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.