The Lidcombe Program

What is the Lidcombe Program?

The Lidcombe Program is a behavioural treatment for young children who stutter. It was developed by a research team led by Professor Mark Onslow, consisting of researchers at the Faculty of Health Sciences, The University of Sydney, and clinicians at the Stuttering Unit, Bankstown Health Service. The program takes its name from the suburb of Sydney where the Faculty of Health Sciences is located. The program 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. At these visits, the speech pathologist trains 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 parental feedback is overwhelmingly positive, because the parent comments primarily when the child speaks fluently 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 out of 10, where 10 is "very severe stuttering" and 0 is "no stuttering." At each clinic visit, the speech pathologist and the parent examine these scores for the previous week to see what effect the treatment is having outside the clinic. These parental measures are essential because it is well known that stuttering may improve in a clinic without necessarily improving where it really matters-outside in the real world. The Lidcombe Program is conducted in two stages. In 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 a very low level. Stage 2 of the program commences at this point. The aim of Stage 2 is to maintain the absence, or low level, of stuttering for at least one year. The frequency of parental feedback during Stage 2 is reduced, as is the frequency of clinic visits, providing that stuttering remains at the low level at entry to Stage 2. This maintenance part of the program is essential because it is well known that stuttering may reappear after the conclusion of an apparently 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 program as set out in the Lidcombe Program Manual are always included, the way they are implemented is adjusted to suit each child and family.

Why does it work?
The reason or reasons why the Lidcombe Program appears to work so well are unknown. Preliminary research suggests, however, that improvement is neither because children reduce the complexity of the language they use, nor because they change the way they speak in any way. Research is continuing at the ASRC into why the treatment works.

Who uses it?
The Lidcombe Program was developed in Australia and is now used by more than 80% of speech pathologists in Australia who treat children who stutter. The specialist clinicians at the Stuttering Unit in Sydney use it with all preschool children who stutter. The first report of the treatment was published in 1990 and this was followed by regular reports in scientific and professional journals, books, and at speech-language pathology conferences. The Lidcombe Program is now widely used in Canada, the United Kingdom and New Zealand. There is also considerable interest in South Africa, the United States, and several non-English speaking countries. 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, and Australia. You can read about this consortium in the October 2003 edition of the ASRC Newsletter, which is available at our downloads page.

Is it effective?

A considerable amount of research has been conducted into the Lidcombe Program, and development of the Lidcombe Program continues to be an important focus of ASRC research. Research to date has shown that for preschool children participating in the program, stuttering is no longer present, or is present to only a very mild degree, after treatment, and that this outcome has been maintained in those children who have been monitored for a number of years. Preliminary research is also showing 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. At present, there are two major, international clinical trials of the Lidcombe Program being conducted: One in New Zealand and one in Germany.

Some children recover naturally from stuttering. Because of this, the question is often asked: Is treatment for stuttering in young children more effective that natural recovery? More specifically, do the reductions in stuttering that occur after treatment with the Lidcombe Program reflect anything other than natural recovery? Randomised, controlled trials of the Lidcombe Program, currently under way, will explore the efficacy of this treatment and provide the "gold standard" of scientific evidence. In the meantime, there is enough evidence to suggest that the program has a powerful therapeutic effect that is above and beyond the effects of natural recovery. First, factors that predict how quickly children respond to the treatment are different from factors that predict natural recovery and, second, the program also reduces stuttering in older children for whom natural recovery is unlikely.

How long does it take?
Children differ in the time they take to complete the Lidcombe Program. However, research has shown that the average number of weekly clinic visits needed for preschool children to reach Stage 2 of the program is around 11. Children whose stuttering is more severe tend to take more than 11 visits, while children whose stuttering is less severe tend to take fewer than 11 visits. It also seems that—for preschool children only—delaying treatment with the Lidcombe Program for a year or so after onset does not make the child's stuttering less responsive to the treatment.

Contents of the manual

• Overview
  
• Essential Components
  Parental Verbal Contingencies
  Measurement of Stuttering
  Weekly Clinic Visits
  Treatment in Structured and Unstructured Conversations
  Programmed Maintenance
  
• Procedures
  Evaluation
  Stage 1
  Stage 2
  
• Individualising the LP
  Age of the Child
  Stuttering Severity
  Basic behaviour
  Personality of the child and the parent
  Family circumstances
  
• Appendice A (Summary of research findings and bibliography)


• Appendice B (Clinical measures for two children)