What is the Lidcombe Program?
The Lidcombe Program is a behavioural treatment for young children who stutter. The program takes its name from the suburb of Sydney where the Australian Stuttering Research Centre is located, at The University of Sydney.
The treatment is administered by a parent or carer in the child's everyday environment. Parents learn how to do the treatment during weekly visits to the speech pathologist. During these visits, the speech pathologist teaches the parent by demonstrating various features of the treatment, observing the parent do the treatment, and giving the parent feedback about how they are going with the treatment. This parent training is essential, because it is the speech pathologist's responsibility to ensure that the treatment is done appropriately and is a positive experience for the child and the family.
The treatment is direct. This means that it involves the parent commenting directly about the child's speech. This parent feedback is overwhelmingly positive. The parent comments primarily when the child speaks without stuttering and only occasionally when the child stutters. The parent does not comment on the child's speech all the time, but chooses specific times during the day in which to give the child feedback.
As well as learning how to give feedback effectively, the parent also learns to measure the child's stuttering by scoring it each day. “1” is “no stuttering,” “2” is “extremely mild stuttering,” and “10” is "extremely severe stuttering." At each clinic visit, the speech pathologist and the parent look at these severity ratings for the previous week to see what effect the treatment is having outside the clinic. This is an essential process because stuttering has to be fixed outside the clinic in the real world.
The Lidcombe Program is conducted in two stages. During Stage 1, the parent conducts the treatment each day and the parent and child attend the speech clinic once a week. This continues until stuttering either disappears or reaches an extremely low level. Stage 2 of the program starts at this point. The aim of Stage 2 is to keep stuttering away for at least one year. The use of parent feedback during Stage 2 is reduced, as is the number of clinic visits, providing that stuttering remains at the low level it was at the start of Stage 2. This maintenance part of the program is essential because it is well known that stuttering may reappear after a successful treatment.
All children and families are different, and the speech pathologist takes this into account when supervising the treatment. While the essential features of the treatment as set out in the Lidcombe Program Manual are always included, the way they are implemented is adjusted to suit each child and family.
Who uses it?
The Lidcombe Program was developed in Australia and is now used by most speech pathologists there. The manual has been translated into five languages, and these translations can be downloaded from this website. There is an international Lidcombe Program Trainers Consortium, with members in the United Kingdom, the United States, Canada, New Zealand, Denmark, Germany, the Netherlands. The Consortium has provided Lidcombe Program training to thousands of speech pathologists in those and other countries. You can read about the consortium at this website.
Does the Lidcombe Program work?
Yes, independently replicated clinical trials show that it does work to get rid of stuttering. Clinical trials have also shown that it works in a telehealth version, where the speech pathologist and family actually never meet; the treatment is done either by telephone or, more commonly these days, with Skype over the internet.
Research has also shown that the program is safe. It does not appear to interfere with parent-child relationships and has no apparent effect on other aspects of communication. Indeed, parents report that their children are more outgoing and talk more after treatment because they are no longer stuttering.
Is the Lidcombe Program better than natural recovery?
It is known that some children will recover from stuttering without needing formal treatment. However, treatment should normally begin within one year after the onset of stuttering during the preschool years. If treatment is delayed any longer there is a risk that treatment will not be effective. Recent research has shown that not many children will recover from stuttering within that one-year period after onset.
Normally, the speech pathologist will wait for up to one year, more commonly six months, to see if a preschooler’s stuttering will resolve on its own. However, there is good evidence that when the decision is made to begin Lidcombe Program treatment that it is much better than natural recovery. With what is called a meta-analysis, it has been shown that a stuttering child who receives the Lidcombe Program has seven or eight times better odds of not stuttering that a child who does not receive the Lidcombe Program.
How long does it take?
Children differ in the time they take to complete the Lidcombe Program. However, on average it takes about 12 visits to the clinic to get to he point where stuttering has gone or is at an extremely low level. After that, three more clinic visits are required to be sure, and then Stage 2 begins, where the parent and child make fewer visits to the speech clinic. Children with more severe stuttering will generally take a little longer.
Group Lidcome Program training
The randomised controlled trial of group delivery of the Lidcombe Program has been completed. Until the final outcomes and associated findings have been peer reviewed and published, it is not possible to offer training for this service delivery alternative. However, the final results have been compiled and are planned for journal submission during early 2011. Speech pathologists who are interested in receiving training in conducting group Lidcombe Program treatment can submit an expression of interest to our CPES Coordinator, Jane Kelly (). For those clinicians who register we will provide progress updates as soon as the research is available. We will also contact you when training is available.