I am an SLP student who has been wondering about the Lidcombe program for a while [...] I've just been wondering about the Lidcombe success rates. How come the Jones et al (2005, British Medical Journal) had such a huge difference between the control group and the actual subjects. The field of stuttering is a complex one, as our professor said. One could fill a library with books that are all about stuttering and still none of them is absolutely right about it. The problem is that somehow they managed to pull off such a huge difference between the groups. The same incidents seems to occur with other studies as well like Miller et al (2009, AmericanHere are possible explanations for the big difference:
Journal Of Speech-Language Pathology) and Latterman et al (2008, Journal of Fluency Disorders). The sample was very small so some of the differences could be explained by pure statistics. I don't really believe in completely behavioral therapy because stuttering has (probably) a mostly neurobiological background. I am wondering what were your thoughts about the systematical, but yet small data, concerning the success of Lindcombe. The spontaneous recovery rates might easily have huge differences between such a small sample groups but it's consistent between few studies that I've quickly read through.
1) Every adult treatment of nearly any type leads to a significant reduction in dysfluency. Therefore, we must NOT look at outcome after therapy, but six months or one year after therapy. And that's EXACTLY what happened in their follow-up study, some relapsed.
2) The trial were not blinded at all, and the control group did nothing. That's VERY different to the standard random control trial, where both groups are given IDENTICAL pills. Here only one group was given treatment, and the other group waited.
3) The children in treatment have much more familiarity with the therapy environment. They have been conditioned to behave in a different way. They have been told that stuttering, or non-control of speech, is undesirable.
4) The treated kids are used to perform in the clinic environment. For them, it has become a kind of playground, and so later measurements are probably biased downwards.
4) You cannot even talk about success of Lidcombe, because the success factor might be a component common to all interventions, e.g. parent-child intervention.
5) Sample size is small.
6) I would not be surprised if behavioural treatment makes kids who recover naturally recover faster. I speculate that the neurobiological issue resolves within weeks or months but that the learned behaviours are still there without the neurobiological basis and will only gradually wane. But treatment might eliminate these learned behaviours faster.
And more questions:
And I was also wondering about the high spontaneous recovery rate you mentioned (~80%?). That seems a tad high and if I remember right it was originally conducted by the Yairi group at the University of Illinois. A systematic review about the articles widens and drops the scale by a large margin. I have to admit that since stuttering isn't something I've really kept up with I can't remember the exact numbers and right now I can't open up the article database to check it... the clinical data I've heard of was also less than 80%. But by no means, it had absolutely nothing to do with science. This just came up so that's why I even mention about it. I am very interested about everything in a very strict and scientific way. That's why I am pretty suspicious about the Lidcombe program.The number depends on the definition. What exactly is stuttering? For example, the latest large scale survey has many more than 5% of kids stuttering, leading to even higher recovery rates. But some criticise the too stringent definition.
I personally prefer to work with 80% or 90%, because I want to be conservative. If I say a lower number and I am wrong, treatments will suddenly be effective without being effective. But if I aim for a higher number and I am wrong, the burden of proof has just been higher for treatment efficacy.
The answer is that there is no real answer. The best I can say is that the vast majority of kids recover. As a first approximation rule, if your child stutters, expect that he or she will recover.
Charles Van Riper, the father of what we consider stuttering therapy, once said (I've got it on tape as well) that he had never ever seen any stuttering person cured - except that maybe one or two adults were capable enough to control the stuttering so that they could avoid the persons they interacted with from noticing that they actually had some trouble with their fluencies. Charles Van Riper himself knew his 'techniques' very well and could control his stuttering but after listening to his audio recordings I could easily notice that he had some short pauses and other minor dysfluencies in his spontaneous speech. That is why I don't really believe in anything like that. They taught us that the early intervention has (probably) a positive affect on child's attitudes and feelings towards his/her stuttering. By addressing that early on the speech therapy would be easier and therefore more successful. As stuttering has a huge, huge and huge impact on the stuttering person it's really hard to work on stuttering when someone has been stuttering without any kind of (professional) support or help through his/her childhood and even early adulthood.I agree.