Introductions

We are all from different parts of the country: Rosemarie Hayhow is from Bristol, Rebecca Pitt from London and I work for the Norwich Community Health Partnership who sponsored my trip to and training in Sydney. It is not my intention here to explain in detail what the components of the Lidcombe programme are - this has already been done by Onslow and Harrison in the autumn 1995 edition of Speaking Out - nor indeed to take any theoretical stance, but rather to give my impressions as a British clinician and a specialist in stuttering of what I saw and learnt whilst in Sydney, and also hopefully to allay some of the fears expressed in this country as to the harm the programme may cause. However, to make things clearer it is worth outlining some of the background and ideas on which it is based.

The Australian Position

Firstly, the Australian position is that stammering in its early stages is a physical condition and that a child is able, with the correct prompts, to overcome his/her initial problems. In other words, if a child is helped in the right way he/she will eventually learn to speak fluently. With some this can take as little as six weeks, with others it can take up to a year or more, but eventually the vast majority will be stutter-free. I would stress we are talking about real stuttering, not just normal non-fluency. Secondly, because they believe the underlying difficulty is physical, the treatment is aimed at that difficulty, within the child, not the family, though of course the family plays a vital role in the eventual outcome.

The Programme

Briefly, the programme aims to teach the parents/carers how to praise their child for speaking fluently, and how to correct them occasionally when they do stutter. The parents are trained to measure the stutter and carry out the therapy between clinic visits, and they are monitored and supported throughout the whole process by the clinician. Such is the flexibility of the programme that the needs and circumstances of each particular family are catered for, and it is unlikely that any two families will carry it out in exactly the same way. The therapy is good fun and ultimately enables the child to speak fluently, to monitor their own speech and to enjoy the whole experience of communication.

These were the things we had been told and what we had traveled half the world to see for ourselves, and to learn how to do. We were taught the theoretical basis at the University of Sydney but the majority of our time was spent in the Stuttering Unit in Bankstown, a suburb of Sydney, where we were invited to observe and participate in the therapy as we wished. While Rebecca, an Australian herself, was well versed in the Lidcombe programme, Rosemarie and I, coming from the British tradition, had yet to see the programme in action.

Questions and Fears

The many questions, and indeed fears, that had been expressed in Britain not only by the press and UK publications, but also by my colleagues, by me, and by parents to whom I had spoken about the programme, were there to be answered. Questions such as did it really work across the board or were children somehow pre-selected? Was it harmful to children because of the imputed 'negative' messages about their speech that such a direct approach could bring with it? By bringing attention to the child's speech would psychological damage ensue and indeed compound the problems of stuttering? And was the treatment as simplistic as some commentators had suggested and therefore wholly inappropriate for such a complex condition as we all know stuttering to be?

While it would be true to say I went to Sydney in a positive frame of mind, I certainly had no preconceptions and I was ready to evaluate my experiences quite freely. What in fact I saw during my seven or eight days of clinical visits answered all my questions and more, and the help and co-operation given us by all the clinicians involved was invaluable.

The Clinic and the Children

Bankstown Stuttering Unit is an ordinary community clinic, taking all comers, and different only in that it specialises in stuttering. Its catchment area is multicultural and certainly not among the most privileged of Sydney's many suburbs. Access to it was through a lively shopping mall where the wonderful smells of fresh fruit and vegetables blended with the aromatic spices and herbs from the shop at the corner. Once inside the clinic we were able either to observe through a one-way mirror or to join in with the therapy as we wished. What we saw there were happy, relaxed children unconcerned at having their stutter openly talked about or measured, or by practising stuttered words again. In fact they seemed to enjoy the whole process and were generally more than willing to join in while the therapists and their parents/carers helped them to "fix up their speech". Obviously some children were more sensitive than others but great care and consideration was taken with regard to their reactions and therapy was made to fit accordingly. The overall emphasis was on fluent speech rather than stuttering and there was no sense whatsoever of therapy being coercive or unpleasantly confrontational. I believe that no more 'negative' messages were being received than in an average clinic session where phonological (sound) difficulties were being addressed, something that happens all the time in this country without any such questions being raised. It is highly doubtful that parents would keep bringing their children if such were the case, and all the parents we spoke to had nothing but good to say of the treatment. In fact the whole notion that damage might be caused by these therapists became risible, if not actually offensive, when we saw the sensitivity and thought with which the children were treated and how the therapy was manipulated to meet their individual needs.

Simple and Flexible

This brings me to my final point here as to whether, as one would suggest, the Lidcombe programme is somewhat simplistic. It is, as the creators of it would say, conceptually simple but procedurally complex, and to me the joy of the programme lies in its very flexibility, that it can be tailored to meet the needs and circumstances of each individual child and family and yet still operate efficiently. The inherent need to be creative and to problem solve in order to allow each family to use it to their maximum potential was brought home to us again and again. The programme is far from simplistic it is not a recipe and is therefore adaptable enough to take account of individuals.

The Importance of Training

The only word of caution I would give is that I believe the therapy could be carried out incompetently if one were to believe that the programme followed a rigid and prescribed format. A thorough grounding in the programme's components, flexibility, problem-solving skills and adaptability are essential to carry the programme through effectively. Therapists need to be trained, and we are hoping there will be courses put on in Britain, in the New Year, in conjunction with the University of Sydney. In the meantime the three of us will be implementing the treatment in our own clinics, as we individually think fit, and evaluating it together to ascertain whether we can produce the same results as our counterparts in Australia. From my own point of view, having had the opportunity of travelling to Sydney and learning what I have, I felt it would be most unfortunate if we in the United Kingdom should take a stance against the Lidcombe programme - based in many cases on surmise - when in fact we could use it to enrich the many skills we already have as a profession in dealing with stuttering children and their families.

Finally ...

Finally, I would like to thank the speech pathologists from the Stuttering Unit at Bankstown - Cheryl Andrews, Elizabeth Harrison, Vanessa Shearman and Margaret Webber - as well as their colleagues at the University of Sydney - Mark Onslow, Sue O'Brian, Ann Packman and Sally Stocker-Hewat - for all their time and skill in training us, for their hospitality, and most especially for answering with such care and patience all the innumerable questions we raised with them

From the Summer 1997 issue of 'Speaking Out'

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