Thursday, July 19, 2012

BREAKING NEWS: Lidcombe no better than Demands & Capacities

Last week, the International Fluency Association's conference was held in Tours, France. Check out the IFA 2012 website: here. I as many others boycotted, voluntarily or due to a lack of money, the conference organised by Elsevier, the publishing company that has the academic community against themselves for over-charging. Even the local organisers have expressed their concern to me.

Anyway, I have breaking news for you. As you might remember, I have been and am a strong critic of what I see as sloppy outcome trials done by the Lidcombe consortium testing their own therapy approach, and force-feeding that approach to the therapy community as the gold standard.

In previous posts, I talked about an interesting trial with far better methodology (especially on sample size and observation period.) They decided to split the kids into two groups: one doing Lidcombe, and the other group doing Demand & Capacity. The published pilot study of 30 kids showed no difference between the two approaches. After much difficulties (including some unacceptable actions by some people), they managed to get a full long-term 18 month trial started with at least 120 kids, much more than the Lidcombe studies ever did but with zero public exposure, except on this blog.

At her IFA talk last week, Marie-Christen Franken said that their preliminary analyses show no difference between treatment when they compare pre with 18 months follow-up randomisation in percentage of stuttered syllables. They found an effect of time and of severity. Final results are not expected for a few months, as the PhD student is on maternity leave...

Anyway, to conclude, the combined evidence (from the pilot study and the preliminary results) point to the fact that both approaches show no difference in outcome. The message to all therapists in the world  should be crystal clear: don't believe what the Lidcombe people preached that they are the gold standard and no other approach should be not used as not tested. Other approaches are not worse. This fits well to evidence from psychotherapy showing that no method is better (except for a few special cases) and what counts is the PATIENT-CLIENT RELATIONSHIP.

But if no-one is better, maybe nothing is ultimately effective. The trial cannot answer absolute outcome as they did not have a control group.


12 comments:

Anonymous said...

These results do not surprise me.

Anonymous said...

Honestly, there is no cure for stuttering.

Only a stutter himself can cure himself or atleast acheive fluency

Every stutterer is different. Add to that his upbringing and other environmental factors..

We all know children take what they learn as a child throughout their entire lives.
Language, fears, behaviours and many other things

So its impossible that ONE CURE WORKS FOR ALL..

I am working on self-cure now. lets see how it goes. I need to understand and work on my shortcomings. I know its possible so im working on that

Complex problems have simple solutions. I believe this applies to stuttering also.

PRACTICE MAKES PERFECT.

Jon said...

I seriously doubt that any system can do more than nudge the tail of the curve into remission.

Regarding the results - assuming you have them correct - the claim is that they can get to children early and prevent them from becoming chronic cases. To that extent, you shouldn't need statistics. A simple count would tell you how many children have stopped stuttering.

As to the degree of stuttering - in which you do need statistics - I'd look to incidence of blocking first. If you're not blocking as much, then severity is the lesser issue.

They say they got an effect for severity? It's not surprising that a theraputic program could teach children to back off the most severe behaviors. That's a nice theraputic effect in practice if you can't do anything else, but it's not what the early intervention people claim.

All in all, it's as I expected. It makes little sense to think you can teach your way out of a neurological condition. You may be able to manipulate it or mask it, but you can't make the brain re-grow itself.

Fabi said...

Hello,
I just want say thanks again for this blog and the interesting articles, especially this last one. To me, the most difficult question is whether it's possible at all to find a method in order to measure the severity of stuttering! Isn't it always a matter of how much a stutterer is avoiding or using tricks that help him/her concealing his symptomes...?

Elliot said...

The part that you bolded seems to say that Lidcolm did show an improvement in reducing severity/duration of stuttering, but didn't reduce the percentage of stuttered syllables. This seems like a positive result to me, given that the reduction in severity was significant enough. A person can become a much more efficient communicator by only reducing their severity and not reducing their percentage of stuttered syllables.

Tom Weidig said...

@Jon: I agree with most of your comments.

>>>the claim is that they can get to children early and prevent them from becoming chronic cases. To that extent, you shouldn't need statistics. A simple count would tell you how many children have stopped stuttering.

NO that is not really the case, because the trial does not have a control group that did not get treatment. We know that the natural recovery rate is high, and so any treatment must show that it is higher than that rate. But no-one knows the rate exactly, and you need to take care of statistical fluctuations. it is all much more complicated than simply counting.

>>> They say they got an effect for severity? It's not surprising that a theraputic program could teach children to back off the most severe behaviors. That's a nice theraputic effect in practice if you can't do anything else, but it's not what the early intervention people claim.

No, the severity effect relates to the fact that kids with more severe stuttering were LESS likely to recover fully.

And, even if severity goes down with all, you need to look at long-term change. Will these symptoms come back?

>> All in all, it's as I expected. It makes little sense to think you can teach your way out of a neurological condition. You may be able to manipulate it or mask it, but you can't make the brain re-grow itself.

Yes.

Tom Weidig said...

@Fabi: yes measuring stuttering severity is very tricky

@Eliot: yes, i agree severity reduction is certainly beneficial.

however, here the severity effect refers to the fact that kids with more severe stuttering recovered less often. also, you need to look at long-term effect. this severity might well come back in teenage life as the stuttering is still there.

AND, most importantly, they look at average severity, so it could be that many recovered and the other keep the same severity, but ON AVERAGE severity has gone down.

Umm said...

Hi all,

Why isn't there interest in stuttering medication any more. I'm trying Saphris now and want to share my results with everyone. See here: http://stutteringonsaphris.blogspot.com/

Jon said...

Tom

As I understand, the claim of the early interventionists is that if they get to a child early enough, before the condition has become chronic, they can prevent stuttering from becoming locked in. That is, they can 'cure' it. If that was true, and one of the other of these two therapies actually worked, then the effect should show up without a non-treatment control.

There's a saying in statistics - if you have a talking dog, you don't need statistics. If you have a cure for stuttering, you don't need to tease out 'percent of stuttered syllables.' Whatever the natural recovery rate is, it should be the same in both treatments, so a higher recovery rate in one treatment should stand out. If they can't actually stop childhood stuttering from becoming persistent, they should say so explicitly.

The 'severity effect' implies that there was a difference in severity between the two treatments - at least to me. I'll have to see the results to learn what is going on here.

I suspect that all you can really do with children is make sure you don't aggravate the condition with negative reinforcement. The whole 'parents speaking more slowly' thing sounds foolish to me.

My parents didn't speak fast, or use big words, or elaborate grammatical constructions - there were working class high school graduates, and they never responded to my stuttering in a negative way.

So there goes the premise of both systems - there were neither excessive demands, nor negative responses. Both look back to the Evil Prince of stuttering, Wendell Johnson, who was debunked decades ago. As so often happens, however, the followers keep highjacking the Old Man's ideas into their theories, keeping the corpse alive. We're dealing with a failure of neurological development, not a flawed parent-child interaction.

Robert Woolley said...

Hi Tom,

I, as you know don't agree that cures don't exist, I have one and it's 99.9% there.
However, what I would like elaboration on is your term Patient-Client Relationship. Are you referring to "buy in" to the message or something quite different? Can you point me to any literature if you have some. I'm quite interested in this idea.

Rob Woolley

Joel Korte said...

Hi Tom,

Did the results of this study ever get published?

Thanks!

Tom Weidig said...

Hopefully they will be presented at this year's ISA conference in the Netherlands.