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From:
Date: 19 Oct 2007
Time: 17:55:43 -0500
Remote Name: 129.78.220.7
Hi Andy, In my response to Katie I said “it would be grossly incompetent if a clinician, treating a client of any age with any disorder, set the client up for failure and exacerbated any negative attitudes towards communication.” So, if a child did not respond to the Lidcombe Program, or any other treatment, it would probably have just those effects to put him or her through it again. There are a number of issues to consider in contemplating your question. The first is related to the issue above. Benchmarks for responsiveness to the Lidcombe Program are known: in four weeks there should be a one-third drop in severity (Onslow et al. 2002) and the median number of clinic visits to get to normal sounding speech is 12 (Jones et al., 2000; Kingston et al., 2003; Rousseau et al., 2007). So you don’t need to go for a long period to know that treatment is not going to work. Another issue is that the reasons that it might not work for a family might well lead you to choose a simpler, rather than a more complicated treatment as a second choice. A set of issues relate to me being an evidence based pracitioner. Fundamentally, I will not consider for a child’s health care a treatment that does not at least have entry level clinical trials data to make such a choice ethical. Also, evidence based practice leads to different choices in different situations. If for example you do not have comprehensive training in a treatment method, you cannot do the treatment with a child. So, with that in mind, if a child I was treating did not respond to the Lidcombe Program (that was the case, I recall, seven years ago) I would contemplate the treatment reported by Trajkovski et al. (2006). True, it is only entry level clinical trials data, but myself and my colleagues have extensive experience with it because we are conducting several clinical trials at present. Tell me if I am making sense. I look forward to you reply. Regards, Mark. Kingston, M., Huber, A., Onslow, M., Jones, M., & Packman, A. (2003). Predicting treatment time with the Lidcombe Program: Replication and meta-analysis. International Journal of Language and Communication Disorders, 38, 165-177. Onslow, M., Harrison, E., Jones, M., & Packman, A. (2002). Beyond-clinic speech measures during the Lidcombe Program of early stuttering intervention. Acquiring Knowledge in Speech, Language and Hearing, 4(2), 82-85. Rousseau, I., Packman, A., Onslow, M., Harrison, L., & Jones, M. (2007). Language, phonology, and treatment time in the Lidcombe Program: A prospective study in a Phase II trial. Journal of Communication Disorders, 40, 382-397. Trajkovski, N., Andrews, C., O’Brian, S., Onslow, M., & Packman, A. (2006). Treating stuttering in a preschool child with syllable timed speech: a case report. Behaviour Change.23, 270-277..