318 Section III • Treatment of Stuttering

in all situations, the treatment is gradually faded in a system atic fashion during Stage 2, which is the maintenance stage of treatment. roughout the program, the clinician and parent regularly assess the child’s stuttering using the severity rating chart and use those measures to make treatment decisions and problem solve any barriers to progress. S TAGE 1: T HE F IRST C LINIC V ISIT Stage 1 of the Lidcombe Program begins with the rst clinic visit when the clinician meets with the parent (or other care giver) and child to accomplish three goals: (1) to explain severity ratings (SRs) to the parent, (2) to assess the child’s stuttering and overall ease of speaking, and (3) to teach the parent to conduct daily practice sessions. Stage 1 clinic visits are typically 1 hour in duration. Assessment of Stuttering Using the SR Assessment of the child’s stuttering is carried out primarily by using the Severity Rating (SR) Scale (see Chapter 9; Figure 9.4). is is a 0 to 10 scale that the clinician and parent use in each clinic meeting. In addition, the parent records SRs at the end of every day, re ecting their judgment of the child’s stut tering severity that day. e daily SRs are crucial data used to assess the child’s progress and make decisions about verbal contingencies. On the SR Scale, a 0 represents no stuttering, a 1 represents extremely mild stuttering that a casual observer would not notice, and a 10 represents extremely severe stut tering. 1 In the rst clinic meeting, a er discussing the scale in detail with the parent, the parent and I play and talk with the child to obtain an adequate, representative sample of the child’s stuttering. I then ask the parent to tell me what SR they would give the child’s speech in that sample, which I compare with my own judgment of the child’s SR. It is usually pos sible with only a little discussion to ensure that the parent is using the scale appropriately. On the rare occasion that the parent’s rating di ers from mine by more than 1 point plus or minus, I explain how I came up with my rating and then try to determine if the parent seems to understand my rationale and is likely to be accurate in their future ratings. I o en say to a parent if there is any stuttering, the score can’t be 0, and if you think about is the stuttering is mild, moderate, or severe, it will help you come up with a score that is in the lower, mid dle, or top part of the scale. If I have doubts, I use video clips of the child’s speech to help teach the parent how to use the scale. I typically ask the parents to make videos of the child’s speech at home during the rst few weeks of treatment so that I can continue to “calibrate” the parent’s ratings. Once I’m sure that the parent understands the scale, I ask them to rate the child’s speech at the end of every day and to bring the ratings to our weekly meetings. e standard Lidcombe

procedure has the parent bring in a chart that displays each day’s SRs of the child. I encourage the parent to add com ments to the chart if the child has gone through a period of increased stuttering, sickness, or other event that the parent feels may have an impact on severity or the child’s response to treatment. If it would be helpful to the parent, there is an online scale available from ASRC downloads. is can be lled out online and e-mailed to the clinician. Assessing the Child’s Percentage of Syllables Stuttered (%SS) e use of %SS to assess the child’s stuttering is optional because it simply assesses the frequency of the child’s stut tering, rather than characteristics of the severity of the stut tering. When I am conducting LP treatment, I usually assess the child’s %SS at the beginning of treatment and at other important points in the program such as when the child moves from Stage 1 to Stage 2. For a formal assessment using %SS, I typically video record the clinic session and later score the child’s stuttering from their speech in that sample, which should be at least 300 syllables. Teaching the Parent to Conduct Daily Practice Sessions A critical part of the rst clinic visit is to show the parent how to conduct the daily practice sessions. It is most important to create situations that not only are fun but also stimulate and encourage a lot of uent speech in the child. is enables the parent to begin treatment using a great deal of positive verbal contingencies for uency. To demonstrate for the par ent, I begin by using a picture book or picture cards with the child to elicit short, uent words. To keep the child’s interest, I talk with a lot of enthusiasm and move through the pictures quickly. I usually name a picture or two myself as a model for the child and then ask them to name some pictures. A er the child is engaged in the task and is producing a good deal of uent speech (because the task is designed to limit the length of the response and thus producing much uency), I praise the child’s uency immediately by saying something spe ci cally about their speech, such as “ at was really smooth talking!” or “You said that really smoothly!” It is important to make the praise directly relevant to the child’s uency , rather than general praise (ie, not “You are doing well!” but “You said those words really smoothly”). A er modeling for the parent, I ask them to work with the child, and I coach the parent if necessary.

1 e Lidcombe Program changed the 0 to 9 scale to a 0 to 10 scale in 2023, to make it similar to many scales that are 0 to 10. With children who have more severe stuttering, I may need to begin with single-syllable words or have the child repeat the word a er me. Children who have milder stutter ing can progress quickly from single words to carrier phrases (such as “I like _____”) and to short sentences of three or four words. Figure 14.2 shows a linguistic hierarchy that most children can quickly climb on the way to natural conversa tions in the beginning of Stage 1. It is important to keep in mind and share with the parent the idea that the point of the Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

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