The Lidcombe Program Flashcards
What are the basic facts about the lidcombe program?
Evidence based treatment
Parent based behavioural treatment for early stuttering.
Everyday situations and speaking environments.
Consists of two stages (stage 1 = no stuttering and stage 2 = maintenance)
Individualised for the child
Parent training
2 treatment formats: session and online praise and correction
Done for 10 minutes a day in varying situations.
Why does the Lidcombe program work?
No over-learning of stuttering.
Adults have potent reinforces for children - affection etc.
Parents use common parenting practices.
Treatment occurs where the problems occurs.
Urges children to make some adjustment to their underlying neural processing patterns during a period when they are reasonable degrees of freedom in motor speech development remaining. Before myelinisation.
What happens in stage 1?
Stutter free speech is praised.
Stuttered speech is corrected.
Praise correction ratio 5:1
Praise - good talking etc. Must be specific not good boy etc.
Correction: Oops that was a bumpy.
Not constant consistent or invasive.
Parental verbal contingencies implemented in weekly 1 hour visits to speech path.
Parent must also do severity ratings, collecting measures
Therapist assesses, diagnoses, monitors progress, sets goals, manages parent, problem solving, evaluating.
Child does self-monitoring, self-evaluating.
What do you do if you can’t provide the 5:1 ratio?
Change how structured the conversation is.
What is the severity rating scale used?
10 point severity rating scale done daily.
1 = no stuttering.
2 = very mild
10 = extremely severe
Practice with clinician in clinic.
It is sensitive to stuttering type not just frequency.
Doesn’t require the child’s compliance.
What are some other methods of measuring stuttering?
Percentage of syllables stuttered: Tells frequency but not types of severity. Poor interjudge reliability. Can be used to validate SR.
Stutters per minute speaking time. Record 10 min coversation, count stutters per unit of time.
What is structured vs unstructured coversation?
Structured conversation provides one spot in the utterance for the child to give a response. Parent starts treatment in highly structured way. It is easy to present contingencies safely and correctly. Structure so that child can maintain 1-2 in severity rating.
Unstructured usually is an open ended question allowing the child to direct the conversation. Parents moves to unstructured more naturalistic conversations later in stage 1.
What are some of the key elements of praise?
Be sincere Don't overdo it Vary wording Acknowledge stutter free speech! You can request a self-evaluation ONLY for stutter free speech.
What do you do when the child stutters?
Aim is assistance not punishment.
Can you say that again?
If they can’t self correct then model and move on.
What is stage 2?
Monitoring phase. Detecting any relapse or return to stuttering.
To facilitate and transfer durability - vary the settings and materials used in treatment, make feedback unpredictable, use self-monitoring and self-evaluation.
Starts when child has less than 1% SS for two weeks and severity rating of 1 or 2 for a full week (at least 4 x 1).
Child now earns longer times between appointments.
If they fail at any stage of maintenance than they need to start again.
If the child relapses (generally within first 9 weeks) than return to prior step or stage 1.
How can the Lidcombe program be individualised?
Age of child - determines types of activity and duration.
Stuttering severity - Make the treatment more structured when child is sever so as to maintain 10:1 ratio.
Basic behaviour - Rules, structure may be required for talkative children.
Personality of child and parent - parent or child may feel uncomfortable about attention being drawn to stuttering, so start with praise for stutter free speech only.
Family circumstances - Time management, commitment etc.
What are some common misconceptions about the Lidcombe program?
That it’s a quick fix.
It’s harmful to children.
Drawing attention to stuttering will make it worse.
That scientific evidence that supports it is flawed.
What are some other fluency programs?
Westmead Program - Syllable-timed speech treatment.
ELU - Extended length of utterance. Operant methodology. Programmed treatment.
Speech motor improvement program - Useful adjunct to therapy not comprehensive by itself.
