Tuesday, September 13, 2005

How good is Lidcombe?

I admit that I am not an expert on the details of the Lidcombe therapy. So please correct me when I go off stage. But here are some (possibly controversial) thoughts:

1) I am still not 100% convinced that research has conclusively shown that the Lidcombe therapy gives lasting and clearly-above the natural recovery rate fluency to dysfluent kids.

2) The people who do Lidcombe therapy have no precise understanding why it should work, apart from some general intuition that targeted practise and "pressure" will change the children's behaviour.

3) Any intervention (whether Lidcombe or something else) might have an effect.

4) Politically speaking, Lidcombe is wonderful whether it is effective or not. And I tell you why. Parents dont want people like me telling them: "Well, 80% recover anyway. There two approaches. One say X and the other says Y. Lidcombe might be good but who knows" They want CERTAINTY: "Yes, we can solve your child's problem. And we tell you how to help them." And even if this certainty is completely misguided. The absurd fact is that 80% of the parents will be very satisfied! Their thinking goes: "our child did Lidcombe - problem solved - Lidcombe is an effective therapy".

5) Intuitively, Lidcombe could well at least partially be a consequence of the male big belly phenomenon. You tell them: "You have a big belly". And they strengthen their stomach muscles and the big belly is suddenly gone. No big belly anymore! Hey. But then after a while, the big belly comes back. And so to Liddcombe. The big belly is the dysfluency. The Lidcombe therapy is the "pressure" or "re-enforcement" of a different than naturally developed behaviour. And it could well be that after this period the child goes naturally back to its natural behaviour. But I agree that at this young age the effect for permanent change is greater. But it could well be that some aspects of the child's brain, like speech and language circuits, are hard to change after the age 3 to 4, whereas others like movements, habits, pyschological or social certainly are. So it is very important to follow up the kids over several years after they have left Lidcombe. And any outcome study should study possible relapse too.

6) What part of Lidcombe does the treatment effect?

FINALLY, 7) Research on Lidcombe therapy has clearly shown that the days of Johnson & co are numbered. Where are the kids that should recover less often if you make them aware of their stuttering? Very clearly, giving Licombe to kids does not make them stutter more...that is for sure.

In this light, Lidcombe deserves credit! And the supporter of Johnson & co's approaches to stuttering must seriously review their own thinking, not just for kids but also for adults. NO, stuttering is not caused by self-identity issues (they view themselves as stutterers, if they did not have that view, they would not stutter). Stuttering causes people to develop an too unrealistically negative view of themselves as speakers that their speech impediment forces on them.


Tish said...

I take issue with no 2:
"The people who do Lidcombe therapy have no precise understanding why it should work, apart from some general intuition that targeted practice and "pressure" will change the children's behaviour."

Rather insulting to some of us who actually work or have worked in the field.
Lidcombe works because it removes tension and repetitions which result from the tension. The excess tension begins because there have been sudden changes or difficulties in the child's life - a new sibling has arrived, a parent has disappeared from the scene... Lidcombe gives the child the attention he needs to reassure him.
Sometimes the method doesn't even need to be implemented. A three year old came to me with his mother and baby sister. We discussed, in front of him, changes to his life. His mother had been aware that he was upset that his father was working away - so upset that he would not even talk to his dad on the phone. He was upset too that his father gave more attention to the baby because she did not reject him. We were sympathetic and, quite frankly, I told him not to stammer. He never stammered again. His mother said he stopped stammering in the car on his way home. The family gave him and his problems proper attention. It's not that he was attention seeking - rather, the discussion reassured him that all was well and that he was well-loved.
So, in this case the repetitions did not develop into a verbal tic. Please read my theory of stammering - that stammering/stuttering is a complex vocal tic - and perhaps someone might carry out some research in this area. PLEASE for XXXsake!


Tish Sims

Tom Weidig said...

I have replied to your message in my latest post.