Chapter 14 • Treatment of Older Preschool Children: Beginning Stuttering 321

selectively at rst, so that the parent can judge how the child is responding. If the child reacts well, which is usually the case, the parent can begin using verbal contingencies in more and more conversations, but at the same time, the parent should make sure that the child is not overwhelmed by too frequent attention to their speech. e child needs to experi ence the normal ow of conversation for its own sake, rather than feel that everything they say is being evaluated. is is especially essential for sensitive children but is probably valu able for all children to avoid increasing the child’s sense of being scrutinized for their speech. Another issue that may arise relative to contingencies in natural conversations is who is giving the verbal contingen cies. In general, only the person who has been meeting with the clinician should be conducting practice sessions and giv ing verbal contingencies in natural conversations. In some cases where it seems really needed, both parents, and even other family members, may be involved in the natural con versations. When this is done, it must be done very carefully and be individualized for each family. Any individual who is giving verbal contingencies must be meeting with the clini cian to make sure that the contingencies are done properly. is will ensure that many more instances of praise for uency be given than requests for self-correction of stuttering and that requests for self-correction be done in a supportive man ner. Also, the focus on the content of the conversation rather than its uency needs to remain a top priority. Contingencies in natural conversations at home and weekly meetings in the clinic continue until the child is essen tially uent and can move to Stage 2. is point is reached when two criteria are met: (1) the parent’s SRs for 3 weeks in a row are all 0s and 1s, with at least four of the ratings being 0 each week, and (2) the clinician’s SRs for the entire clinic visit are 0s or 1s for these same 3 weeks. Meeting these criteria is vital if the child is to remain uent a er treatment. If the clinician has any doubts about the reliability and validity of the parent’s SRs, they should request that the parent bring an audio or video recording of the child’s speech at home to con rm that the criteria are met. e clinician can also check with others who have daily contact with the child to verify that the child has the level of uency that the parent’s SRs indicate. S TAGE 2: M AINTENANCE

child is enjoying the practice sessions and is responding well to the contingencies for both uency and stuttering. Every child and every family are di erent, so the program must be individualized in each case. For example, some children may indicate they are uncomfortable with such praise as “ at was really smooth talking.” In this case, the parent can ask the child what they would like the parent to say when the child is talking smoothly. Alternatively, the parent can use one of the other verbal contingencies for uency. Some children who don’t react well to praise will happily respond to requests to self-evaluate their uency. One child I worked with preferred that the parent put a penny in a jar, which made a nice “plink” sound, rather than verbally praise their uency. Another child who loved the Boston Red Sox asked his mother to say “ at’s Red Sox talking!” a er uent speech. You can guess what the child asked the parent to say a er the child stut tered. It had to do with a New York team. S TAGE 1: I NTRODUCING V ERBAL C ONTINGENCIES IN N ATURAL C ONVERSATIONS When treatment has progressed well for 2 or 3 weeks, and SRs indicate an increase in stutter-free speech, a gradual transition can be made from practice sessions to natural con versations. us, verbal contingencies of praise, acknowledg ment of stutters, and requests for correction can now be given in typical daily conversations, such as during meals, riding in the car, shopping, and playing. When treatment is rst introduced in natural conversations, practice sessions usually continue for a time to make the transition easy. When con tingencies in natural conversations have been going well for a week or two and stuttering continues to decrease, practice sessions can be faded gradually. For example, each week, one or two practice sessions may be dropped until they have all been discontinued and replaced with contingencies in natu ral conversations. ere are several reasons why practice sessions may sub sequently be reinstated or even increased. e rst reason is if SRs increase when natural conversations have largely replaced practice sessions, practice sessions should be reinstated until the child’s SRs have returned to earlier levels. Another reason for continuing or reinstating practice sessions is if the child asks to continue practice sessions for a period of time as the transition to natural conversations is made. Sometimes par ents feel that things are going so well in practice sessions that they believe the transition to natural conversations should be made slowly. Several issues may warrant consideration when using con tingencies in natural conversations is just getting underway. Parents may wish to begin with just praise for uent utter ances and then add acknowledgment for uency and for stut tering, requests for self-evaluation, and, nally, requests for self-correction of stuttering. If problems appear in response to any of these verbal contingencies, they can be solved immediately. It is also important that verbal contingencies not be given relentlessly throughout each day but are used

One of the most important components of the Lidcombe Pro gram is its maintenance procedure. Because relapse is com mon in stuttering treatment, parents are cautioned when they begin Stage 1 of the Lidcombe Program that it is essential that they continue to work with the clinician through the end of Stage 2. ey are reminded of this throughout Stage 1 so that the procedures of the second stage are expected. Stage 2 consists of 30-minute clinic visits that are scheduled at gradu ally wider intervals. Typically, there are two visits at 2-week intervals, then two visits at 4-week intervals, then two visits at 8-week intervals, and, nally, one visit 16 weeks later. During Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

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