Frequently Asked Questions
What is stuttering?
Stuttering is a disorder in where speech is interrupted by repeated movements and fixed postures of the speech mechanism. These interruptions may be accompanied by signs of struggle and tension. The speech disruptions of stuttering range from mild to severe, and stuttering may also be quite variable within individuals. For example, with children, stuttering may come and go over days or months. In older children and adults, stuttering may vary according to the communicative context.
What causes stuttering?
There are many theories and popular beliefs about what causes stuttering. However, despite considerable scientific research from the second half of the 20th century onwards, the cause of the disorder remains a mystery. All we can say at present is that stuttering is most likely due to some problem with the neural processing of the brain areas that support speech production. In other words, individuals inherit a problem where speech muscles won’t do what they should do, when they are needed to do it. However, at present it is not known for certain how that genetic susceptibility works, and the precise nature of the trouble with neural speech processing is not known. The problem begins to appear as young children develop their language skills.
In short, stuttering is thought to be a physical disorder and is not caused by psychological factors such as nervousness or stress, or parenting practices or the way parents communicate with their children when they are young. Nothing about parenting style or the family environment is known to cause stuttering. Stuttering tends to run in families, and it is generally accepted that this is because genetics is involved in the cause. However, the precise nature of the inheritance is unknown at present. Psychological factors such as anxiety or stress can complicate the problem if it persists into late childhood and adolescence.
What should I do if my child has started to stutter?
If your child has started to stutter then it is recommended that you contact a speech-language pathologist to seek advice for your particular child. In general terms, the onset of stuttering can be distressing for some children and for parents, particularly if the onset was sudden and unexpected as is often the case.
It is important that you reassure your child and be patient and wait for them to finish what they are saying. If they become upset or annoyed about the stutter and you can help them, then that is OK if they are accepting of this help. Unlike adults, children are still learning to talk and they are often accepting of parental help in those situations.
When is the best time to treat stuttering?
While many young children will recover naturally from early stuttering, but there are few factors that predict this recovery. It is well known that many more girls than boys recover naturally and that the longer a child has been stuttering the greater the odds that the child may persist in stuttering. The speech-language pathologist will evaluate and advise the best timing for intervention for you and your can you buy priligy online child. Typically, it is a good idea to monitor your child’s severity of stuttering for at least 6 months following onset, especially if your child is less than 4 years old at onset.
Delaying treatment for a short period of time in preschool age children will not affect the outcome of therapy with the Lidcombe Program. Given all other things being equal, it would probably be all right to continue to monitor severity until the child is nearing 4 years. If the situation changes in any way, e.g., the child becomes distressed about stuttering, you may want to contact your speech-language pathologist to see if the recommendation for initiating treatment has changed.
What is likely to happen if my child isn't treated?
When treatment is delayed for some time, the psychological effects of stuttering on the child and family must be considered. Reports of child frustration as a result of teasing or other negative feedback could increase the fears and avoidance behaviours that are sometimes noted in older children who stutter. While there is some evidence to suggest that the Lidcombe Program can be effective therapy for some school age children, it would be best clinical practice to introduce treatment before the age of 6 years if possible.
What is the Lidcombe Program?
The Lidcombe Program is a behavioural treatment for children who stutter who are younger than 6 years. It may be suitable for some older children. The program takes its name from the suburb of Sydney where the Australian Stuttering Research Centre is located, at The University of Sydney.
The treatment is administered by a parent or carer in the child’s everyday environment. Parents learn how to do the treatment during weekly visits to the speech pathologist. During these visits, the speech-language pathologist teaches the parent by demonstrating various features of the treatment, observing the parent do the treatment, and giving parents feedback about how they are going with the treatment. This parent training is essential, because it is the speech-language pathologist’s responsibility to ensure that the treatment is done appropriately and is a positive experience for the child and the family.
The treatment is direct. This means that it involves the parent commenting directly about the child’s speech. This parent feedback needs to be generally positive. The parent comments primarily when the child speaks without stuttering and only occasionally when the child stutters. The parent does not comment on the child’s speech all the time, but chooses specific times during the day during which to give the child feedback.
As well as learning how to give feedback effectively, the parent also learns to measure the child’s stuttering each day with a scale from 1 to 10, where 1 is no stuttering, 2 is extremely mild stuttering, and 10 is extremely severe stuttering. At each clinic visit, the speech pathologist and the parent discuss these severity ratings for the previous week to see what effect the treatment is having outside the clinic. This is an essential process to ensure that the treatment works properly.
The Lidcombe Program has two stages.
During Stage 1, the parent conducts the treatment each day and the parent and child attend the speech clinic once a week. This continues until stuttering either is gone or reaches an extremely low level.
Stage 2 of the program—or maintenance—starts at this time and lasts around a year. The aim of Stage 2 is to keep stuttering from returning. The use of parent feedback during Stage 2 is reduced, as is the number of clinic visits, providing that stuttering remains at the low level it was at the start of Stage 2. This maintenance part of the program is essential because it is well known that stuttering may reappear after a successful treatment.
All children and families are different, and the speech pathologist takes this into account when supervising the treatment. While the essential features of the treatment as set out in the Lidcombe Program Treatment Guide are always included, the way they are implemented is adjusted to suit each child and family. The treatment guide can be downloaded by clicking here.
Who uses the Lidcombe Program?
The Lidcombe Program was developed in Australia and is now used by most speech-language pathologists there. The Lidcombe Program Treatment Guide has been translated into a number of languages, and these translations can be downloaded from this website. There is an international Lidcombe Program Trainers Consortium, with members in several countries. The Consortium has provided Lidcombe Program training to thousands of speech-language pathologists in those and other countries. You can read about the consortium at this website.
Does the Lidcombe Program Work?
Yes, independently replicated clinical trials show that it does work to get rid of stuttering. Clinical trials have also shown that it works in a telehealth version, where the speech pathologist and family actually never meet; the treatment is done either by telephone or, more commonly these days, with Skype over the internet.
Research has also shown that the program is safe. It does not appear to interfere with parent-child relationships and has no apparent effect on other aspects of communication. Indeed, parents report that their children are more outgoing and talk more after treatment because they are no longer stuttering.
How long does the Lidcombe Program take?
Children differ in the time they take to complete the Lidcombe Program. However, on average it takes about 12 visits to the clinic to get to he point where stuttering has gone or is at an extremely low level. After that, three more clinic visits are required to be sure, and then Stage 2 begins, where the parent and child make fewer visits to the speech clinic. Children with more severe stuttering will generally take a little longer.
Is the Lidcombe Program better than natural recovery?
It is known that some children will recover from stuttering without needing formal treatment. However, treatment should normally begin within one year after the onset of stuttering during the preschool years. If treatment is delayed any longer there is a risk that treatment will not be effective. Recent research has shown that not many children will recover from stuttering within that one-year period after onset.
Normally, the speech-language pathologist will wait for up to one year, more commonly six months, to see if a preschooler’s stuttering will resolve on its own. However, there is good evidence that when the decision is made to begin Lidcombe Program treatment that it is much better than natural recovery. With what is called a meta-analysis, it has been shown that a stuttering child who receives the Lidcombe Program has seven or eight times better odds of not stuttering that a child who does not receive the Lidcombe Program.