Wednesday, March 18, 2015

Deborah Theodoros has been misinformed about the efficacy of Lidcombe

The Australian Speech and Language Association's president Deborah Theodoros seems to be badly misinformed about the efficacy of Lidcombe as she wrote in her statement on Graig Coleman's concern about making Lidcombe the treatment of choice in Australia:
"early stuttering intervention at a level which is demonstrated to be highly efficacious and supported by the strongest level of evidence."
As I understand she is not an expert in stuttering so someone must have whispered in her ear and she refused, so far, to lend her other ear to an opposing opinion. Her statement is completely overblown. (check also my first response to the debate)

Let's deconstruct her statement: "demonstrated to be highly efficacious:"

This is simply not the case if you look at the long-term data and if you know, like me, the many cases clinicians tell me about where it did not work. Even Onslow, Packman, et al's recognize that
At the time of this follow-up, the children were aged 7-12 years, with a mean of 5 years post-randomization in the 2005 trial. Twenty of the 29 children in the treatment arm and eight of the 25 children in the control (no treatment) arm were able to be contacted. Of the children in the treatment group, one (5%) failed to complete treatment and 19 had completed treatment successfully and had zero or near-zero frequency of stuttering. Three of the children (16%) who had completed treatment successfully had relapsed after 2 or more years of speech that was below 1% syllables stuttered. Meaningful comparison with the control group was not possible because an insufficient number of control children were located and some of them received treatment after completing the trial.
To conclude, the treatment was not "highly efficacious" at all, especially if you compare it to the natural recovery rate of 70%-80%. And due to the small number of 29 children, the statistics are bad. And there was no control group to control for natural recovery, so you cannot actually judge the relative performance to a non-treated group.

The statement "supported by the strongest level of evidence." is, as you can see, completely overblown.

Deborah Theodoros should seek independent counsel on this matter to counter the notion that her statement and her association projects a certain carelessness regarding dissenting opinion. She cannot just hear the arguments of those that have worked hard to create and establish, and then also measure the treatment; a clear conflict of interest. All in good intention but nevertheless Lidcombe is neither "highly efficacious" nor supported by "the strongest level of evidence."


Anonymous said...

Natural recovery is 80% from onset of stuttering. Advice is normally to wait for a year post onset before starting the Lidcombe Program to allow for natural recovery and children also work through the programme quicker a year post onset. Packman says that a half or more of children will have recovered by a year; it is therefore incorrect to say that 80% of those receiving the Lidcombe Profram would have recovered naturally; the figure would be much lower a year post onset.

Tom Weidig said...

My comment was in the context of their first trial. I think for the trial the kids were taken earlier than one year.


1) It is not even clear what the exact natural recovery rate is, also because the definition of what is stuttering and when was the stuttering onset is not that clear.

2) There is only one large-scale study, again from Australia involving Onslow & Packman, which shows data until the age of 5 or so. They have a longer time period now but it is not published yet. They had a recovery rate of 90% or so. Would be interesting to see the full study.

3) I am not sure if this study shows at what age and after onset they enter treatment.

4) The only correct way to empirically test this is to have a control group and clear criteria what stuttering is. This has only been done once for a small amount of kids 20-30 for six months which is statistically not that meaningful.

Tom Weidig said...

The statement by "Packman says that a half or more of children will have recovered by a year" contradicts the data of the long-term large-scale Reilly study:

"By age 4 years, the cumulative incidence of stuttering onset was 11.2% (95% confidence interval [CI]: 9.7% to 12.8%)... Only 9 of 142 children (6.3%; 95% CI: 2.9% to 11.7%) recovered within 12 months of onset."

In this study, less than 10% recover within a year.

Jane said...

This data is at odds with that given on The Stuttering Foundation website.

They discuss prevalence and risk factors and have fourteen references including Yairi and Ambrose from The University of Illinois.

They state:

'Between 75% and 80% of all children who begin stuttering will stop within 12 to 24 months without speech therapy. If the child has been stuttering longer than 6 months, he may be less likely to outgrow it on his own. If he has been stuttering longer than 12 months, there is an even smaller likelihood he will outgrow it on his own.'

They say: 'Longitudinal research studies by Drs. Ehud Yairi and Nicoline G. Ambrose and colleagues at the University of Illinois provide excellent new information about the development of stuttering in early childhood. Their findings are helping speech-language pathologists determine who is most likely to outgrow stuttering versus who is most likely to develop a lifelong stuttering problem.
Research reports include:
Yairi, E. & Ambrose, N. (1992). A longitudinal study of stuttering in children: A preliminary report. Journal of Speech, Language, and Hearing Research, 35, 755-760.
Ambrose, N. & Yairi, E. (1999). Normative disfluency data for early childhood stuttering. Journal of Speech, Language, and Hearing Research, 42, 895-909.
Yairi, E. & Ambrose, N. (1999). Early childhood stuttering I: Persistence and recovery rates. Journal of Speech, Language, and Hearing Research, 42, 1097-1112.
Yairi, E. & Ambrose, N. (2005). Early Childhood Stuttering: For Clinicians by Clinicians, ProEd, Austin, TX.

Jane said...

Just a comment on the recovery rate, following on from yours above:

I have read various percentages for natural recovery, often between 74 and 80%. I'd put 80% in my comment above as I remembered this is the figure you had quoted in your post 'Is your kid still stuttering after Lidcombe?' This does fit with the incidence of stuttering being approximately 5% and the prevalence approximately 1%.

Anonymous said...

An interesting point that Dr Franken makes is that natural recovery in the clinical population may be lower than 80%. She discusses this idea in her discussion on preschool stuttering and its treatment on Stuttertalk.