JCPSLP Vol 21 No 3 2019

Multimodal communication

Further predictors of Lidcombe Program treatment time Verity MacMillan, Stacey Sheedy, and Mark Onslow

This research determined variables potentially involved in influencing Lidcombe Program treatment time. The method used retrospective case studies of 10 pre-school children with rapid treatment responses and 10 with slow treatment responses. Results were consistent with existing findings that associated pretreatment stuttering severity with longer treatment time. A new suggestion emerged about children whose siblings had been successfully treated; those cases were more likely to be associated with shorter treatment times. Slow treatment was associated with file reports of parents having difficulty learning Lidcombe Program procedures and with parents not complying with recommended practice sessions. Some variables were identified more frequently for either the rapid or slow response groups of children. Considering the clinical importance of these preliminary findings, they compel a replication with prospective methods that involve strong statistical power. T he Lidcombe Program is a behavioural early intervention for stuttering. The treatment, outlined in the current Lidcombe Program Treatment Guide (Onslow et al., 2019), involves parent-delivered verbal contingencies for stuttered speech and stutter-free speech during daily practice sessions and during everyday conversations. Parents acknowledge the occurrence of stuttering moments and request self-correction, and parents acknowledge, praise, and request the child to self-evaluate periods during which their children are stutter- free. During Stage 1 of the treatment, children attain no stuttering or nearly no stuttering. Children commence Stage 2 (maintenance) when they achieve very low levels of stuttering over at least 3 weeks. Parents are assisted to plan for treatment gains to remain long-term and progression through Stage 2 is contingent on maintaining these very low levels of stuttering. During treatment, parents measure the severity of their children’s stuttering each day with a simple 10-point scale (SR), and those measures are

used to guide the treatment process. Additionally, clinicians can rate the child’s speech during clinic visits using the optional percentage syllables stuttered (%SS) measure. The Lidcombe Program is supported by successful randomised clinical trials of standard, group, and telepractice treatment formats (Arnott et al., 2014; Bridgman, Onslow, O’Brian, Jones, & Block, 2016; de Sonneville-Koedoot, Stolk, Rietveld, & Franken, 2015; Jones et al., 2005; Lewis, Packman, Onslow, Simpson, & Jones, 2008). The odds ratio for the treatment has been measured as 7.7 (Lewis et al., 2008) meaning that at follow- up the children who received the treatment had 7.7 better odds of attaining below 1.0 percentage syllables stuttered (%SS) than children who did not receive the treatment. Consequently, the treatment has attained widespread acceptance as a viable consideration for evidence-based early stuttering intervention (Baxter et al., 2015; Blomgren, 2013; Nye et al., 2013; Wallace et al., 2015). Fifteen publication sources (N = 894), including clinical trials, file audits, and translational research, report median numbers of clinic visits required for children to complete Stage 1 of treatment and begin Stage 2 (Onslow, 2019). The median reported number for those papers is 17 clinic visits. One feature of that database is the wide range of treatment times required for children to complete Stage 1, from a minimum median of 11 and a maximum median of 30 clinic visits reported (Onslow, 2019). There are many possible methodological variables that could have impacted treatment times as measured in those studies, particularly considering that the bulk of the data come from retrospective file audit methods, collected over a considerable period during which the Lidcombe Program treatment process changed slightly. An early iteration of the Lidcombe Program Guide (Australian Stuttering Research Centre, 2002) states that criteria for Stage 2 are: (a) %SS less than 1.0 within the clinic, and (b) SR scores for the previous week of 1 or 2, with at least four of these being 1. By 2008 the guide added that these criteria need to be achieved for three consecutive clinic visits before commencing Stage 2 (Packman, Webber, Harrison, & Onslow, 2008). However, any information about clinically identifiable case variables that might influence that wide range of Stage 1 treatment times is useful for speech- language pathologists (SLPs). Knowledge about factors that may impact a child’s treatment time helps SLPs and parents plan and implement Lidcombe Program treatment.

KEYWORDS LIDCOMBE PROGRAM PREDICTORS TREATMENT TIME

THIS ARTICLE HAS BEEN PEER- REVIEWED

Verity MacMillan (top), Stacey Sheedy (centre), and Mark Onslow

159

JCPSLP Volume 21, Number 3 2019

www.speechpathologyaustralia.org.au