Stuttering

322 Section III • Treatment of Stuttering

Sometimes, progress toward uent speech is stalled for several weeks, or previous gains are momentarily lost. If so, I usually begin by talking to the parent about what they think might be occurring. Parents are o en able to pinpoint some thing they have changed about the way they are doing treat ment. Or it may be that a parent misunderstands some aspect of treatment. us, it is essential to have parents demonstrate how they conduct treatment, and it may be even more helpful to have them bring in a video of treatment at home. Examples of things that may go wrong include the following: (1) par ents are less attentive to praising uent speech regularly so that fewer positive reinforcements are made than requests for corrections; (2) parents become lax about the consistency of practice sessions so that many days are missed and treatment becomes inconsistent; (3) other family members, while try ing to be helpful, make mistakes in providing verbal contin gencies because they have not been trained; (4) the child is overly sensitive to verbal contingencies and asks parents to stop using them; and (5) some children who stutter severely at the beginning of treatment have trouble generating ade quate uency in structured sessions; (6) some children have co-existing de cits like phonology and/or language prob lems, and LP treatment take longer. e problems that arise from misunderstanding the parameters of treatment can usually be resolved by sup portive feedback and guidance of the parent and modeling of appropriate behavior. Other issues, such as conducting treatment inconsistently, may require brainstorming with the parent about how treatment can be conducted more regularly. If a child isn’t enjoying conversations, progress will be stalled. But it is not di cult to coach parents in deliver ing treatment in ways that are enjoyable, e ective, and fun for both parent and child. Clinicians who have worked with preschool-age children have usually learned how to keep a child interested and achieve therapy goals at the same time. It may be appropriate for other family members to become involved in practice sessions, but they must be trained by the clinician to deliver contingencies e ectively. Practice sessions may be shared by both parents and other caregivers, but the clinician should ensure that whoever is delivering treatment is doing so accurately, and direct training is the best way to achieve this. If a child objects to the parent’s verbal contingencies a er treatment has gone on for some months, it is usually helpful to ask the child how they would like the parent to respond to uent speech and to stuttering. Some sensitive children prefer nonverbal contingencies such as a wink or a “thumbs up” a er several uent utterances and just a quick eye contact a er a stutter.

this period, parents continue to provide verbal contingencies for uency and stuttering just as they did during Stage 1 and continue to record SRs, but the clinician guides the parents in gradually decreasing their verbal contingencies until they are completely discontinued. To progress through this schedule of visits, the child must maintain the same level of uency achieved to begin Stage 2 (clinician SRs of 0 or 1 for the entire clinic visit and parent SRs beyond the clinic visit of 0s and 1s, with at least four rat ings of 0 during any given week). When the parent and child come in for a scheduled clinic visit, the clinician has a natural conversation with the child without providing verbal contin gencies, followed by a discussion of how the child’s speech has been since the previous visit, using the severity ratings from the previous week that are provided by the parent. is discussion, as always, is focused on the parent’s SRs and reports of how the child is responding to verbal contingen cies. At each visit, the clinician and parent decide whether to continue decreasing the frequency of clinic visits or to make some changes, such as keeping to the current frequency of visits, resuming or increasing contingencies in natural con versations, or reinstating both practice sessions and contin gencies in natural conversations. It is also possible that some aspect of the verbal contingencies may need to be adjusted. For example, sometimes a child becomes so uent that when stutters do occur, parents or other family members apply contingencies to stuttering without concurrently giving more contingencies for stutter-free speech. Sometimes, making this adjustment of reinstating praise for stutter-free speech will solve a problem of stuttering re-emerging or increasing in frequency. In other cases, stuttering reappears because of momentary period of stress, such as the birth of a sibling, or the family moving to a new home. In such cases, reinstating weekly visits may help the parent and clinician get the child back on track. Stage 2 takes about a year to complete for most children. Although minor relapses may occur, parents are usually able to accurately assess what changes need to be made to bring the child back to essentially stutter-free speech. Extensive research has been done on the use of telehealth to deliver LP (eg, Wilson et al., 2004). ere is strong evi dence that telehealth delivery produces results as good as clinic delivery. P ROBLEM -S OLVING In general, the Lidcombe Program runs smoothly without much di culty if clinicians carefully follow the manualized format that is described in the Treatment Guide. However, it is common for minor problems to arise during Stages 1 and 2. is section describes some common problems that may occur and their possible solutions. For more detailed descrip tions of troubleshooting and special cases, see the Lidcombe Program Treatment Guide (March 2021), available as a download from the Lidcombe Program Trainers Consortium website (asrc@ s.usyd.edu.au).

With children who have moderate or severe stuttering, it is critical to structure their treatment conversations so that the child is largely stutter-free and only stutters occasion ally. One way to do this is to ensure that in practice sessions, the child is, at rst, using only short utterances (which are more likely to be uent). Short uent utterances should be Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.