This article originally appeared in a 2007 edition of the CSA newsletter.
Research published in recent years, including in the British Medical Journal, offers pretty solid support for the efficacy of the Lidcombe Program in treating young children who stutter. A CSA Voices reporter, Jaan Pill, speaks with Rosalee Shenker, head of the Montreal Fluency Centre, who described how the Lidcombe Program found its way to Canada.
He also speaks with Mark Onslow, director of the Australian Stuttering Research Centre at the University of Sydney, in the course of his recent North American lecture tour.
Rosalee Shenker played a key role in bringing the Lidcombe Program to Canada beginning in 1996.
That year, she attended a meeting in Monterey, California of the American Speech-Language-Hearing Association (ASHA) Special Interest Division 4, a group that brings together clinicians and researchers who specialize in treatment of stuttering. Mark Onslow of Australia was the last speaker at that particular meeting. Rosalee Shenker didn’t know much about him. As it turned out, everything he said in his presentation made sense to her in terms of what she knew about early stuttering.
Rosalie arranged for Ann Packman and Mark Onslow from the Australian Stuttering Research Centre to visit Montreal. Rosalee Shenker and her colleagues subsequently tried the Lidcombe Program and some time later Mark Onslow arrived for a second visit, after which the Montreal Fluency Centre began offering clinical training in the Lidcombe Program. Close to 1,500 clinicians have now been trained in the program in Canada. The Montreal Fluency Centre maintains a list of clinicians across Canada who are trained in this program. The list is available online at the Montreal Fluency Centre website.
Stuttering treatment in general, in children and adults, has traditionally been prone to relapse – because of the challenge of taking what a person learns in a clinic and generalizing that to everyday speaking situations outside the clinic. Research indicates that the Lidcombe Program successfully addresses the critical issues of long-term relapse and generalization.
A reporter spoke by phone with Mark Onslow on November 4, 2006. An edited transcript of the conversation follows.
Could you tell me how the Lidcombe Program came to be developed?
Mark Onslow: How it was developed is a long story, but in the mid nineteen-fifties, some laboratory experiments were done that made it obvious that stuttering could be changed according to what’s called contingent stimulation.
Or to say it in another way, it became obvious that stuttering was an operant, so that if you rewarded people who stutter for not stuttering, you could see a gradual increase [in not stuttering]. Unfortunately, the laboratory discoveries were [that] if you gave electric shocks on stuttering, stuttering would decrease momentarily – and this, of course, was enormously controversial when it first appeared, in the mid-fifties. That was not the sort of experiments you should do.
Where was that research done?
It was done in America. The bulk of it turned out to have been done in the University of Minnesota. The importance of the work finally attained some clinical significance when, in the mid-seventies, a paper was published showing that if you used the procedure with very small children, it might have some clinically important benefits.
In a paper in 1972, what was done was, a couple of children, individually, were set in a little room, and spoke to a little puppet, illuminated in a box. And the kids talked to the puppet, and had a great time, but the light went off when thestuttering occurred. Over time, the children stopped stutter-ing, and their stuttering went away for a long period.
This paper was published in the States, or Australia?
It was published in the Journal of Speech and Hearing Research; it was published internationally. And it was extremely controversial, because in the nineteen-seventies, there was a strong belief that doing this sort of thing was what would cause stuttering.
Wendell Johnson’s diagnosogenic theory – that you might have heard of – said that this was wrong, and this was a very bad thing to do, and so it was basically – it lay dormant for many years. In the mid-eighties, at Lidcombe, we sort of looked at the literature, and had the idea that it might be good to have parents basically do what the puppet did, with a few variations.
What parents do in the Lidcombe Program is they praise kids for not stuttering, and every now and then when a stutter occurs, they will just acknowledge it, and say, “Oh, that was a bumpy word.” And a few times a day they will just ask kids to repeat an utterance, without a stutter.
