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suggestion in the present results that children with an older sibling who successfully completed the Lidcombe Program required fewer Stage 1 clinic visits than other children. Taken together, children with mild stuttering whose siblings have successfully completed Lidcombe Program treatment may respond more quickly to treatment than other children. One possible explanation for this result is a practice effect because of prior parent training, although the design of the study does not permit any definitive conclusion about the matter. In any event, this may be useful information to consider for planning optimal management of large caseloads. A novel suggestion to emerge from this research is an association between rapid clinical response and file entries at assessment indicating that children’s stuttering contained only repeated movements. In other words, slower clinical response may be associated with stuttering that involved fixed postures or extraneous behaviours. There are recurring accounts of repeated movements being an early stage of stuttering development (Ambrose & Yairi, 1999; Bloodstein & Grossman, 1981; Bluemel, 1932; Reilly et al., 2009; Yairi, 1983). Consequently, if the present finding of a link between repeated movements and treatment responsiveness is replicated, there would be considerable implications for treatment planning and implementation. Any comparison of the present results with those of Reilly et al. (2013) needs to be guarded because of the methodological differences between the studies, as the present data pertain to clinical children and Reilly et al. (2013) used a community cohort. However, it is of interest that the present finding is inconsistent with the finding of Reilly et al. (2013) that children were more likely to recover naturally if their parents reported that they did not have repeated movements. This inconsistency prompts speculation that the mechanisms of natural recovery associated with the Reilly et al. (2013) study, and the present study of Lidcombe Program recovery, may differ. As such, it is inconsistent with speculation that the fundamental mechanism of Lidcombe Program involves hastening of natural recovery (O’Brian & Onslow, 2011). The Lidcombe Program Treatment Guide (Onslow et al., 2019) indicates 10–15 minutes of daily practice sessions with verbal contingencies as part of Stage 1. Results showed a connection between slow treatment and parents being unable to sustain these recommendations for daily practice sessions. These results are consistent with findings (Goodhue et al., 2010; Hayhow, 2009) that some parents experience this difficulty. The file entries reported for the present study (see Results) are consistent with quotes from parents provided by Goodhue et al. (2010) and by summary comments by Hayhow (2009) about parents who found the program to be problematic from the start: It’s only 10 minutes but I still find sometimes I struggle to actually fit it in. It’s hard to remember to praise all the time, you forget.” (Goodhue et al., 2010, p. 75) Home therapy sessions were often conducted on the children’s terms as these parents experienced difficulty in taking a firm lead. They were more often at a loss to know how to manage their children’s speaking.” (Goodhue et al., 2010, p. 24) So, some parents in the present study departed from ideal Lidcombe Program treatment practice sessions – at least according to SLP file entries – and this appears to have negatively affected their treatment time. The reasons for those departures are varied and include the child refusing to cooperate and walking away from the session,

the child being very distractible and losing focus on the practice session conversation, and the child being very verbal or “chatty” and therefore hard to keep at low levels of stuttering. Consequently, it would be of interest for SLPs to identify such children during assessment. The present findings confirmed previous file audits that child gender and age at the start of treatment are not related to treatment time (Jones et al., 2000; Kingston et al., 2003). The present results suggested, additionally, that longer treatment time was not associated with whether English was a first language for the child. Finally, no suggestions were found in the present results that children who are slow to complete Stage 1 of the Lidcombe Program, but who complete it successfully, will have subsequent problems maintaining their treatment benefits during Stage 2. There were no differences between the groups for parent or SLP severity measures during or at the end of Stage 2. Long treatment times for the Lidcombe Program are inevitable, and it is reassuring that the present study found no sign of them resulting in poor clinical outcomes. However, this conclusion pertains only to children who do progress through the treatment satisfactorily, albeit slowly. Naturally, there will be some children who are not successful during Stage 1 of the Lidcombe Program, and the present results do not pertain to them. The present study is a retrospective investigation with a small sample size and therefore results must be considered within the context of these limitations. Two of the present findings in particular need to be interpreted cautiously because of the retrospective methods of this study. These are findings that there is an association between treatment time and parental ability to learn Lidcombe Program procedures and to manage the practice sessions. These aspects of parent skill were recorded subjectively by SLPs, without the benefit of an a priori operational definition. Additionally, there is potential for bias with these data because the SLPs may have been more prone to make file entry notes of such problems in cases of slow treatment response than for cases with rapid treatment response. Regardless, considering the clinical importance of these preliminary findings, they compel a replication with prospective methods involving strong statistical power. Acknowledgments This work was supported by the National Health and Medical Research Council Australia under Program Grant #633007. References Ambrose, N. G., & Yairi, E. (1999). Normative disfluency data for early childhood stuttering. Journal of Speech, Language, and Hearing Research , 42 , 895–909. Arnott, S., Onslow, M., O’Brian, S., Packman, A., Jones, M., & Block, S. (2014). Group Lidcombe Program treatment for early stuttering: A randomized controlled trial. Journal of Speech, Language, and Hearing Research , 57 , 1606–1618. Australian Stuttering Research Centre (2002). Manual for the Lidcombe Program of early stuttering intervention. Retreived from http://sydney.edu.au/health_ sciences/asrc/ docs/LP_Manual_English_ January_2002.pdf Baxter, S., Johnson, M., Blank, L., Cantrell, A., Brumfitt, S., Enderby, P., & Goyder, E. (2015). The state of the art in non-pharmacological interventions for developmental stuttering. Part 1: A systematic review of effectiveness. International Journal of Language and Communication Disorders , 50 , 676–718.

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