1. Both approaches are concerned that non-fluency in children does not persist into adulthood.

2. The establishment of an effective therapeutic relationship with the child and his parents is central to both approaches. It is through this relationship that problems are explored.

3. Neither the Lidcombe programme, nor specialist therapists in Britain would advocate a "wait and see" approach where anyone, child or parents, express concern.

4. Both approaches agree that non-fluency/stammering in children can be successfully treated early. We also note that this usually involves minimal intervention i.e. only a few hours or a few appointments.

5. In terms of the therapy itself, the similarities can be summarised as:
parents spend extra one-to-one time with the child
extra praise and reinforcement is given
parents are counselled
parents are trained to alter their communicative style
non-fluency/stammering is discussed openly with the child when he expresses concern or behaves in a manner which would indicate that he is concerned
any parenting/family problems are discussed and problem solving is facilitated
a long-term commitment is required
follow-up is a necessary part of management

Differences

1. The Lidcombe programme, specifically the correcting of non-fluent speech, does not make theoretical sense.
a) psychology would tell us that we should not tell a child that what he is doing is wrong or 'maladaptive'. This undermines the child and can lead him to construe himself as a 'stammerer'.
b) developmental psychology would tell us that we should not correct normal developmental
sequences.
For some children the stumblings of pre-school speech are part of a normal process of acquiring language. In the same way that we would not criticise or correct a toddler who falls over when learning to walk, we should not correct his speech where it is part of the child's developmental pattern.

2. The Lidcombe approach is at odds with current research and the thinking of many specialists in America, Europe and the U.K. Most people now believe that stammering is a complex disorder resulting from and interaction of a number of elements, including language, age, and family background.
It cannot, therefore, be managed in a simplistic way i.e. by changing one aspect.

3. The basis of the Lidcombe programme is an 'operant' approach, that is stammering can be corrected by providing negative feedback. This was an hypothesis popular in the 60s and fell out of favour. In recent times there have been three experiments which have attempted to prove the validity of this approach with PRE-schooners. This amounts to eight children upon whom it has been tried. This cannot be considered an adequate empirical basis and further evidence is needed before it can justifiably be used in therapy.

4. Most authorities accept that stammering is not an unitary disorder and there are subgroups of people who stammer. It is also accepted that stammering, in Professor Onslow's words is "wildly fluctuating". It is therefore, difficult to justify an approach which treats all children in the same way and at the same stage. whereas this approach may be appropriate for some children, it seems unlikely that all children could benefit as has been claimed.

5. Finally, when one examines the journal articles which describe the Lidcombe programme a number of methodical problems are evident:
no control group
many children had mild stammering at the beginning of the study
there is evidence that some children's stammering was reducing before the treatment began
spontaneous recovery has not been controlled for
it is not proved that the correcting of dysfluent speech and praise of fluency was responsible for the change.

Despite the problems with the Lidcombe programme. Professor Onslow has stimulated a useful debate in the U.K. and forced speech and language therapists to re-evaluate and justify their approaches. This has been a valuable exercise and we are grateful to Professor Onslow for his contributions.

From the Summer 1996 issue of 'Speaking Out'.

back to Lidcombe Programme menu