Developing a Stand-alone Internet Version of the Lidcombe Program for Early Stuttering

The Lidcombe Program is an evidence-based program and is the preferred intervention option in Australia to treat preschool age children who stutter. Speech pathologists help parents to implement the program at home by training them during regular visits at the clinic. Parents learn how to identify stuttering, rate stuttering severity and provide verbal contingencies during conversations. However, the Lidcombe Program is not accessible to all families that need it. Known obstacles that hinder access to the Lidcombe Program, delivered according to the Lidcombe Program Treatment Guides (Onslow, Packman & Harrison, 2003; Packman et al., 2014), are work or time restrictions of speech pathologists due to heavy caseload, and distance for families who live remotely (Rousseau, Packman, Onslow, Dredge & Harrison, 2002; Wilson, Lincoln & Onslow, 2002). The construction of a stand-alone Internet-based intervention, that is, an intervention that does not require the physical involvement of a speech pathologist when delivered, has the potential to overcome these obstacles. This thesis presents the construction and trialling of the first part of an Internet version of the Lidcombe Program, and the construction of a problem-solving tool for parents who do the program. The thesis is presented in six sections. Section I provides an overview of early stuttering, including its onset, cause and course. Potential impacts on social development and intervention for different age groups are discussed and an overview of treatment options for preschool age children is given. Subsequently the Lidcombe Program is introduced, as well as evidence that supports it. Different delivery formats of the Lidcombe Program are explained and insight in how the Lidcombe Program translates into everyday practice is provided. Section II explores theoretical issues that may need to be taken into consideration when developing the Internet Lidcombe Program. First, an overview of telehealth interventions in speech pathology is given, which results in understanding some practical issues related to its application. Aspects of other Internet-based health interventions are then discussed, to identify potential issues for the development of the Internet Lidcombe Program. The literature on adult learning and Internet-based learning is then reviewed, because the Lidcombe Program is directed towards parents of preschool age children who stutter and therefore it is essential to understand how they learn. Next, the design of the Internet Lidcombe Program is explained, including the necessary adaptations of the clinic-based Lidcombe Program components. It becomes clear that the Internet Lidcombe Program needs to be separated into two parts. Part 1 consists of a Parent Training (hereafter called Internet Parent Training), in which parents are introduced to the Lidcombe Program components, and Part 2 consists of Treatment (hereafter called Internet Treatment), in which parents start treating their child. Section III identifies the need for problem-solving support throughout the Internet Lidcombe Program and describes the qualitative problem-solving study conducted to (1) identify treatment problems that can emerge during the course of the Lidcombe Program and (2) develop potential solutions to solve them. This study was conducted in two parts. In Part I of the study, template analysis was applied to identify the treatment problems. Template analysis is based on the construction of a template through an iterative process of collecting and analysing data. Data were collected using various sources, including a brainstorming meeting, Lidcombe Program publications, reports of participants at different sites and in-depth interviews with expert speech pathologists. Part II of the study provided solutions through interviews with seven speech pathologists experienced with the Lidcombe Program. A summary structured around the main themes is given in this thesis. The findings of this study are reported in a qualitative description, organised in the template. They support the development of the Internet Lidcombe Program and the construction of a problem-solving tool for the program. Section IV illustrates how the findings of the problem-solving study are incorporated and how the identified theoretical issues related to Internet-based health interventions and adult education are addressed in the Internet Parent Training. Section V reports the feasibility study of the Internet Parent Training. Six parents of preschool age children who were about to commence the Lidcombe Program in a clinic completed the Internet Parent Training. Outcome measures were participants’ knowledge, skills, experiences and usage data, and the reports of participants and treating speech pathologists about starting the clinic-based Lidcombe Program after completing the Internet Parent Training. Results indicated that the Internet Parent Training could be optimised with a few small modifications, but overall it seemed to provide the training in stuttering and Lidcombe Program components for which it was constructed. Section VI discusses the implications of the problem-solving study and the feasibility study of the Internet Parent Training, and explores the future directions of the Internet Lidcombe Program

Treatment for preschool age children who stutter: Protocol of a randomised, non-inferiority parallel group pragmatic trial with Mini-KIDS, social cognitive behaviour treatment and the Lidcombe Program-TreatPaCS.

