It is recommended to aim for Stage 2 criteria of mostly 1s and some 2s with children under 6 years of age. If this criteria is elevated then there would likely be a greater risk of relapse. It is important to ensure that all problem-solving for further progress has happened before making any decision to elevate criteria or discontinue treatment.

However, there might be circumstances where a parent cannot continue treatment as they have “burnt out” or don’t have the time to commit to the amount of treatment that is required. It would not be appropriate to continue regular treatment in those circumstances. Also, if the child’s severity is not improving, then they may form a negative view of speech therapy. It would be better to avoid that so that when the child is older, they might consider further speech therapy favourably.

If the child has maintained stable severity for a long time then elevated criteria may be considered. In that situation the speech-language pathologist would explain the risk of relapse to the parents and attempt to determine whether the child’s speech was stable enough to maintain. The parent should be informed that by the long-term treatment outcomes are not able to be predicted. If an attempt to maintain severity at this level is made, the speech-language pathologist will need to determine how much treatment will be required to maintain that level in the long-term.

If the SRs are not stable enough to maintain then there is no point in Stage 2 because relapse is likely and the speech-language pathologist has already established that the parent is unable to commit to further therapy. This becomes complicated and it might be better to discontinue treatment in that circumstance.