Thursday, October 07, 2010

Questions on Lidcombe / early child intervention

A reader left some challenging questions for me:
1) What choice do we have today. What choice do parents of children who stutter have today in the year 2010? Parents can't wait.

Parents feel that they have to do something now, but this is a fallacy a priori. Often, the best reaction in an emergency is to stay calm and don't do anything for at least 10 seconds!

My recommendation

1) go for a check-up to eliminate other language, hearing, and speech issues.

2) wait a few months as most will recover, unless stuttering is too severe and the child suffers visibly.

3) choose an experienced therapist that you like and let her/him do whatever they do.

4) pray best case scenario, natural recovery, and expect worst case scenario by focusing on improving psychosocial adaptation to a life-time stuttering brain.

2) No treatment or Lidcombe treatment?
Lidcombe treatment a few months after onset as I can only see upside potential. Those who would
recover naturally anyway, might recover earlier. Those who will not recover, receive effectively behavioural and cognitive therapy that, if done well, helped by parents, and in a cooperative child, might optimize psychosocial adaptation.

I am not concerned that direct treatment might build up some negative attitudes in the child. The child will be faced by those any way in its social environment.

3) What if you had a child who stutters? What would you do?
I would go to the SLT, and ask for a check-up of speech and language. After excluding any other issue, I will probably wait for a few months. And then I look for an experienced SLT and let her/him to the treatment they offer. And yes, if I were in Montreal, I would go to Rosalee, because she is nice and experienced with kids. ;-)

BUT I would not expect that "stuttering will be eliminated" forever, but rather than if all goes well, my child would optimize psychosocial adaptation and I probably have to expect some relapse over the years.

If s/he recovered fully, I would not say thank you Rosalee but thank you nature.

4) What is a better alternative for a child who stutters? Are you willing to take any risks?
There are various approaches, also demands and capacity treatment, Michael Palin centre treatment. My gut feeling is that, like in psychotherapies, the content is not that important, but the quality of the therapist, the parents, and the child.

I only take a risk if I know there is a risk. So far the evidence is flawed and fuzzy, so I cannot behave in a risky way.


Deryk Beal said...

Hi Tom

It is important that we distinguish between an erroneous wait and see approach and a rational monitoring approach to the early phases of developmental stuttering. Although it is true that if parents wait a few months there is a high likelihood that their child who stutters will recover naturally, there is the inherent risk that some readers may interpret your post to mean that a child will grow out of his or her stuttering and that nothing is to be done over the course of those few months. In his book, The Lidcombe Program of Early Stuttering Intervention: A Clinician's Guide, Mark Onslow very clearly describes an active monitoring approach that can be used to track the child’s stuttering in those first few months and or years. This approach has benefits for the family, child and clinician. Active monitoring of this kind maintains the clinician-family-child relationship and leaves the door open for education and counseling about the disorder. The approach ensures that the family remains engaged in collecting information about the child’s stuttering patterns. This information is used together with stuttering counts made on a weekly basis by the clinician to inform the clinical decisions made by the family-clinician team. It also demonstrates for the family that there are often truly long periods of little to no disfluency. The act of simply waiting to see would mean passing up the opportunity to benefit from the information available, for both clinician and family, over this time. It also puts the family and child at risk to misinformation from sources that cannot be trusted as well as for falling off of the radar of the their local service provider.

Deryk Beal, PhD, CCC-SLP, S-LP(C)

Anonymous said...

Was at a Self-Help Support Group meeting this summer where a group of School SLP's were attending. One of them who worked at an inner-city school shared the following: She was using the Lidcombe Approach with a 6-7year old boy and pointed out his "bumpy" speech and asked him to try his "smooth" speech to which the boy responded "F F F F*ck You".

She dismissed him from speech therapy class within a week.

As a person who stutters, I thought that boy was wise beyond his years, and I guess that the SLP would not pass Tom's "Shenker's nice" test.

Terry said...

Nice response Deryk!

As to the anonymous - wouldn't you dismiss a child for poor behaviour from a classroom? If he spoke like that to his class teacher he'd likely get disciplined - why should the SLP put up with anything different?

Anonymous said...

"PLEEEEEAAASSSSE - Fix your bumpy speech! Try your smooth speech!"

"F*CK YOU" said the child.

Makes me laugh; couldn't stop for a while!

Sounds like a really smart little bro'from the hood!