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Clinical Question: Is the Lidcombe program for decreasing stuttering effective for preschool children?

Setting: Outpatient (specialty)

Study Design: Randomized controlled trial (single-blinded)

Allocation: Concealed

Synopsis: Stuttering, which occurs in approximately one out of 20 children, disappears without intervention in 74 percent of instances. For children who continue to stutter, the current strategy is preschool intervention because stuttering is more difficult to correct as children get older. The Lidcombe program is a method in which parents provide specific feedback to their stuttering children to correct the behavior (for a description seehttp://www.fhs.usyd.edu.au/ASRC).

This study enrolled 54 three- to six-year-old children with stuttering in New Zealand; 47 completed the nine-month study. The children were randomized, using concealed allocation, to receive treatment by the Lidcombe program or to receive no treatment, with the promise to enroll them into the Lidcombe program if it proved successful. The use of a no treatment group rather than an active treatment group raised the possibility that any benefit could be caused by increased attention from the parents and not by the study treatment.

Parents and children in the active treatment group met with a speech pathologist weekly for evaluation. Every day, for a prescribed period, parents were asked to give specific feedback to their children on their speech. For example, stutter-free speech was acknowledged (“That was smooth”) or praised (“That was good talking”) stuttering also was acknowledged (“That was a bit bumpy”), and self-correction was encouraged (“Can you say that again?”). Treatment was withdrawn as the percentage of stutter-free speech increased.

Speech samples collected at nine months were noticeably different between the treatment and control groups. The percent of syllables stuttered decreased from 6.5 to 1.5 percent in the treated children compared with a 6.8 to 3.9 percent decline in the control group (2.3 percentage point difference; 95% confidence interval (CI), 0.8 to 3.9; P = .003). Significantly more children in the treated group decreased to a stuttering rate of less than 1 percent of syllables compared with the children in the control group (number needed to treat = 2.3; 95% CI, 1.4 to 14.5). [ corrected]

Bottom Line: The Lidcombe program, a speech pathologist–directed, parent-administered method of providing feedback to children who stutter, markedly decreases stuttering, with one half of patients becoming stutter-free at the end of the nine-month trial. Physicians can refer patients who stutter to a speech pathologist who can implement this simple program. (Level of Evidence: 1b)

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

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This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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