Stuttering

320 Section III • Treatment of Stuttering

also indicate when to move from Stage 1 to Stage 2 of the Lidcombe Program . A er the clinician and parent complete their ratings of the child’s speech, they discuss the week’s SRs and the prog ress of the home treatment. As they talk, the child usually plays by themselves in the same room, with some interac tion and encouragement from the parent and the clinician. e openness with which discussions of the week’s progress take place is a hallmark of the Lidcombe Program. ere is no attempt to keep the child from overhearing the parent and clinician discussion of the child’s stuttering. e matter-of fact manner in which the clinician and parent discuss the child’s speech seems to make it more likely that both the par ent and child will feel less anxious about the child’s stuttering and may reduce any shame the child might feel about their di culty. During the parent and clinician’s discussion, some children o en make noise to call attention to themselves. In my experience, this is not because the child objects to the dis cussion of their stuttering but is only an attempt to bring the focus back more obviously on themselves. At such times, it may be helpful if the clinician simply tells the child, “Right now, I want to talk to your mommy/daddy for just a minute; then we’ll play again!” or the parent may take a minute to play with the child. As the clinician looks over the parent’s weekly SRs, the cli nician may ask about the days in which ratings are higher or lower than average, or the clinician and parent may brain storm solutions to problems that may be indicated by lack of change in the ratings. is is o en a time when videos of the practice sessions from home are useful, so that the clinician can assess how they are being conducted. It is also essential that the parent demonstrate treatment during each clinic visit to show how they are conducting the treatment at home by doing a few minutes of a practice session with the child using the verbal contingencies (Fig. 14.3). When adequate progress is being made and home SRs and clinic assessments indicate that the child is becoming more uent, new treatment proce dures can be introduced.

Once a parent is appropriately and accurately reinforc ing uency, they may be taught to use mildly negative verbal contingencies for stuttering in practice sessions. e mildest such contingency is verbally acknowledging the occurrence of an unambiguous stutter . Only unambiguous stutters should be acknowledged because normal dis uencies should not be treated as stutters. e descriptions of normal dis u encies and stuttered dis uencies in Chapter 7 clarify this dif ference. I typically model an acknowledgment of stuttering for the parent, which is given a er several contingencies for uent utterances. It is important that the parent learn to use contingencies for uency several times before using a ver bal contingency for stuttered speech. When I demonstrate acknowledgment of stuttering, I use comments like “a little bumpy one there” or “that one was a little bumpy.” I make the statement quietly, immediately a er the stutter and without any negative in ection in my voice. Acknowledgment does not require a response from the child, although some chil dren will spontaneously repeat the word that was dis uent, and the parent should praise the attempt. A er I have mod eled how to acknowledge stutters, I ask the parent to try it, but only a er they have praised several of the child’s uent utterances. Most children hardly seem to notice the acknowl edgment, although some may stop momentarily and look at the parent when it is given. Typically, I ask parents to continue using contingencies for uency and begin using acknowledg ment of stuttering for a week before introducing further ver bal contingencies for stuttering. What I have described is my way of using the LP treatment. However, there is exibility in how verbal contingencies are delivered, and each clinician should decide on their own—a er they receive training in LP—exactly how to teach parents to deliver contingencies. In the following weekly meeting, I introduce requests for self-correction of unambiguous stuttering. is verbal con tingency asks the child to say the stuttered word again with a phrase such as (if the child has stuttered on “I”) “Can you say ‘I’ again?” Such requests are made in a positive, support ive manner , and it is important that the parent practice this contingency a er the clinician demonstrates it. Some parents may be hesitant to request a self-correction and may convey their concern to the child. Others may inadvertently use a slightly negative or impatient tone when asking for a correc tion. However, a clinician’s patient modeling and subsequent coaching can do wonders to shape parents’ responses into helpful, supportive requests. A er the child has repeated the word uently, the parent should praise the self-correction with comments like “Nice job of making that word smooth.” If a child ignores a parent’s request for self-correction or refuses to self-correct, the par ent just moves on. If the child says the word again but stutters again, the parent may say something supportive like “ at’s OK; sometimes those words are hard.” In the subsequent weeks, the clinician monitors the child’s progress and ensures that the parent is delivering verbal con tingencies e ectively. e clinician also checks to see that the

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Figure 14.3 Clinician observing a father demonstrating a practice session with his child.