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Working with families
70
ACQ
Volume 12, Number 2 2010
ACQ
uiring knowledge in speech, language and hearing
Natasha
Trajkovski
(top) and Ann
Packman
This article
has been
peer-
reviewed
Keywords
child
Lidcombe
Program
problem-
solving
stuttering
treatment
Westmead
Program
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
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
Parents as therapists in
early stuttering intervention:
Problem-solving for the
speech pathologist
Natasha Trajkovski, Cheryl Andrews, and Ann Packman