Stuttering

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Chapter 14 • Treatment of Older Preschool Children: Beginning Stuttering

treated group and the control group nal levels of stuttering relative to their variability in stuttering was very large; in fact, the authors indicate that it was more than twice the mini mally clinically signi cant di erence stated in their treatment protocol before the study was done. While the majority of research on the Lidcombe Program has been done in Australia, publications from researchers in the United Kingdom, Canada, and other countries have appeared. For example, Miller and Guitar (2009) showed that Lidcombe can be very successful when implemented by supervised graduate students with excellent outcomes for 15 preschool children. It was found that duration of treat ment (number of sessions required to reach the end of Stage 1) was predicted by scores on the Stuttering Severity Instru ment (Riley, 2009); children who stuttered more severely before treatment took longer to become uent. is is important information for clinicians so they can let parents of children with more severe stuttering know that treatment may take 20 sessions or more. In a later study, Guitar et al. (2015) combined the data from these original 15 children and added 14 more children, all of whom were assessed pre treatment and 2 years a er treatment. Long-term outcome indicated that most children showed near-zero stuttering, and for the few others, stuttering was substantially reduced. Stuttering severity before treatment was a strong predictor of outcome; such children who were more severe before treatment had slightly more residual stuttering at long term assessment. In this study, girls did slightly better long term than boys when assessed 2 years a er treatment. In other studies, Latterman et al. (2008) assessed the outcome of Lidcombe treatment in Germany, showing it to be quite e ective, and Femrell et al. (2012) reported on its success in Sweden. e Lidcombe group in Australia has also published data on conducting the Lidcombe treatment in a group setting (Arnott et al., 2014) as well as webcam delivery of Lidcombe to parents over the internet (O’Brian et al., 2014). In both of those treatment environments, the Lidcombe approach was found to be e ective compared to traditional delivery proce dures. Recent research has also explored the mechanism by which the Lidcombe Program works (Amato Maguire et al., 2022; Santayana et al., 2021).

reinforced but not longer ones. is “di erential” reinforce ment of shorter utterances will teach the child to make short, uent utterances for the rst part of the training. en, a er the child is reliably experiencing mostly uent speech in the practice sessions, longer utterances can be stimulated. With the help of the clinician’s instruction and modeling, the par ent can learn how to move the child up a linguistic hierarchy of increasingly longer and more complex sentences while preserving uency. It should be noted, however, that if the child remains stutter-free even when using longer sentences at the beginning of treatment, the parent should allow that. e Lidcombe Program is an e ective treatment approach, and its e ectiveness is maximized if the clinician attends a training workshop conducted by the Lidcombe Program Trainers Consortium. Information about workshops, research articles on treatment outcome, and a treatment manual are available on the Lidcombe website (Lidcombeprogram.org). A er training, the clinician can join an online Lidcombe dis cussion group, which provides a wealth of information about various challenges that may arise in treatment. O UTCOME R ESEARCH ON THE L IDCOMBE P ROGRAM A number of studies have reported that the Lidcombe Pro gram is e ective in eliminating stuttering in most preschool ers. A long-term outcome study of 42 children treated with the program showed that their stuttering was at near-zero levels 4 to 7 years a er treatment (Lincoln & Onslow, 1997). Other research reported that the mean number of clinic vis its needed to complete Stage 1 treatment in a sample of 29 children was 18 clinic visits (median = 16) (Rousseau et al., 2007). In response to concerns expressed by critics that the Lidcombe Program might produce negative psychological e ects, Woods et al. (2002) compared pre- and posttreatment measures of the Child Behavior Checklist 2 (Achenbach, 1988) and the Attachment Q-Set 3 (Waters, 1995) and found no ill e ects of treatment on the children’s psychological health. In fact, the Child Behavior Checklist showed improvement in the children’s behavior a er treatment. An important research tool for assessing treatment e ec tiveness is a randomized controlled trial. To use this proce dure to test stuttering treatment, a group of children who stutter would be divided in half. One-half would be given a treatment, and the other half would be given no treatment (the untreated group would eventually be treated once the study data have been collected). Just such a study was carried out in New Zealand (Jones et al., 2005). When the Lidcombe treated group ( n = 29) was compared with the untreated group ( n = 25), a signi cantly ( P = .003) greater improve ment was seen with the Lidcombe-treated group. e “e ect size” was 2.3 %SS. is means that the di erence between the 2 e Child Behavior Checklist is a form lled out by parents to determine if a child has a behavior problem. 3 e Attachment Q-Set is a tool to assess how securely a child feels attached to their parent/caregiver.

In summary, the Lidcombe Program appears to be an e ective treatment for older preschool children who stut ter, with a vast number of studies supporting its use. ere have been recent concerns about Lidcombe’s emphasis on stutter-free speech—given the popularity of accepting stut tered speech as “normal” because of neurodiversity. How ever, in my experience, when Lidcombe is carried out by a trained clinician, children and parents feel great relief when stuttering is eliminated. e children I have treated with Lidcombe beam with pride when they announce, as treat ment is ending, “I’m a good talker!” and their parents glow with the satisfaction that they have been a major factor in this change. Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.