Basically, that’s it. That’s the history of the Lidcombe Program. And last year we published a randomized controlled trial in the British Medical Journal, showing that it looks like it really is an efficacious treatment.
That gives me the kind of background that I need. Could you also tell me a bit about your current lecture tour?
I’m currently [November 4, 2006] doing a lecture tour of this continent. I’ve given a three-hour presentation in Seattle, and then a three-hour presentation in Milwaukee, and then I’ve come up here to work with Rosalee [Shenker], because I’m doing some research projects with a PhD student. And then I’ll go down to Vermont, to work with Barry Guitar, who’s very interested in doing clinical trials comparing the Lidcombe Program with a parent-child interaction therapy.
And after Vermont, I’ll go to Montclair State University and I’ll be giving lectures to students there. And then the University of Southern Florida in Tampa: I’ll be giving a three-hour presentation there, and then after that I’m up to Miami, to give two papers at ASHA, and after that I’m across to the University of Arizona to give a three-hour presentation there, and after Arizona, I fly to Hawaii, and I give a three-hour presentation at the University of Hawaii, and then I have a little rest.
The research that’s going to be shared at ASHA, as I understand – is Barry Guitar going to be speaking about some seven-year study?
What’s happening is, basically, there’s a long panel presentation with a number of people that’ve been instrumental in developing the Lidcombe Program. They’re going to present a panel thing: Everything you wanted to know about the Lidcombe Program. And we’re presenting the material for an hour and a half, and then we’re allowing the audience to ask questions for an hour and a half.
There are various sorts of long-term data. There are three papers that I know of that have now followed the kids up for a long period, and the picture looks pretty good. We don’t say “cure,” but we say that treatment effects are [extremely] robust. The randomized controlled study that we published in the British Medical Journal: We’ve now just completed a follow-up study where we phoned those kids when they were school-aged children. And the results are looking good.
You might [also] want to note [that] one of the research directions for the Lidcombe Program is to adapt it for Telehealth, and in a country like Canada, that’s really important. There have been two published clinical trials, and in Sydney we’ve just completed a third randomized trial of Telehealth, where the therapist never actually met the person face to face, and it seems to work. It takes longer, but it works. That’s really important.
I would say that, in summary: Someone who begins stuttering in the preschool years, the picture is a lot better than it’s ever been before, because the Lidcombe Program is only one of many treatments that are available.
According to my count, if you use a reasonable definition of what is a clinical trial, there’ve been 13 published, and there’s six other treatments, besides the Lidcombe Program, that someone can choose from if they want to take an evidence-based approach to the disorder.
If someone, a speech pathologist, is an evidence-based practitioner, they can choose from six treatments that’ve been [vetted] in clinical trials.
I would be interested if you would have any reflections that you want to share about the state of the art for adult stuttering treatment programs, and also any comments you may wish to share about the SpeechEasy sort of approach to dealing with adults who stutter.
Well, the SpeechEasy approach, my only comment about that is, that there are no clinical data yet, and so that governs my perspective a great deal. We’re in the process of determining whether a clinical trial is warranted at the moment, at the ASRC. That’s my view on that.
What’s your perspective in terms of your understanding of advances in the field for adults who stutter?
I think the advances in the field can be divided into two. One is the search to find a way to get people who stutter to have functional speech again, because the average person who stutters can say about half as much as anyone else, without effective treatment. And so Part One is to give them some way of having functional speech, [though] it’s not always easy; it’s not without penalty, but they can get through life saying nearly as much as everyone else, and there have been a great many advances there.
The other part of the field that I find really exciting now is that some people who stutter cope with what’s starting to become obvious, namely that they have a great deal of social anxiety. And I think they’re the big ways to go.
Lidcombe resources
You can find additional information about the Lidcombe Program by doing Google searches for the following sets of keywords:
- Montreal Fluency Centre
- Lidcombe referral list
- ASRC Lidcombe
- Lidcombe program
- British Medical Journal Lidcombe