Stuttering

Treatment Comparison
Emma H. Hinzman & Kristin L. Heitzman
INTRODUCTION
Stuttering is a fluency disorder that causes a
disruption in the flow of speech.

● Developmental Stuttering
● Chronic Stuttering
● Benefits of Early Intervention

If stuttering persists, the child may experience long

term educational, emotional, social, vocational and
mental health issues associated with it
 PICO Question

In children with stuttering, what is the

comparison between Palin parent
Child Interaction and the Lidcombe
Program on elimination?
 Two Interventions:

Palin Parent-Child Interaction Program (PIC Program)

&

Lidcombe Program (LP)

Major Differences
● Indirect vs Direct Treatment
-PCI focuses on changing child’s environment
-LP focuses on directly on the child’s speech
● “Dosage” of Treatment
-PCI is 6 therapy sessions (re-evaluation)
-LP is daily home treatment & once a week in-clinic until stuttering is eliminated or significantly
reduced
● Parents
-PCI requires both parents
-LP only requires one parent
● Aims
-PCI has multiple with reducing stuttering
-LP has the main goal to eliminate stuttering
● Treatment Plan
-PCI is changed from child to child
-LP is modified from child to child
 01
Palin Parent Child
Interaction
PIC Interaction Goals
Overall Goals:
- Lower the effects of stuttering on the child and parent’s
- Strengthen child’s fluency
- Increase parent’s and child’s understanding of about stuttering, while making sure the parent’s are
comfortable with managing stuttering.

Originated:
- The idea that internal and external factors influence stuttering

Parental Knowledge and Confidence:

- Program Emphasis
Influential Factors
Physiological Factors
- Family history, well-being, sleep, health

Speech Motor Factors

- Speech motor skills, speech rate, stammering type, frequency

Language & Communication Factors

- Language & social communication skills

Psychological Factors
- Temperament, awareness and impact of stuttering, negative reactions, parents’ anxiety

Environmental Factors
- Family communication styles, routines, pace
PIC Program Details
Step 1: Comprehensive Assessment
- Detailed case history conducted with parents and child that includes language and fluency assessment, as well
as an interview seeing how aware the child is about their stuttering
- These two interviews allow the therapist and parents identify the physiological, linguistic, environmental, and
emotional strengths needed

Step 2: Individualized Plan

- After the comprehensive assessment, each child is then given a plan based off of their linguistic, environmental
and emotional strengths and needs

Step 3: Therapy
- Therapy starts with a six once-weekly clinic session.
- Working on interaction strategies, such as increasing pause
- Child strategies, identifying slow speech rate

Six week home therapy:

- Parents practice and implement therapy strategies learned with the therapist
- Maintain a written record of “Special Time”. The therapist reviews the notes from parents and gives feedback
on any information needed
PIC Program Details
Step 4: Final Consolation
- Parents continue at home therapy and check in with a therapist at the 6 and 12 month mark.
- Once the 12 month mark is up, the parents have a sit down meeting discussing any concerns that they may
have. While also making sure that the child and parent’s are comfortable with managing stuttering

If parents are still not comfortable and want more therapy:

- Therapist will fix therapy strategies accordingly such as having the child have a bigger part in the therapy
session. Allowing them to make some more adjustments to his/her speech and communication
- Offer regular sessions, top-up sessions and monitoring sessions when needed
02
Lidcombe
Program
Lidcombe Program
Overall Goal:
Eliminate Stuttering or significantly reduce it

Originated:
Early research showing response contingent stimulation reduced stuttering

Verbal Contingencies:
Commenting after the child stutters or doesn’t stutter (in sessions and during natural conversations)
Program Details
Phase 1: Eliminate stuttering
-Treatment continues until this occurs or until it is reduced at a significant level!
-Treatment remains the same but adapts to each individual child and family

● Once a week in-clinic sessions (45-60 minutes per week/session)

-SLP is demonstrating treatment, observing parent do the treatment, giving the parents feedback and
reinforcement, ensuring intervention is a positive experience for the child and parent
-coaching parent to conduct at home treatment in their natural, everyday (10-15 minute practice sessions)

❏ Severity Rating:
-tracks progress at home and in-clinic
❏ Child Conversations
❏ Discussion of Progress
❏ Verbal Contingencies
Lidcombe Program
Verbal Contingencies:
Commenting after the child stutters or doesn’t stutter (in sessions and during natural conversations)

STUTTER-FREE SPEECH:
*Clinicians MUST make sure parents are being genuine with their praise while also not overdoing it!!
*Teach these to parents first!!

#1: Praise - “That was lovely smooth talking.”

