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The Lidcombe Programme

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Evidence rating: 2+
Cost rating: 2

The Lidcombe Programme is for parents with a child (aged three to six) with a diagnosed stuttering problem.

The programme is delivered by qualified speech and language therapists, trained to use the manualised Lidcombe protocol. It is delivered in two stages that are determined by the child’s progress with a typical period of treatment lasting between six and 12 months.

During stage one, parents attend weekly visits where they are coached in strategies in responding appropriately to periods of stutter-free speech and unambiguous stuttering. Parents are expected to set aside time to work with their child on a daily basis, as well as to develop strategies for everyday interactions. Stage two begins once the child’s stuttering has disappeared or dropped to a very low level. At this point, clinic visits are reduced but not stopped so that parents can learn maintenance strategies should the stuttering reappear.

EIF Programme Assessment

Evidence rating: 2+
Level 2 indicates that the programme has evidence of improving a child outcome from a study involving at least 20 participants, representing 60% of the sample, using validated instruments. This programme does not receive a rating of 3 as its best evidence is not from a rigorously conducted RCT or QED evaluation
Cost rating: 2
A rating of 2 indicates that a programme has a medium-low cost to set up and deliver, compared with other interventions reviewed by EIF. This is equivalent to an estimated unit cost of €125 - €599. This figure is based on an analysis of UK costs and a conversion rate of 1.19.

What does the plus mean?

The plus rating indicates that a programme’s best available evidence is based on an evaluation that is more rigorous than a level 2 standard but does not meet the criteria for level 3.

Child outcomes

This programme can affect outcomes for children in Active and healthy, physical and mental wellbeing.

According to the best available evidence for this programme's impact, it can achieve the following positive outcomes for children:

Enhancing school achievement & employment

Reductions in stuttering

based on study 1

based on study 2

This programme also has evidence of supporting positive outcomes for couples, parents or families that may be relevant to a commissioning decision. Please see About the evidence for more detail.

Who is it for?

The best available evidence for this programme relates to the following age-groups:

Preschool

How is it delivered?

The best available evidence for this programme relates to implementation through these delivery models:

  • Individual

Where is it delivered?

The best available evidence for this programme relates to its implementation in these settings:

  • Out-patient health setting

How is it targeted?

The best available evidence for this programme relates to its implementation as:

  • Targeted indicated

Where has it been implemented?

  • Germany
  • New Zealand

Ireland provision

This programme has not been implemented in Ireland.

Ireland evaluation

This programme’s best evidence does not include evaluation conducted in Ireland.

About the programme

What happens during the delivery?

How is it delivered?

The Lidcombe Programme is delivered by one speech-language therapist, speech pathologist or speech-language pathologist over 16 sessions of 45–60 minutes to individual parents and their children.


What happens during the intervention?

  • The programme starts with a structured conversation that is designed to facilitate stutter-free speech. This allows the parent the opportunity to present plenty of positive verbal reinforcement to encourage fluent speech.
  • The first stage of the intervention consists of training sessions at home where they are taught how to respond appropriately to encourage fluent speech.
  • When parents have been observed practicing the various behaviours designed to encourage stutter-free speech, the conversations progress to less structured conversations outside the training sessions and outside the home.

What are the implementation requirements?

Who can deliver it?

  • The practitioner who delivers the programme is a speech-language therapist, speech pathologist, speech-language pathologist with NFQ-6 level qualifications


What are the training requirements?

  • The practitioner has 14 hours of programme training. Booster training is recommended.

How are the practitioners supervised?

  • It is recommended that practitioners are supervised by a host-agency supervisor qualified to NFQ-6 level with no required training.


What are the systems for maintaining fidelity?


Is there a licensing requirement?

There is no licence required to run this programme.


How does it work? (Theory of Change)

How does it work?

  • Stuttering in children typically occurs between the ages of two and five.
  • Parents can reduce the incidence of stuttering in their children through verbal and non-verbal behaviour, designed to encourage fluent speech.
  • Parents learn how to praise and acknowledge stutter-free speech, acknowledge unambiguous stuttering, and encourage their children to correct themselves when they stutter.   
  • In the short term, parents are better able to encourage fluent speech without causing their child distress.
  • In the longer term, stuttering is reduced.

Intended outcomes


Contact details

Mark Onslow
University of Sydney
mark.onslow@sydney.edu.au


About the evidence

The Lidcombe Programme’s most rigorous evidence comes from two RCTs which were conducted in New Zealand and Germany. 

These studies identified statistically significant positive impact on child outcomes.

A programme receives the same rating as its most robust study, which in this case are the Jones et al. (2005) and Lattermann et al. (2007) studies, and so the programme receives a Level 2+ rating overall.

Study 1

Citation:Jones et al (2005)
Design:RCT
Country:New Zealand
Sample:54 children with an identified stuttering problem
Timing:Post-test
Child outcomes:
  • Reductions in stuttering
Other outcomes:
    Study rating:2+

    Jones, M., Onslow, M., Packman, A., Williams, S., Ormond, T., Schwarz, I., & Gebski, V. (2005). Randomised controlled trial of the Lidcombe programme of early stuttering intervention. British Medical Journal, 331(7518), 659. doi:10.1136/bmj.38520.451840.E0.

    Available at
    http://www.bmj.com/content/331/7518/659

    Study design and sample

    The first study is an RCT.  

    This study involved random assignment of children to a Lidcombe Programme treatment group and a no-treatment control group. 

    This study was conducted in New Zealand, with a sample of 54 children (between three to six years of age) wait-listed for stuttering treatment. 

    Measures

    Proportion of syllables stuttered assessed through audiotape recordings by experienced speech pathologists (blind to assignment) (expert observation of behaviour).

    Findings

    This study identified statistically significant positive impact on one child outcome: reductions in stuttering.

    The conclusions that can be drawn from this study are limited by methodological issues pertaining to a lack of intention-to-treat analysis, hence why a higher rating is not achieved.

    Study 2

    Citation:Lattermann et al (2007)
    Design:RCT
    Country:Germany
    Sample:46 children with an identified stuttering problem
    Timing:Post-test
    Child outcomes:
    • Reductions in stuttering
    Other outcomes:
      Study rating:2+

      Lattermann, C., Euler, H.A., & Neumann, K. (2007). A randomized control trial to investigate the impact of the Lidcombe Program on early stuttering in German-speaking pre-schoolers. Journal of Fluency Disorders, 33, 52-65.

      Available at
      https://www.ncbi.nlm.nih.gov/pubmed/18280869

      Study design and sample

      The second study is an RCT.  

      This study involved random assignment of children to a Lidcombe Programme treatment group and a no treatment group. 

      This study was conducted in Germany, with a sample of 46 children (aged three to six) with a diagnosed stuttering problem. 

      Measures

      Child stuttering frequency was audio recorded during spontaneous play (at home and clinic) and were assessed by a speech pathologist (blind to group assignment) (expert observation of behaviour).

      Findings

      This study identified statistically significant positive impact on one child outcome: reductions in stuttering.

      The conclusions that can be drawn from this study are limited by methodological issues pertaining to a lack of clarity around how randomisation was conducted, hence why a higher rating is not achieved.

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