ACQ Vol 12 No 2 2010

Working with families

Parents as therapists in early stuttering intervention: Problem-solving for the speech pathologist Natasha Trajkovski, Cheryl Andrews, and Ann Packman

The aim of this paper is to suggest ways of addressing some common problems that may arise in those interventions for early stuttering where parents deliver the treatment. Common problems are discussed and possible solutions are suggested to the following seven issues: 1. The child gets bored during treatment. 2. Rewards do not motivate the child to participate in treatment. 3. The child is overly talkative during the treatment session. 4. The parent has difficulty using the severity rating scale. 5. The parent has difficulty identifying stutters. 6. Parents are unable to schedule regular treatment times. 7. The child’s siblings distract the parent or child during treatment. For ease of reference, problems are divided into those which relate to the child and those which relate to the parent. S tuttering is a speech disorder that emerges during early childhood. It is characterised by repeated movements and fixed postures of the speech mechanism. While a proportion of children recover naturally from stuttering (Yairi & Ambrose, 2005), a child who does not recover or receive effective treatment will likely have lifelong, intractably impaired speech. The consensus, therefore, is to conduct treatment during the preschool years. A number of treatments for early stuttering exist (see Onslow & Packman, 1999), each associated with specific advantages and disadvantages. It is not the authors’ intention to evaluate all treatments for early stuttering; rather, the purpose of this paper is to address some of the common problems that can arise when working with families in the treatment of early stuttering. Accordingly, this paper draws on the experiences of three speech pathologists (SPs) who have specialised in the

treatment of early stuttering. At the time of writing, all of the authors held clinical and research positions at the Australian Stuttering Research Centre (ASRC) and, as such, were experienced in the use of the Lidcombe Program (Onslow, Packman, & Harrison, 2003) and the Westmead Program (Trajkovski, Andrews, O’Brian, Onslow, & Packman, 2006) of early stuttering intervention. Parents as therapists for early stuttering In both the Lidcombe Program and the Westmead Program, a parent (or carer) delivers the treatment in the child’s everyday environment. They do this under the guidance and supervision of an SP. In the Lidcombe Program, the child and parent attend the clinic each week and the SP trains the parent to deliver verbal contingencies (comments) for stuttering and for periods of stutter-free speech (the manual of the program can be downloaded from the ASRC website, www.fhs.usyd.edu.au/asrc). The parent also learns how to measure and record the child’s stuttering severity each day on a 10-point scale. Initially, the parent delivers treatment for short periods in highly controlled situations, for example, sitting with the child and talking about a book. As the child’s speech improves, treatment is conducted in less controlled situations, for example, playing with toys. This transition can be daunting for some parents. Nevertheless, it is imperative for the SP to ensure that parents complete treatment safely and as instructed. To do so, the SP observes the parent demonstrating how treatment is being conducted each week and suggests modifications for the following week. The Lidcombe Program is now used routinely in Australian speech clinics (Rousseau, Packman, Onslow, Robinson, & Harrison, 2002). The Westmead Program has been developed more recently, and differs from the Lidcombe Program in that a novel speech pattern, namely syllable timed speech (STS), is used to instate fluency. It is well known that stuttering decreases or completely disappears when people speak rhythmically (for an overview see Packman, Onslow, Richard, & van Doorn, 1996). Initial trials of the Westmead Program indicate that even very young children can use STS to control stuttering on imitation and with minimum instruction. Hence, the task of instating fluency in the Westmead Program is much simpler for the parent than in the Lidcombe Program. The parent simply models STS for set periods

Keywords child Lidcombe Program problem- solving stuttering treatment Westmead Program

This article has been peer- reviewed

Natasha Trajkovski (top) and Ann Packman

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ACQ Volume 12, Number 2 2010

ACQ uiring knowledge in speech, language and hearing