ACQ Vol 12 No 2 2010

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ACQ Volume 12, Number 2 2010 71
worth investigating with the parent the personal interests of
each child so as to ensure compliance during treatment.
Problem 2
Rewards do not motivate the child to participate
in treatment.
Possible solution More often than not, reward systems are
abandoned prematurely for being ineffective. However, with
a tailored system that is relevant to the individual child,
rewards can be a powerful treatment tool. Generally, children
tend to express lack of interest toward a particular system
when the reward is either repetitive, or delivered in an
inconsistent manner. It thus may be necessary for the parent
to vary the form of reward used along with the way in which
it is delivered, until an effective system is achieved. It is
important for SPs to support the parent in developing reward
systems that are both motivating for the child and practical
for the parent to deliver. If a particular system is not feasible,
or not suited to the child, its components are less likely to be
followed through. Such inconsistency will only lead the
child’s lack of interest and non-compliance.
Problem 3
The child is overly talkative during the treatment
session.
Possible solution In the Lidcombe Program it may be
necessary for the parent to limit the child’s speech output in
order to establish fluency. Contingencies will not be effective
if the child does not hear them, which can happen when a
child talks incessantly. In order to control the amount of
speech elicited from a child during treatment, the SP may
consider training parents to use conversational techniques
such as mirroring and closed-ended questions. Mirroring
involves the listener repeating part of the conversation back
to the speaker in order to convey their attention and
understanding, for example:
Child: “Dolly is going to the shops today to buy a new
dress.”
Parent: “To buy a new dress?”
When used for the purposes of controlling speech output,
mirroring provides a natural conversation break, allowing
parents to re-direct speech output. Similarly, closed-ended
questions can be effective in establishing speech constraints,
whereby the child is only required to respond using specific
pieces of information. In practice, closed-ended questions
can be combined with mirroring, for example:
Child: “Dolly is going to the shops today to buy a new
dress.”
Parent: “To buy a new dress, what colour will it be?”
Together, these conversational techniques give parents
a natural, yet purposeful method of conversing with their
talkative child for the purposes of conducting treatment.
Problems involving parents
Problem 4
The parent has difficulty using the severity
rating scale.
Possible solution A 10-point severity rating scale is used by
parents in both the Lidcombe Program and the Westmead
Program. The aim is to provide information about a child’s
response to treatment beyond the clinic. Usually, parents
each day and encourages the child to use the pattern.
Again, the parent uses the Lidcombe severity rating scale to
measure the child’s stuttering each day.
Problem-solving
Generally, participation in treatment for early stuttering is a
positive experience for families (Packman & Langevin, 2009).
With the Lidcombe Program, parents report being willing and
enthusiastic about treatment, while children demonstrate
overall enjoyment participating in therapeutic activities
(Packman, Hansen, & Herland, 2006). When stuttering does
not decrease over time as expected, conducting treatment
can become burdensome and frustrating for all involved
(Hayhow, 2009). For the SP, the situation may become
overwhelming given the constant drive toward healthcare
efficiency that is common in the Australian public sector.
While the implementation of the Westmead Program is
simpler than the Lidcombe Program, many of the logistic
difficulties faced by parents acting as therapists are the
same. However, evaluation of the Westmead Program is still
in its early stages and the experiences of parents have yet to
be fully investigated.
Below, the experiences of two clinicians who specialise
in stuttering are presented in order to provide SPs with
direction when addressing some common problems that
may arise when working with parents in the treatment of
early stuttering. It is hoped that this paper will assist SPs to
customise treatment for each child. For ease of reference
a problem-solving format is used, which is divided into
problems involving children and problems involving parents.
Problems involving children
Problem 1
The child gets bored during treatment.
Possible solution As with treatment for other
communication disorders, children tend to demonstrate
boredom when an activity is either too difficult or too simple.
Even though it is important to set the child up for success
during treatment, it is equally as important to provide the
child with opportunities to challenge the child’s system. As a
general rule of thumb, it may be useful for the parent to
commence each treatment session at a level that will ensure
the child is successful and gradually work toward more
challenging goals as the session progresses. It is often the
case that, in order to set the child up for success, structured
activities such as imitation, modelling, or picture description
tasks may be necessary. Such tasks, however, can have the
effect of limiting language output and as a result may
become frustrating for the child. To combat the situation, a
reward system may be introduced.
For younger children, rewards should be tangible and
immediate, e.g., a tick on a page, a peg on a string, or a
gem in a box. Where possible, the parent should avoid using
rewards that will distract the child from the treatment task.
If immediate rewards do not provide sufficient motivation,
the child may exchange them for a more interesting reward
once treatment has been completed, e.g., a trip to the park,
time on the computer, or the opportunity to play a game. For
older children, immediate rewards become less relevant and
the topic of conversation tends to present as the motivating
factor. Discovering relevant subjects can take time; it is well