are, however, in uenced by the family. e clinician teaches the family member providing the at-home treatment to be matter-of fact about the child’s “smooth” and “bumpy” speech. e clinician and family member openly discuss the child’s stut tering during their weekly meetings when the child is also present. ese aspects of treatment are intended to reduce any embarrassment or shame that was associated with stut tering and foster the child’s acceptance of stuttering as just a little slip-up, like bumping into a table or tipping over their For the past many years, I have been using the Lidcombe Program (LP) (Guitar et al., 2015; Onslow et al., 1990, 2003) to treat preschool children with beginning stuttering. I was initially trained in using this program in a workshop led by Rosalee Shenker in collaboration with the Montreal Fluency Centre. Subsequently, I developed more expertise through consultation and mentoring from Rosalee and my colleagues, Julie Reville, Melissa Bruce, and Danra Kazenski. Follow-up training with Elisabeth Harrison—one of the developers of LP—further sharpened my skills. For readers interested in using this approach, I urge you to obtain formal training at one of the many workshops o ered around the world by the Lidcombe Program Consortium. More information on LP is available at http://www.lidcombeprogram.org. On this web site, the link to “Lidcombe Program Trainers Consortium” provides a brief video “lptc-an introduction” in which the program is described in a way that both families and clini cians can get a clear overview of the program and its exibil ity to adjust to di erent families and di erent children. On the website, there are also links to pages that provide infor mation in the following categories: Families and Caregivers, Speech-Language Pathologists, and Teachers and Health Pro fessionals. e information for Speech-Language Pathologists includes copies of materials needed for using the Lidcombe Program, including the treatment guide that can be found by clicking on the Research and Publications link. More infor mation about stuttering treatment can be found by connect ing with the Australian Stuttering Research Centre (ASRC), available through Google and other search engines. Moreover, an excellent chapter in Guitar and McCauley (2010), written by Harrison and Onslow, gives a detailed description of LP. Fourteen short video clips on Lippincott Connect (Chapter 14 videos) show Harrison (a master LP clinician) treating a preschool child using LP. Although LP is ever-evolving as its Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. tricycle. is is a far cry from the “conspiracy of silence” that formerly characterized the treatment of children who stutter. Maintenance Procedures Systematically fading contact with the child and their family is vital for maintaining uency. In my experience, if families leave treatment a er uency is achieved without having par ticipated in a maintenance program, stuttering seems more likely to return. us, it is important for clinicians to stress the importance of maintenance procedures at the outset of treatment. Moreover, the clinician and family should con tinue with careful data collection as contact is faded, so that the family can return to regular weekly meetings and discuss appropriate contingencies for uency and stuttering if any relapse occurs. Clinical Methods Clinical Procedures: Lidcombe Program