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From: Bob Quesal
Date: 10/4/02
Time: 11:39:18 AM
Remote Name: 143.43.201.67
Hi Caroline:
You raise important points (and also show why my trying to respond to these complex topics with a "Reader's Digest" response is not always a good idea).
As someone who believes that there is a lot more to the disorder of stuttering than the surface behaviors, I find the arguments about "evidence-based practice" to be a bit circular. Most of the "evidence" we have for "effective" treatments show changes in surface behavior. Most of us have worked with clients who have not been helped - LONG TERM - by such treatments. When we work on less observable aspects of the disorder, like attitudes and beliefs, we are told either that 1) they are not important, or 2) the effectiveness of the treatments that address these aspects has not been empirically demonstrated, so they are not valid.
So, my comment about WHY Lidcombe works, addressed (in part) the notion that it is POSSIBLE that the children undergoing this treatment are simply learning to hide their stuttering. Not likely, I admit, but possible. Further, it is also POSSIBLE the the kids you are seeing, who have concomitant problems (SLI and phonology) may be evidencing a different type of disfluency (perhaps language-based) which is being remediated as language and phono skills improve. Is that definitely the case? Of course not. Is it possible? I'd say it is.
There is no doubt that Lidcombe appears to be a valuable treatment for certain kids who stutter. That's why I am eager to learn more about it, so that I can do it RIGHT. Because the other argument I hear about why these "evidence-based" treatments fail is that they are not applied properly. So it seems to be blame the clinician or blame the client, but never blame the treatment. After all, there is evidence to support the efficacy of the treatments.
Of course, the Diagnosogenic theory was also based on published research. ;-)>
I hope this clarifies things, although I fear I may be digging myself I deeper and deeper.
;-)>
Bob Q.