Speech Therapists answer Questions About the Lidcombe Program

The Lidcombe Program is a highly specialised behavioural treatment for children who stutter, developed at the University of Sydney, Australia. Named after the suburb of Sydney where it was conceived, the program has gained substantial recognition and credibility over the past few decades.

It is arguably the most popular early intervention program for stuttering in Australia and New Zealand, often considered the first-line treatment for young children between the ages of 3 to 6 years old in these countries. Its popularity has also been growing globally, with practising practitioners in countries like the United States, the United Kingdom, and Canada.

The parent-centred approach of the Lidcombe Program sets it apart from many other stuttering interventions and is a fundamental pillar of its methodology. This approach empowers parents to take an active role in their child's treatment by training them to administer the therapy themselves, under the guidance of a practising speech-language pathologist. By training parents to deliver the treatment, the therapy can be seamlessly integrated into the child's daily life. Conversations during mealtime, playtime, or bedtime become opportunities for practicing fluency, which eliminates the need for disruptive, isolated therapy sessions. This can make the treatment experience less stressful for both the child and the family.

One of the key mechanisms of the Lidcombe program is "verbal contingencies," which are specific, structured responses that parents are trained to provide during conversations with their child. When the child speaks fluently, the parent offers affirmative feedback, often in the form of simple praises like "That was smooth talking!" In instances where stuttering occurs, the parent may gently acknowledge it and ask the child to correct the utterance. This continuous feedback mechanism is integrated into daily life, turning regular interactions into opportunities for therapy and learning. Parents closely collaborate with practising speech-language pathologists, who guide them in administering the program, monitoring progress through a severity rating scale, and making adjustments to the treatment plan as needed.

The program is evidence-based, with numerous studies validating its efficacy. For example, a randomised controlled trial published in the "Journal of Speech, Language, and Hearing Research" found that 82% of the children in the treatment group showed significantly less stuttering compared to their baseline after 11 months.

An integral part of the program is a stuttering severity rating scale that parents are trained to use. This scale is a tool for both the clinician and the parent to monitor progress and adapt the treatment plan as needed. Software like SpeechFit can help track stuttering severity.

The Lidcombe Program stands as a cornerstone in the field of stuttering intervention for young children. Its parent-centred, evidence-based approach, combined with its widespread adoption and success rates, make it a highly regarded choice for treating childhood stuttering.

The Lidcombe Program is a family-focused behavioural treatment for children who stutter. It was developed at the Australian Stuttering Research Centre at the University of Sydney. The main feature that distinguishes the Lidcombe Program is its proactive involvement of parents or caregivers in the treatment process. Under professional supervision, parents are trained to provide on-the-spot feedback to their children about their speech fluency during everyday conversations. The program consists of two main stages: Stage 1, which aims at reducing stuttering to near-zero levels, and Stage 2, which focuses on maintaining that fluency over time.

The effectiveness of the Lidcombe Program has been the subject of numerous scientific studies, and it's considered one of the most evidence-based treatments for childhood stuttering. While individual results can vary, research indicates that many children who complete the program experience significant reductions in stuttering. Some studies have shown up to 95% success rate in reducing stuttering to minimal levels^[1]. Clinical trials have shown the Lidcombe program to be effective in group settings^[2] as well as over telehealth^[3]. While many children experience substantial improvement, a complete "cure" is not guaranteed.

The program is most effective when initiated at a young age, typically between 2 and 6 years old. However, some research suggests that the program can be adapted for older children, up to the ages of 10^[4]. Early intervention is generally preferred, as it often leads to quicker and more enduring results.

The length of the treatment varies widely among children and can be influenced by the severity of the stutter, the child’s age, and how consistently the program is followed. Stage 1 can last anywhere from a few months to over a year. Stage 2, the maintenance phase, can also vary in length but is generally shorter. Your speech-language pathologist will help you tailor the program to your child's individual needs.

The Lidcombe Program is rooted in the principles of operant conditioning, a type of learning in which behaviour is strengthened or weakened by the consequences that follow it. It aims to reshape speech patterns by offering immediate and consistent feedback on the child's speech fluency.

Parents or caregivers are central to the Lidcombe Program. Under the guidance of a practising speech-language pathologist, parents are trained to provide immediate, real-world feedback during daily interactions with their child. This includes offering verbal praise for fluent speech and giving gentle correction or asking for a repetition when stuttering occurs. Parents are also responsible for daily at-home practice sessions and monitoring the child's progress, often through the use of severity rating scales.

Yes, it is generally recommended to undertake the Lidcombe Program under the guidance of a certified speech therapist trained in the methodology. The program involves weekly visits to the therapist and daily at-home exercises led by the parent or caregiver, who works in close collaboration with the therapist.