peer reviewedStuttering is a speech disorder in which the flow of speech is disrupted by involuntary repetitions of sounds, syllables, words or phrases, stretched sounds or silent pauses in which the person is unable to produce sounds and sound transitions. Treatment success is the highest if stuttering is treated before the age of 6 years, before it develops into "persistent" stuttering. Stuttering treatment programs that focus directly on the speech of the child, like the Lidcombe Program, have shown to be effective in this age group. Mini-KIDS is also a treatment that focuses directly on the speech of the child. It is possible that capturing the increased brain plasticity at this age in combination with creating optimal conditions for recovery underlie these treatments' success rate. A treatment focusing on the cognitions, emotions and behaviour of the child, the social cognitive behaviour treatment (SCBT), is also frequently delivered in Belgium. In this study we want to compare, and collect data on the effectiveness, of these three treatment programs: Mini-KIDS, SCBT and the Lidcombe Program (protocol registered under number NCT05185726). 249 children will be allocated to one of three treatment groups. Stuttering specialists will treat the child (and guide the parents) with Mini-KIDS, the SCBT or the Lidcombe Program. They will be trained to deliver the programs meticulously. At 18 months after randomisation, the speech fluency of the child and the attitude of the child and parent(s) towards speech will be measured. It is expected that the three programs will achieve the same (near) zero levels of stuttering in nearly all children and a positive attitude towards speech at 18 months after the start of treatment. The amount of treatment hours to reach the (near) zero levels of stuttering will be compared between the different programmes. For families as well as for the health system this could generate important information

Kennis over stotteren en doorverwijsgedrag van huis- en kinderartsen [Knowledge about stuttering and referal behavior of general practitioners and pediatricians].

Achtergrond: De cumulatieve incidentie voor stotteren bij kleuters tot 4 jaar is 11%. Het stotteren kan leiden tot een grote bezorgdheid bij ouders en onaangename beleving bij de kleuter. Het is belangrijk stottertherapie tijdig op te starten aangezien het het meest succesvol is op kleuterleeftijd. Een correcte identificatie en doorverwijzing zo snel mogelijk na het ontstaan van het stotteren is dus van primordiaal belang. Voor sommige ouders is de huis- of kinderarts het eerste aanspreekpunt voor het stotteren van hun kleuter. Bedoeling: Peilen naar de kennis en het doorverwijsgedrag van huis- en kinderartsen. Methode: We volgden de methodiek van Yairi en Carrico (1992). Met een vragenlijst werden 71 artsen bevraagd. Resultaten: (1) Kennis: Nagenoeg alle artsen (97,1%) vinden dat ze onvoldoende informatie krijgen tijdens hun opleiding. Nieuwe wetenschappelijke inzichten blijken echter onvoldoende gekend. (2) Doorverwijsgedrag: de meerderheid (70,6%) verwijst door naar een logopedist. Eén vijfde echter (21,1%) raadt ouders aan het stotteren te negeren omdat het kind er eventueel zal uitgroeien. Discussie: De laatste twee decennia is de kennis omtrent ontwikkelingsstotteren enorm toegenomen. Deze kennis blijkt nog onvoldoende opgenomen te zijn door artsen, ongeacht hun leeftijd

Speech disfluencies in Yiddish-Dutch speaking children.

Objective: to determine the distribution of speech disfluencies in typically developing fluent Yiddish-Dutch children Background: The diagnosis of stuttering is often based on the number and type of disfluencies produced in a speech sample. The normative reference that is most frequently used is based on monolingual, English-speaking children (Ambrose & Yairi, 1999). It is unclear to what extent this reference is also applicable for the speech of bilingual speakers. This is an important question since this population is growing rapidly. Method: Speech samples were collected from 30 fluent bilingual Yiddish-Dutch children aged between 6;01 and 7;07 years and 30 fluent bilingual Yiddish-Dutch children aged between 9;00 and 10;04 years. Two raters independently evaluated the speech in the samples as typically developing fluent speech. Speech samples were transcribed. Type and frequency of disfluencies were analyzed based on Ambrose & Yairi’s classification system of stuttering-like disfluencies (SLD; i.e., part- and single-syllable word repetition and dysrythmic phonation) and other disfluencies (OD; i.e., interjection, revision, and multisyllable/phrase repetition). In addition, revisions were categorized into phonological, lexical or grammatical revisions. Language dominance was determined by a detailed parental questionnaire. Results: In both age groups, Yiddish was the dominant language and children produced significantly more disfluencies in the nondominant language, i.e. Dutch. The average %SLD was 3.51% for Yiddish and 4.45% for Dutch in the youngest group and 2,92% for Yiddish and 5,09% for Dutch in the oldest group. Monosyllabic word repetitions were the type of SLD produced most often in both groups. Interjections and (lexical) revisions were the most often used type of OD. Discussion: The findings of bilingual children will be contrasted with earlier findings in monolingual children. We will argue that one needs to be careful using monolingual reference data for bilinguals. Since this will result in too many (bilingual) children being falsely positively diagnosed with stuttering