article

The Lidcombe Programme: parent and therapist’s views

Susanne Platt, Stephanie Burgess | 01.12.2013

Mother Susanne Platt reflects upon her experience of undergoing the Lidcombe Programme with her son Oliver, and Stephanie Burgess gives her perspective from the other side of the therapy relationship.

“Oliver was an early talker,” says Susanne. “He has always been very articulate with an excellent vocabulary and is keen to participate in any conversation going. His language development has always been ahead of his age. At around 2 years old he woke up one day with a stammer. It was a shock. But a family friend, who was a speech therapist, told us this was very common, especially in boys, and would probably rectify itself – which it did. This happened a few times over the years.

‘When Oliver started school (aged 4 years and 3 months), the stammer returned but much more severely than before. Some days he struggled to speak clearly at all and started to make noises and funny faces, and gave up what he was trying to say; he was obviously angry and frustrated. We then sought professional help.

‘Initially we tried to reduce the ‘demands’ placed on Oliver – we reduced our questions, gave him plenty of time to talk, reassured him it was okay to have ‘tricky words’ (as we call them), stopped and really listened when he spoke. We initiated daily one-on-one play sessions where Oliver was in total control and praised him as much as we could. Although his frustration levels reduced and he continued to participate in conversations both at school and at home, his stammering was still very up and down.

‘In April he was really struggling again so we paid another visit to Stephanie, who suggested the Lidcombe Programme.”

The therapist

Oliver’s Speech and Language Therapist (SLT) Stephanie Burgess: “When I see a young child who is stammering, I rarely work directly on their speech, instead taking a ‘least first’ approach. This involves offering information, advice and reassurance to parents and helping them to identify what things do or don’t help their child with their talking, something which Susanne already had a good feel for. We know that approximately 80% of young children who stammer will recover spontaneously anyway, and in the majority of cases I see, this initial intervention is enough to help the child to re-find his fluency.

‘In Oliver’s case, he had already been stammering for a couple of years when he came for therapy. Susanne had tried lots of things to reduce the pressure on Oliver, but he continued to stammer and was becoming more aware of it and upset by it. I therefore suggested to Susanne that we try a more direct approach and explained the Lidcombe Programme to her.”

What is the Lidcombe Programme?

As Stephanie explains, “The Lidcombe Programme, based on behavioural principles, was developed for young children, ideally younger than 6, and aims to eliminate stammering completely. Treatment is not carried out by the therapist but by parents or carers, who deliver the treatment at home every day. The role of the therapist is to teach parents how to deliver what Lidcombe calls ‘parental verbal contingencies for stammer-free speech and stammered speech’ – this is the treatment agent.”

She continues, “Verbal contingencies for stammer-free speech might include acknowledgement and/or praise, such as saying, “That was lovely smooth talking,” or “no bumps there,” or a request for self-evaluation, e.g. “Was that smooth?” Stammered speech can also be acknowledged, e.g. saying, “I heard a bump,” and the parent can request self-correction, asking the child to say the stammered words again smoothly. The important rule to stress to parents is that there must be at least five comments on stammer-free speech for every comment on stammered speech. The treatment sessions are carefully tailored to maximise the child’s stammer-free speech.

‘Treatment is monitored and adapted through regular clinic visits and should be carried out in a way which is enjoyable for both parent and child. The therapist needs to make sure the contingencies do not become invasive or negatively affect the communication between parent and child.

‘Lidcombe is a bit of a ‘Marmite’ approach, with some strong advocates and equally strong opponents among SLTs. Prior to being trained in Lidcombe, I had always felt that it sounded like a rather rigid and prescriptive approach which might not fit in with my client-centred ethos. However, I was also conscious that not being able to offer it left a gap in my therapeutic armoury for children who stammer. I therefore took the opportunity several months ago to attend an excellent course, which reassured me that Lidcombe can be used flexibly to suit each individual child and family. Since then, I have had great support from the therapists who delivered the training to help me in applying the programme.”

Results

“Starting the Lidcombe Programme has been a really positive experience for Oliver and me,” says Susanne. “As a parent, it meant that I was actively doing something that would help my child. I had previously felt helpless, but now I was empowered.

‘Initially, the tightly structured ‘smooth talking’ sessions felt a bit unnatural, and having to ‘perform’ in front of Stephanie was daunting, although she was always positive and supportive. But after about a fortnight the sessions became part of our daily routine and I almost didn’t have to think about what I was saying; it became much more natural.

‘Since Oliver has been on the programme his fluency has definitely improved. Even on his most dysfluent days Oliver manages some fluent speech and we have had some days where his speech has been 100% fluent. Part of the programme involves rating Oliver’s fluency each day and it has been wonderful to see the lines on the graph slowly heading down towards greater and greater fluency; long may it continue!

Drawbacks?

SLT Stephanie explains, “The main disadvantage of Lidcombe, from my perspective, is that it requires a lot of therapy time. I am fortunate that, at the NHS Trust I work for in Airedale, I can make my own clinical decisions about how often and for how long I see clients, but I suspect that this is not the case for all clinicians. It also requires a great deal of commitment and no small amount of skill on the part of the parent. While Susanne has been brilliant in implementing and persevering with the programme, I know from my experience with other families that some parents can find this level of commitment very difficult, not to say quite stressful.” Oliver’s mum Susanne agrees: “The programme certainly requires dedication and commitment from the parent and I do wonder how parents in full-time employment manage. As a part-time teacher I have the advantage of having days when I’m not at work, and I’m used to sharing play activities and stories with young children. I am also, by nature, a ‘rule follower’, so being asked to deliver the smooth talking sessions exactly as Stephanie explained them has not been a problem.”

Stephanie adds, “On the positive side, as Susanne says, it can be very empowering for parents to feel that they are doing something positive to help their child. For Oliver, Lidcombe certainly seems to be an approach which suits him, and he clearly loves doing his smooth talking sessions. Since starting the programme, his level of stammering, and, more importantly, his level of frustration have reduced considerably.”

She continues, “As for me, I don’t mind a bit of Marmite, but I also want to be able to offer jam or honey if that’s what suits people better. Having had both positive and negative experiences of using Lidcombe in the last few months, it is not an approach that I would automatically reach for with every child who comes into my clinic, but I certainly feel that my therapy shelf is enhanced by having Lidcombe on it.”

And what does Oliver think of the smooth talking? “I like the comments that Mummy says back to me. It’s helping me with trying to stop my tricky words.”


Lidcombe facts

  • Taking its name from the suburb in Sydney where the Australian Stuttering Research Centre is located, the Lidcombe Programme is now used by most therapists in Australia.
  • Since its introduction to the UK in 1996, over 3,000 SLTs here have been trained in the programme, and it is growing in popularity.
  • On average, it takes about twelve clinic sessions of the programme to get to the point where stammering has gone or is at an extremely low level.

Sources: Rosemarie Hayhow, Speech & Language Therapy Reseach Unit, Frenchay Hospital; Mary Kingston of the Lidcombe News; and the Australian Stuttering Research Centre.

From Speaking Out Winter 2013, p.20