Mixed Messages

Currently, I am a graduate student enrolled in a stuttering class. We have been talking about different types of treatment. The Lidcombe method is a direct technique that has been abundant in the research articles that we have been reviewing in class. I am wondering how practicing SLP’s and individuals who stutter view this method of therapy? One aspect of this method is to praise for stutter-free speech and to correct stuttered speech. We have discussed the importance of treating an individual as a whole and helping the client accept his or her stutter. Correcting speech doesn’t seem to help the individual accept his or her stutter. There seem to be conflicting ideas what are your thoughts?

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Mixed Messages — 1 Comment

  1. Hi, and many thanks for your thoughtful question. I agree, it can sometimes appear that a tension exists between the idea of acceptance and some therapy approaches that seek to facilitate recovery from stuttering for preschool children, but I do not think this is necessarily the case.

    It is ok to stutter. It really is. But it can also be frustrating and infuriating to want to say something and to get stuck. For the conversation to move on, because the other participants haven’t realised that the speaker still has something to say or hasn’t started to initiate their contribution yet. It can also be physically and mentally taxing, dealing with these moments of speech stasis. In short, stuttering can be a burden and it is not a negative to aim to relieve a child of this burden where possible.

    We know that the likelihood of recovery from developmental stuttering is greatest within about four years after stuttering begins. For many people, stuttering begins in the preschool years, and that is why several therapy approaches which aim to facilitate recovery from stuttering are also focused on this age group. Working towards recovery from stuttering is not, however, incompatible with demonstrating general acceptance for a child’s speech and focusing on what that child has to say rather than how it is said.

    Important general points are that the Lidcombe Program is just one of several therapy approaches available for preschool children who stutter, and that the selection of therapy approach needs to be tailored to the needs and characteristics of the child, their family and the situation. The response of the child to any therapy approach needs to be carefully monitored and the approach modified or stopped or an alternative approach selected if there is any indication of a detrimental effect.

    More specifically, as you describe, the methodology of the Lidcombe Program involves specific comments (known as “verbal contingencies”) delivered by a parent in response to stutter-free speech and to moments of stuttering. It has two stages, and the treatment can be reviewed, modified or stopped as appropriate if there is any indication of a negative reaction from the child. In the early stages, such comments are only delivered during short, structured sessions, where the linguistic and cognitive demands on the child are shaped to promote naturally stutter-free speech, and the parent comments on and praises these “smooth” episodes of speech. The child’s reaction to the comments is carefully observed so that, if there is any indication that the child is uncomfortable with such comments, the choice or delivery of the approach can be reassessed. The linguistic demands on the child gradually become more complex during these sessions, so that the likelihood of stuttering increases, but the occasional comments following “smooth” episodes of speech continue. Comments for stuttered speech are introduced later and, again, only used if the child is comfortable with them. In these early stages, verbal contingencies are delivered ONLY during these structured practice sessions, which represent just a small part of the child’s life. Outside these practice sessions, life continues as normal, the comments are not used and the parents are interacting with their child, demonstrating unconditional acceptance, focusing on the content rather than the form of speech.

    IF, and only IF, a child is enjoying the Lidcombe Program and the approach appears to be facilitating less struggle when talking (without having a negative effect on the amount of talking which is happening), a gradual switch takes place from using the verbal contingencies in natural conversations rather than in structured sessions. This can be linked to the concept of generalisation, where concepts established within a controlled environment, are transferred to the real world.

    Remember that use of the Lidcombe Program does not preclude the use of other elements within a therapy package that sees “the whole person”, such as developing language skills, promoting general communication skills, highlighting strengths, developing interests, fostering parental resilience, ensuring the child has sufficient sleep, or educating staff in preschool settings.

    It is necessary when using the Lidcombe Program to remain alert to the messages the child is receiving about their speech and to observe carefully for any signs that a child is using avoidance strategies to reduce stuttering rather than accessing some available or developing potential for increased fluency. I have, however, witnessed the Lidcombe Program in action and know that, for some families, including some families where it is parents who stutter themselves who are delivering the verbal contingencies, it has been experienced as a useful and positive tool. For other children and other families, different approaches have been more appropriate. Like so many other threads in this online conference, the overarching message is that there is no one-size-fits-all when it comes to stuttering!

    I hope that you are enjoying your classes on stuttering, and continue to take the same thoughtful approach to the topics you are discussing.

    With best wishes,
    Kirsten