Sunday, September 13, 2015

How does Lidcombe work? No as they thought it would!

Lidcombe is apparently the miracle treatment for young stuttering children. A recent study by Franken et al. showed that another treatment based on Demands & Capacity theory is equally effective than Lidcombe, a behavioural therapy.

Many times I have said that I am not convinced that Lidcombe treatment is more effective than natural recovery, but they do claim that for a short-term control group the treatment group does much better. And I currently argue: yes that is true but only for those that would have recovered any way AND the therapists and kids know that they are being treated AND the kids know what is expected of them.

Of course, if Lidcombe claims to be a miracle treatment, I expect that they tell me what causes the miracle. And here, I say: they will not find anything. Many outcome studies of psychotherapies have shown that anything can work and that the key success factor is the patient-therapist interaction.

I often criticize the Australian but they did the right trial to look into it. An article on An investigation of the role of parental request for self-correction of stuttering in the Lidcombe Program. by Donaghy, Harrison, O'Brian, Menzies, Onslow, Packman, and Jones gives the answer I expected: nothing.
METHOD: Thirty-four parent-child dyads were randomized to two treatment groups. The control group received standard Lidcombe Program and the experimental group received Lidcombe Program without instruction to parents to use the verbal contingency request for self-correction. Treatment responsiveness was measured as time to 50% stuttering severity reduction. 
RESULT: No differences were found between groups on primary outcome measures of the number of weeks and clinic visits to 50% reduction in stuttering severity. 
CONCLUSION: This clinical experiment challenges the assumption that the verbal contingency request for self-correction contributes to treatment efficacy. Results suggest the need for further research to explore this issue.
So what really drives the treatment outcome?

And the same question goes to the Demands & Capacity treatment.


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Unknown said...

No wonder they found evidence for non-superiority for the full Lidcombe program (the one with instruction to parents to use the verbal contingency).

I don't know how people carry out research in Speech Pathology, but I am convinced that moderate to small effect sizes cannot be detected with 17 participants per group.

At least in Stuttering, I can say for sure that publication bias and low statistical power is the norm.

Anonymous said...

To be or not to be: Stuttering and the human costs of being “un-disabled”


Brian Watermeyera* & Harsha Katharda

pages 11-19
Publishing models and article dates explained

Published online: 14 Sep 2015

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Purpose: The centrality of communicating in human life means that communication difficulties are experienced at a deeply personal level and have significant implications for identity. Intervention methods may interact positively or negatively with these experiences.

Method: This paper explores this intersection in the case of stuttering, suggesting that some intervention styles may dovetail unhelpfully with the “mainstream” prizing of normalcy. In particular, most “western” societies offer a performance-oriented milieu which prizes efficiency, immediacy and competitiveness, diverting energy from the equally important work of understanding and integrating difference.

Result: Given that a person who stutters speaks fluently and with a stutter, stuttering can lean toward a complex view of disability identity—being both able and disabled. This split repertoire invites psychologically costly efforts at being “un-disabled”.

Conclusion: Interventions which amplify this tendency can contribute to an alienation from self amid strivings for normalcy.