Treatment for your child's stuttering without clinic visits

The Lidcombe Program is an effective, evidence-based parent-administered treatment for children who stutter. Stage 1 of the standard treatment requires a parent (or other caregiver) and the child who stutters to come into the clinic every week to see the speech pathologist. This is no issue for many families. But, for some, visiting a speech pathologist weekly is not easy:

Some of us – particularly those living outside cities – don’t live anywhere near a speech pathologist.
Others are let down by a lack of public or other transport options.
For parents with several young kids, just getting everyone fed, dressed and out of the house is a multi-hour chore.
For parents and clients with physical disabilities or mental illnesses (e.g. social anxiety), coming into a speech pathology clinic poses additional obstacles that can be hard to surmount weekly.

For these families – and others who have problems making it to the clinic every week – online telehealth therapy may be an option.

In June 2014, researchers at the Australian Stuttering Research Centre (ASRC) at Sydney University published the results of a small (Phase I) clinical trial. Three pre-school children who stuttered were treated with the Lidcombe Program, with the standard weekly clinic visits replaced by webcam sessions with the speech pathologist. All three children improved, with stuttering severity below 1% syllables stuttered 6 months after completion of the first stage of the treatment.

Even with the odd technical glitch with the (unnamed) webcam software, parents reported several benefits of webcam-consultations:

time and costs saved in not having to travel;
home being a more relaxed and non-threatening environment than the clinic;
no disruptions to siblings’ routines;
the speech pathologist could see the real environment in which the parent worked with their child;
trialing and practising the therapy using their own equipment; and
ability to discuss sensitive issues while the child was in another room.

Despite its positive outcomes, it took an average of 34 webcam consultations (range 26-39) for the children to complete Stage 1 of the treatment – which is around double the benchmark mean of 18 visits for children treated in the clinic (see Rousseau et al, 2007). This result sits logically with older studies showing that telephone delivery of the Lidcombe Program was also less efficient than clinic-based delivery (e.g. Lewis et al., 2008). Interestingly, webcam-delivery was almost 50% more efficient than phone delivery in the 2008 study, suggesting benefits in face-to-face interaction (albeit via webcam).

The positive results of the study justify a much bigger clinical trial with randomised controls, multiple objective outcome measures, blind assessors, and other measures designed to reduce the risk of bias. Webcam delivery has the potential to overcome many barriers we currently face delivering stuttering and other speech therapies to clients and their families, and we will follow the ASRC’s work with interest in the years to come.

Bottom Line

For time and cost reasons, we recommend families come in for clinic-based treatment consultations wherever practical. However, for those families who have limited access to treatment because of distance, transport, family factors or other obstacles, this study suggests that webcam delivery is a potentially safe, effective, viable and practical alternative.

Principal source: O’Brian, S., Smith, K., Onslow, M. (2014). Webcam Delivery of the Lidcombe Program for Early Stuttering: A Phase I Clinical Trial. Journal of Speech, Language, and Hearing Research, 57, 825-830.

Image: http://tinyurl.com/l3ga2sa

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.