For pre-school children younger than six years who are stuttering, there are two therapy approaches that are supported by randomised clinical trials. These are the Lidcombe Program and RESTART-DCM. There is also research evidence for the Westmead Program, but that evidence comes from non-randomised clinical trials. The strongest research evidence is for the Lidcombe Program, which is used throughout Australia, and also internationally.
The Lidcombe Program is administered daily in the child's everyday environment by a parent (or carer), who also keeps a daily record of the severity of the child’s stuttering. During weekly visits to a speech pathologist, the parent learns how to implement the program. At these visits, the speech pathologist demonstrates various features of the program and observes the parent doing the therapy, giving constructive feedback and discussing changes needed for the following week. This parent training is essential so that parents do the treatment appropriately and safely, and make it a positive experience for the child and the family.
The Lidcombe Program is a direct approach, which means that the parent comments to the child directly about the child's speech. This parent feedback is positive and is given when the child talks without stuttering, with only occasional feedback given when the child stutters. When stuttering is at a low level, the frequency of clinic visits decreases. Research has established that the time taken to complete the treatment varies from child to child. It is common for children to take several months for stuttering to be controlled. However, it is important that signs of improvement with the child’s stuttering should occur shortly after treatment begins. More information about the Lidcombe Program can be found on the Lidcombe Program Trainers Consortium website.
RESTART-DCM is a different style of treatment to the Lidcombe Program. It is based on a method of understanding stuttering in young children, known as the Demands and Capacities Model. This model states that stuttering is associated with aspects of the family environment that place demands on the child’s speech. The treatment involves parents alleviating these demands. Some examples with RESTART-DCM treatment include parents making changes to the way they communicate with their children and changes to the general pace of family living. If it is thought necessary, children are given speech drills to train their speech movements. As with the Lidcombe Program, the treatment can require several months for stuttering to be controlled. For more information about RESTART-DCM, please see the RESTART-DCM handbook.
Recent research has shown that pre-schoolers can receive negative reactions from other children about their stuttering, which can lead to the subsequent development of social anxiety. It is now known that children who stutter as young as 7 years are at risk of feeling anxious about talking in social situations. Because of this recent research, the Australian Stuttering Research Centre now recommends that early intervention for stuttering should start as soon as the speech pathologist and parent agree that the child will be able to comply with treatment demands.
School-age children (6–12 years)
For school-age children who stutter, speaking can present many challenges. Anxiety about speech is commonly associated with stuttering at this age. It is important, then, that children in this age group who are stuttering receive treatment and support by a speech pathologist. Families of these children also need this support. There are many treatment options for school-age children who stutter, and a speech pathologist can determine which one is best for the individual needs of the child and family. The speech pathologist also typically works with the child’s school teacher to support the child in the classroom during this time.