The Lidcombe Program is unique in its high level of parental involvement and its focus on providing immediate, real-world feedback. Other treatments may use techniques like speech modification, electronic devices, or focus solely on emotional support. The Lidcombe Program directly targets the behaviour of stuttering, making it quite distinct from many other treatment options.

Yes, the Lidcombe Program is backed by a substantial body of scientific evidence, including randomised controlled trials, which are considered the gold standard in medical research. This makes it one of the most reliable and recommended options for treating childhood stuttering.

Generally, the Lidcombe Program is considered low-risk^[5]. The most significant challenges usually relate to the time commitment required from parents and the potential for emotional strain. Some parents also express concerns about pointing out their child’s stuttering, but studies show that this does not have a negative psychological impact when done as advised in the program.

While the Lidcombe Program is often effective as a standalone treatment, some practitioners and families opt to supplement it with other therapies, particularly for older children. However, combining treatments should be discussed thoroughly with your speech-language pathologist to ensure that therapies complement, rather than conflict with, one another.

During a session, parents will typically engage their child in natural conversation or structured speaking activities. Parents provide immediate feedback during these interactions: giving praise for fluent speech and gently requesting repetition or offering correction when stuttering occurs. Sessions with the speech-language pathologist often involve reviewing progress, troubleshooting challenges, and role-playing to practice feedback techniques.

No specialised equipment or materials are required. All you need is a dedicated time for daily practice sessions and regular check-ins with a practising speech-language pathologist.

Many families report noticeable improvements within a few weeks to a few months. However, this varies from child to child. Consistency in daily practice sessions and parental feedback is key to quicker progress.

Generally, speech pathology visits are covered by private health insurance. A referral from a GP can help you to secure funding. It is advisable to check with your insurance company regarding the coverage for speech therapy and specifically for evidence-based programs like Lidcombe.

You can learn more about funding options for speech therapy here, including NDIS and Medicare funding options. 

Additionally, there are some public health services that you can access free of charge, such as the Stuttering Unit in Bankstown which is available through Medicare to clients from South Western Sydney Local Health District. 

The first step is to consult with a practising speech-language pathologist who is trained in the Lidcombe Program for an initial assessment of your child's stuttering. Based on the assessment, the pathologist will guide you through the training required for the program and work with you to set up a tailored treatment plan.

If stuttering recurs after completing the Lidcombe Program, you should return to your speech-language pathologist for a reassessment. Often, a brief period of more intensive intervention, similar to Stage 1, is effective in restoring fluency.

The program is grounded in the principles of operant conditioning, a behavioural theory that suggests that both positive and negative behaviours can be increased or decreased through reinforcement or punishment.

The Lidcombe Program was developed by a team of researchers at the Australian Stuttering Research Centre, located at the University of Sydney. The team had extensive expertise in the field of speech-language pathology and behavioural psychology.

Most practising speech language pathologists in Australia are trained in Lidcombe. Practising therapists can be found through directories provided by speech-language pathology organisations such as Speech Pathology Australia or by contacting the Australian Stuttering Research Centre. You can also ask for recommendations from paediatricians or local support groups.

The cost per session can vary significantly depending on the location and the qualifications of the therapist. In Australia, for instance, sessions can range from $100 to $250. It's essential to factor this into your budget, especially given the importance of frequent sessions, particularly in the early stages.

You may be eligible for Medicare rebates if your child has a chronic condition and a complex care plan being managed by a medical practitioner. NDIS funding may also be available to you, but to access it you will need to create a plan and get it approved by the NDIA. You can learn more about funding options for speech therapy here, including funding through Medicare and NDIS.

Additionally, there are some public health services that you can access free of charge, such as the Stuttering Unit in Bankstown which is available through Medicare to clients from South Western Sydney Local Health District. 

If you are going through private practice, session prices are generally as follows, but please note that actual prices may differ and you should do your own research to determine which clinic is most suitable for you. 

The program offers a degree of flexibility as it can be tailored to suit a child’s individual needs. However, the core principles of immediate parental feedback and the two-stage approach remain consistent.

Yes, the Lidcombe Program has been successfully adapted for telehealth, which can be particularly useful for families who do not have easy access to practising therapists. These remote sessions are usually conducted through secure video conferencing tools, allowing therapists to guide parents in real-time. Numerous studies have shown that Lidcombe is effective when delivered through telehealth^[3][6][7].

