From: Anne Bothe
Date: 10/3/00
Time: 11:21:36 AM
Remote Name: 128.192.22.206
Thanks, Nancy – Good questions! This is extremely similar to the treatment approach that Dr. Onslow and his colleagues call the "Lidcombe Program," yes. Onslow and his colleagues have developed some particular variations on some general themes, and they get great results (see their papers in JSLHR and in AJSLP). I need to be clear that I'm not doing "The Lidcombe Program," though, just in the sense that I have not been trained by Dr. Onslow to do precisely what his clinicians do.
When did we start praise vs. correction: We jumped right on in with both. It would be possible to develop data-based or theoretical reasons to start with one or the other: There is certainly evidence that reinforcing fluency is enough to change children's speech (one classic reference here is Shaw and Shrum's 1972 paper in JSHD), just as there is evidence that correcting stutters is enough to change children's speech (the original Martin, Kuhl, & Haroldson, 1972, "puppet study" is a classic example here). I think a strict reading of the experimental literature would suggest that the best of the two is actually to do only correcting the stutters, at least as far as how quickly stuttering is reduced and how well the resulting speech generalizes to other situations. Clinically, I think we go with the combination of praise and correction for a number of reasons, not the least of which is that it just feels better to parents and to clinicians to be reinforcing something! That's why we give reinforcers in artic treatment for good productions, not just corrections in artic treatment for incorrect productions, and so on. And there is definitely evidence that the combination is not worse than doing corrections only, so we end up doing the one that feels better – and which also has the advantage that as the stuttering decreases, the parents can still be providing the children with occasional cues about how great their speech sounds.
Children who respond negatively: Dr. Janis Costello Ingham wrote recently that direct treatments for children who stutter have become popular because "their effectiveness is obvious and their harm, fictional" (p. 88 of her chapter in Curlee's "Stuttering and related disorders of fluency," 1999). That's a pretty strong way to phrase it, but I basically agree with her, and that has pretty much been my experience. Of course, if you see any negative effects of anything you're doing in any interpersonal situation of any sort, including a clinical relationship with a preschooler who stutters, then stop and re-assess what you are doing and why you are doing it. But the most negative reaction I can think of was a child who told his mother not to call them "bumpy words," because he didn't like it when she called them "bumpy words." She was wonderful: She just asked him what she should call them. He came up with "dinosaur words," so she proceeded to say, "Uh-oh, dinosaur word!" whenever he stuttered. He was and is a happy and self-confident child, and he's no longer stuttering.
Thanks for your questions!