The Lidcombe Programme
The Lidcombe Program was developed by Onslow and co-workers in Sydney, Australia in the 1980’s and 90’s and is an early intervention programme using principles of behaviour therapy, for pre-school children who stutter which aims to eliminate stuttering in the short and long term. Research has conclusively shown that the greatest chance of eliminating stuttering is in early childhood before it has become really established and research in Australia has shown that most children have been able to achieve and maintain stutter-free speech when the Lidcombe Program is applied correctly from a young age.
Lidcombe therapists believe that stuttering is a ‘speech-motor’ problem, which means that it is a problem of the co-ordination and timing of when we speak. They do not believe that it has a psychological cause but acknowledge that it is distressing for people who stutter and their families.
The aim of the therapy
To eliminate stammering by working directly with a child, giving them a chance to practise stutter-free speech and to ‘fix’ stutters or ‘bumps’.
The reasoning behind the therapy
If we see stuttering as a ‘speech-motor’ problem (something like ‘co-ordination’), then talking fluently is like other motor skills (e.g. throwing a ball) and needs practice in order for it to improve. First of all the skill needs to be taught, then it needs rewarding and finally it needs to be practised until it becomes natural.
The roles of the parent and the speech and language therapist
The Lidcombe Program is a parent-based programme:
- Parents have the primary responsibility to carry out the therapy at home and are taught how to do this either in weekly clinic appointments or through other special arrangements
- The speech therapist’s role is to teach parents ‘step-by-step’ how to do the therapy so that it can be carried out at home. The child, after all, spends most of their time here and parents are very eager to be involved and know what to do for the best.
- Parents and therapists solve problems that might come up together to create an individual programme which suits their child best
- Parents have the skills to help their child immediately if stuttering begins again once the programme is finished. However, therapists are available for consultation a long time after the child begins to be stutter-free (at least two years) and they will want to keep in touch to keep maintenance records.
N.B. Therapy is carried out by the parent/carer who has been trained. More than one parent/carer may carry out the therapy but only if they have attended the training. This is because therapy requires skilled listening and excellent timing and both need practice in order to be accurate.
The key features of the therapy
Keeping accurate measures of speech. The parent keeps a record of severity ratings both in everyday, natural situations and during home practice. The therapist keeps a record of percentage syllables stuttered and will do this either through weekly sessions or by listening to tape recordings of a child periodically. Without both of these measures neither the parent nor the therapist will have a clear idea of how the child is progressing and the therapy cannot progress.
Therapy is carried out initially in structured home practice sessions each day at home. It then moves into more informal, natural unstructured situations when the child is ready. Therapy is faded out when the child is using stutter-free-speech most of the time.
The therapy itself involves acknowledging and praising a child for stutter-free speech and later, helping them correct their stuttering for themselves. The steps to doing this include:
- shaping the child’s speech so that they are fluent
- telling them that they are doing it right ("that was smooth talking")
- praising them for speaking words well ("that was good talking!", "brilliant, smooth talking there", "great, no bumps, lovely talking" )
- very occasionally, asking the child to say a stuttered word again in a stutter-free way (with no bumps). (This occurs later in the programme of therapy).