#2: Self-Evaluation - “Was that smooth?” (for period of time stutter-free speech)
#3: Acknowledge - “That was smooth.”

UNAMBIGUOUS SPEECH:
*NOT used frequently, only on occasion, and must be introduced carefully!!
*SLP’s job to make sure it is a positive experience in sessions

#1: Acknowledge - “That was bumby.”

#2: Self-Correction - “Can you say it again.”
Additional & Optional
Spontaneous Self-Evaluation of Stutter-Free Speech:

Child: “I did smooth talking.”

Parent: “Great, you’re noticing your smooth talking.”

Praise For Spontaneous Self-Correction:

Parent: “Great job! You fixed that stuck word all by yourself.”
Program Details
Phase 2: Maintain the absence or low level of stuttering; hand over parental responsibility
-Gradually terminate verbal contingencies in natural conversations
-Typical appointment is 30 minutes long

● Performance-Contingent Maintenance: 2 appointments 2 weeks apart, then 2 appointments 4 weeks apart,

then 2 appointments 8 weeks apart, and finally one or two appointments 16 weeks apart. Normally takes one
year or more.
Conclusion

According to multiple studies, both programs are effective modes of treatment to receive quality

results post-treatment. Even though studies show that neither of these treatments are superior to

the other, the Lidcombe Program has the most research to back up the claims to eliminate or

reduce stuttering to an extremely low level (Rojas Contreras et al., 2022). The Lidcombe

Program originated from early research about how verbal contingencies have reduced and even

eliminated stuttering, while the Palin Parent Child Interaction has only shown to lower levels of

stuttering, but no report has shown it has eliminated it completely.

 RESOURCES
● Boucand, V. A., Millard, S., & Packman, A. (2014). Early intervention for stuttering: Similarities and differences between two programs. Perspectives on Fluency and Fluency

Disorders, 24(1), 8–19. https://doi.org/10.1044/ffd24.1.8

● Clinic, M. (2021, June 5). Stuttering. Mayo Clinic. Retrieved December 2, 2022, from https://www.mayoclinic.org/diseases-conditions/stuttering/symptoms-causes/syc-20353572

● Donaghy, M., O'Brian, S., Onslow, M., Lowe, R., Jones, M., & Menzies, R. G. (2020). Verbal contingencies in the Lidcombe Program: A noninferiority trial. Journal of Speech,

Language, and Hearing Research, 63(10), 3419–3431. https://doi.org/10.1044/2020_jslhr-20-00155

● Kelman, E. (n.d.). Palin parent-child interaction therapy - california state university ... Palin Parent-Child Interaction Therapy. Retrieved December 5, 2022, from

https://communications.fullerton.edu/centers_and_clinics/ccws/pdf/palin_pci_fullerton_day_2_updated.pdf

● Mayo Foundation for Medical Education and Research. (2021, June 5). Stuttering. Mayo Clinic. Retrieved December 2, 2022, from https://www.mayoclinic.org/diseases-

conditions/stuttering/symptoms-causes/syc-203535

● Millard, S. K., Zebrowski, P., & Kelman, E. (2018). Palin Parent-Child Interaction Therapy: The Bigger Picture. American Journal of Speech-Language Pathology, 27(3S), 1211–

1223. https://doi.org/10.1044/2018_AJSLP-ODC11-17-0199
 RESOURCES
● ​Onslow, M., & Millard, S. (2012). Palin parent child interaction and the Lidcombe Program: Clarifying some issues. Journal of Fluency Disorders, 37(1), 1–8.

https://doi.org/10.1016/j.jfludis.2011.10.002

● Onslow, M., Webber, M., Harrison, E., Arnott, S., Bridgman, K., Carey, B., Sheedy, S., O’Brian, S., MacMillan, V., Lloyd, W., & Hearne, A. (2021). The Lidcombe Program

Treatment Guide, Version 1.3, 1–23.

● Rojas Contreras, D., Saavedra Rojas, P., & Aravena Gallardo, S. L. (2022). Stuttering intervention in children: an integrative literature review. Revista CEFAC, 24.

● Scott, L. A. (2011, October 7). Stuttering therapy for children. Stuttering Foundation: A Nonprofit Organization Helping Those Who Stutter. Retrieved December 2, 2022, from

https://www.stutteringhelp.org/stuttering-therapy-children

● U.S. Department of Health and Human Services. (2016, March 6). Stuttering. National Institute of Deafness and Other Communication Disorders. Retrieved December 2, 2022, from

https://www.nidcd.nih.gov/health/stuttering#:~:text=term%2C%20disfluent%20speech.-,Who%20stutters%3F,are%20developing%20their%20language%20skills.