In the early stages (Stage 1), sessions are typically held weekly. These sessions are critical for training the parents, adapting the program to the child's needs, and monitoring initial progress. As the child progresses into Stage 2 (the maintenance phase), the frequency of sessions may decrease to bi-weekly or even monthly, depending on the child’s needs and progress.

The Lidcombe Program itself is not inherently tied to any specific culture, and its principles of operant conditioning are universal. However, how it is implemented can be adapted to be culturally sensitive. Clinicians can, and should, adapt the program's practices to suit different cultural norms and communication styles.

Parents are trained by a practising speech-language pathologist to offer immediate feedback on their child's speech. Training often involves role-playing, where the therapist models both fluent and stuttered speech, and the parent practices giving appropriate feedback. Parents are also trained to measure and monitor the severity of stuttering, often through a severity rating scale.

The availability of practising Lidcombe therapists can vary depending on your location. In some areas, there might be waiting lists, especially if you are seeking treatment from a particularly sought-after clinician. It's advisable to check with multiple therapy centres or private practitioners to gauge wait times.

Progress is often monitored using a Stuttering Severity Rating, a scale typically ranging from 0 (no stuttering) to 10 (extremely severe stuttering). Parents are trained to use this scale daily to evaluate the child's speech. These evaluations, along with qualitative feedback from the parents and quantitative measurements by the clinician, help tailor the program as needed.

Tools like SpeechFit are invaluable in helping parents monitor stuttering severity on Lidcombe.

Follow-up typically involves less frequent consultations with the speech-language pathologist to monitor the child's progress and address any recurrence of stuttering. The child will usually continue to be monitored using the Stuttering Severity Rating, and adjustments to the program can be made as needed.

The Lidcombe Program is primarily designed for young children, but some clinics and therapists have adapted it for older children and even adolescents. However, its efficacy for older populations has not been as extensively researched as it has been for younger children. The program is generally not recommended for adults.

Yes, daily practice sessions between the parent and child are a crucial component of the Lidcombe Program. These sessions usually involve naturally occurring conversations where the parent provides immediate feedback on the child’s fluency.

While parents are the primary agents of treatment, siblings and other family members can also be trained to offer supportive feedback. The involvement of siblings can be particularly beneficial in making the child more comfortable and in normalising the treatment process. However, parents should remain the primary agents for consistency.

Some speech therapy centres and online platforms offer support groups for families undergoing Lidcombe treatment. These communities provide an avenue for parents to share experiences, tips, and offer emotional support.

The Lidcombe Program is effective for treating various types of stuttering, but it is most commonly used for developmental stuttering in young children. It may not be as effective for neurogenic or psychogenic forms of stuttering.

The program's efficacy in children with additional needs, like Autism Spectrum Disorders or ADHD, is still under research. If your child has additional needs, a comprehensive evaluation by a multi-disciplinary team is crucial before proceeding with any treatment plan.

Missing a session occasionally is generally not detrimental but may slow down progress. Consistency is crucial for the success of the program. Your therapist can provide guidance on how to catch up and may offer online sessions if in-person attendance is not possible.

While there are no required supplementary resources, some therapists may recommend books or apps that help parents better understand stuttering, its emotional components, or the principles of operant conditioning. The Lidcombe Program training manual itself is a valuable resource.

While not a requirement, some parents find it beneficial to inform teachers and school counsellors about the child’s treatment. This is particularly useful if stuttering affects the child’s academic performance or emotional well-being at school.

Some clinics and support groups offer the opportunity to connect with parents who have completed the program. Hearing other parents' experiences can offer invaluable insights and emotional support.

Although the Lidcombe Program primarily targets the behaviour of stuttering, addressing the emotional aspects may require a multi-disciplinary approach. Some families choose to supplement Lidcombe with psychological support to address these issues.

While the program is most effective for children between the ages of 2 and 6, success rates can vary. There is limited data on its effectiveness in older children, but early intervention is generally associated with higher success rates.

While it’s possible to pause treatment, it’s generally not recommended unless absolutely necessary. Consistency is key to the program's success, and interruptions can potentially slow progress.

Yes, research indicates that the positive effects of the Lidcombe Program can be enduring^[1][8]. However, follow-ups are generally recommended to address any recurrences of stuttering.

Navigating the challenges of childhood stuttering can be an emotionally taxing journey for both the child and the family. The Lidcombe Program offers a ray of hope by transforming the home into a therapeutic environment and empowering parents to become active participants in their child's progress. Its unique approach of using everyday interactions as treatment opportunities not only enhances fluency but also fosters emotional support and family cohesion. Backed by evidence and continuously adaptable, this program provides families with the tools they need to turn daily conversations into stepping stones toward a more fluent and confident future for their children.