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From: Ann Packman
Date: 10/6/03
Time: 10:56:25 PM
Remote Name: 129.78.64.100
Yes, I am aware of that study. When you refer to the recovery rate reported in that study, I think you meant to say that approximately 1 out of 5 children did not recover. We need to remember that both the studies you refer to reported recovery rates for the general population. It is likely that the rate of natural recovery is lower than this among children who are seen by the SLP, given that children who recover soon after onset may never be brought to a clinic.
And thank you for your question, it is an important one that many people ask. Answering it, though, is not easy! My view—and this is a general principle—is that it is preferable for a child to recover naturally than to recover with treatment. Treatments for early stuttering typically require parents to do a great deal, such as changing various aspects of their communication style in indirect treatment or putting time aside each day to work directly with the child as happens in the Lidcombe Program. Consequently, it seems to me to be preferable to adopt a “watchful waiting” approach for some period to see if natural recovery occurs. My concern is not so much whether the stuttering will get worse over that period, for it is not clear from the research that this will necessarily be the case. Rather, as a clinician I would want to know how long treatment can be delayed without jeopardising its effectiveness—in the event that the child doesn’t recover naturally.
Fortunately, there is some evidence to guide us here, at least in relation to the Lidcombe Program. Extensive research, conducted with over 300 children and families in Australia and the United Kingdom, indicates that it is very unlikely that the effectiveness of the Program will be compromised by waiting for up to a year after the onset of stuttering. In fact, a trend in the data suggests that children may respond somewhat quicker to the Program if they have been stuttering for a year. Thus, in general, I would have no hesitation in advising a parent to wait for a year, providing that (1) the intended intervention is the Lidcombe Program, and (2) the watchful waiting principle is adhered to. In relation to (2), I would ensure that the child is actively monitored during the waiting time.
Having said all that, it is of course critical to take individual circumstances into account. If in the judgment of the SLP there are strong reasons to intervene earlier, then that could occur. During the waiting time a child may become seriously distressed by the stuttering or the stuttering may get markedly worse. Research indicates that children are likely to take longer to respond to the Lidcombe Program if their stuttering is more severe, so if stuttering is clearly getting worse it may be prudent to introduce the Program earlier, in the hope of minimising treatment time. In any event, the SLP needs to weigh up—in consultation with the parent—the benefits of waiting and those of intervening earlier. In the end, I see the decision about when to intervene in early stuttering as one of clinical judgment, that takes both the available scientific evidence and individual circumstances into account.
I warned you that my answer would not be straightforward, but I hope it is helpful! Much of what I have said here is drawn from a book chapter written by my colleagues Mark Onslow and Joseph Attanasio and myself, see below.
Reference Packman, A., Onslow, M., & Attanasio, J. (2003). The timing of early intervention with the Lidcombe Program. In M. Onslow, A. Packman, & E. Harrison (Eds.) The Lidcombe Program of early stuttering intervention: A clinician’s guide. Austin, TX: Pro-Ed.