Investigating optimal intervention intensity with the Lidcombe Program of early stuttering intervention

This paper addresses optimal intervention intensity in stuttering with reference to the Lidcombe Program of early stuttering intervention. This is an operant program in which the parent provides the actual treatment, for proscribed periods each day, in the child's everyday environment. The parent learns how to do this during weekly visits with the child to the speech-language pathologist. This program was chosen because it is supported by considerable research evidence. This evidence includes randomized controlled trials and file audits. Individual children vary in the time taken to reach the program criteria, with children with milder stuttering taking less time than children whose stuttering is more severe. Hence, the dose depends largely on stuttering severity. Other service delivery models for the Lidcombe Program have been investigated, including telehealth (distance delivery) and group delivery. While telehealth delivery was as efficacious as face-to-face delivery, 3-times more clinician hours were needed to achieve this. Group delivery of the program was also as efficacious as face-to-face delivery but required 30% less clinician time. The fact that treatment is delivered by parents but is directed by the speech-language pathologist raises interesting issues about what constitutes dose.