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Evidence-based practice in stuttering: The Lidcombe Program. Kimberly Farinella-Bocian May 6, 2006. Learner Objectives. The participant will be able to outline the major components of the Lidcombe program.

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learner objectives
Learner Objectives
  • The participant will be able to outline the major components of the Lidcombe program.
  • The participant will be able to outline the key studies supporting the effectiveness of the Lidcombe program.
lidcombe program
Lidcombe program
  • What is it?
    • A parent-administered behavioral intervention designed for young children who stutter
    • Direct intervention approach
        • (Onslow, Costa, & Rue, 1990)
lidcombe program origins
Lidcombe Program Origins
  • Response-contingent stimulation (RCS) procedures
      • (Onslow et al., 1990)
  • RCS procedures treat stuttering in an operant paradigm
    • Association between the behavior and the stimulus that follows (consequence) is established
  • Parents deliver verbal contingencies for stutter-free speech and stuttered speech in the child’s everyday environment
      • (Onslow, Packman, & Harrison, 2002)
what s involved
What’s Involved?
  • Positive reinforcement for stutter-free speech
  • Correction (“punishment”) of unambiguous stuttering behaviors
    • Ratio of 5:1
          • (Onslow, Andrews, & Lincoln, 1994)
lidcombe program components
Lidcombe Program Components
  • When the child produces stutter-free speech, the parent offers positive reinforcement
    • Verbally (“good talking”)
    • Tangible reinforcers (stickers or stamps)
      • For children older than 4 years of age
  • When an unambiguous stuttering behavior occurs, the child is asked by his/her parent to repeat the utterance again without stuttering
    • “Stop, I heard a bumpy word; say [stuttered word] for me again.”
lidcombe program8
Lidcombe Program
  • Initially, verbal contingencies are delivered by parents in structured conversations for 10-15 minutes per day
  • Once parent has mastered necessary skills for successful implementation, he/she is encouraged to deliver the verbal contingencies to the child in everyday, unstructured speaking situations
      • (Onslow, Packman, & Harrison, 2002)
role of the slp
Role of the SLP
  • SLP measures percent syllables stuttered (%SS) at the start of each clinic visit
    • Based on conversational speech sample that is a minimum of 300 syllables or 10 minutes in duration
  • Parent is trained by the SLP to rate the severity of the child’s stuttering each day in everyday speaking situations
    • 10-point severity rating scale where 1 = “no stuttering” and 10 = “extremely severe stuttering”
lidcombe program12
Lidcombe Program
  • Stage 1 (treatment)
    • Parent and child attend the speech clinic 1X/week
    • Treatment conducted by the parent everyday
      • Structured 10-15 minute conversations
      • Unstructured conversations throughout the day
  • Stage 2 (maintenance)
    • Criteria
      • %SS less than 1.0 in the clinic
      • Severity rating scores of 1 or 2 for the previous week, with at least four of those being 1
    • Treatment conducted by parent less frequently
    • Less frequent visits to the speech clinic
evidence based treatment
Evidence-based Treatment
  • Lincoln & Onslow, 1997
    • Lidcombe program highly effective in decreasing stuttering to zero, or near-zero levels
    • Post-treatment stuttering levels were maintained for up to 7 years in 43 children who participated in a long-term outcome study
    • No case of relapse reported
social validity
Social Validity
  • Woods et al., 2002
    • Treatment was found to have no ill-psychological consequences on children
  • Lincoln et al., 1997
    • Speech of children following treatment was not distinguishable from fluent controls based on listener judgment
natural recovery
Natural Recovery?
  • Lincoln, Onslow, Wilson, & Lewis, 1996
    • Similar results obtained in school-age children who are unlikely to experience natural recovery from stuttering
  • Harris et al., 2002; Kingston et al., 2003
    • Short-term reductions in stuttering that occur with the Lidcombe program have been shown to be greater than those seen with natural recovery
conclusion
Conclusion
  • Lidcombe is a safe and highly effective treatment approach for use with young children
lidcombe program on line manual
Lidcombe Program: On-line Manual
  • http://www3.fhs.usyd.edu.au/asrcwww/treatment/lidcombe.htm
references
References
  • Harris, V., Onslow, M., Packman, A., Harrison, E., & Menzies, R. (????). An experimental investigation of the impact of the Lidcombe Program on early stuttering. Journal of Fluency Disorders
  • Harrison, E., & Onslow, M. (1999). Early intervention for stuttering: The Lidcombe Program. In R.F. Curlee (Ed.), Stuttering and related disorders of fluency (2nd Ed.) New York, NY: Thieme.
  • Lincoln, M., & Onslow, M. (1997). Long-term outcome of an early intervention for stuttering. American Journal of Speech-Language Pathology, 6, 51-58.
  • Lincoln, M., Onslow, M., & Reed, V. (1997). Social validity of an early intervention for stuttering: The Lidcombe Program. American Journal of Speech-Language Pathology, 6, 77-84.
  • Lincoln, M., Onslow, M., Wilson, L., & Lewis, C. (1996). A clinical trial of an operant treatment for school-age stuttering children. American Journal of Speech-Language Pathology, 5, 73-85.
  • Onslow, M., & Packman, A. (1999). The Lidcombe Program and natural recovery: Potential choices of initial management strategies for early stuttering. Advances in Speech Language Pathology, 1, 113-121.
  • Onslow, M., & Packman, A. (2001). The Lidcombe Program of early stuttering intervention: Awaiting the results of a randomized controlled trial. Asia Pacific Journal of Speech, Language, and Hearing, 6, 85-89.
  • Onslow, M., Andrews, C., & Lincoln, M. (1994). A control/experimental trial of an operant treatment for early stuttering. Journal of Speech and Hearing Research, 37, 1244-1259.
  • Onslow, M., Costa, L., & Rue, S. (1990). Direct early intervention with stuttering: Some preliminary data. Journal of Speech and Hearing Disorders, 55, 405-416.
  • Onslow, M., Hewat, S., McLeod, S., & Packman, A. (2002). Speech segment timing in children after the Lidcombe Program of early stuttering intervention. Clinical Linguistics and Phonetics, 16, 21-33.
  • Onslow, M., Menzies, R., & Packman, A. (2001). The Lidcombe Program: Development of a parent-conducted operant early intervention for stuttering. Behavior Modification, 25, 116-139.
  • Onslow, M., Pakcman, A., & Harrison, E. (2004). The Lidcombe Program of early stuttering intervention: A clinician’s guide. Austin, TX: Pro-Ed.
  • Woods, S., Shearsby, J., Onslow, M., & Burnham, D. (2002). The psychological impact of the Lidcombe Program of early stuttering intervention: Eight cases studies. International Journal of Language and Communication Disorders.