In prior blog posts, I have talked about the information that I consider when recommending a young child who stutters for treatment. This time, I will begin the discussion of how I select which approach I would use for a child whose need for therapy has already been confirmed.
Many clinicians have fallen into the habit of making blanket recommendations for one approach or another—in part because of their personal preferences and in part because of an apparent believe that a particular approach has a better evidence base than other approaches.
Certainly, the evidence in support of a specific therapy approach is a key factor that should be considered when selecting a therapy approach. Based on the tenets of evidence-based practice, however, this is not the only factor that matters: EBP requires clinicians to consider the literature in addition to their own expertise and skills and the individual needs and preferences of the client, in this case the parent and the child.
Even a cursory review of the available treatment evidence for early childhood stuttering therapy reveals that there is one approach—the Lidcombe program—that enjoys the support of numerous research studies. Numerous reports have shown that many (though not all) children receiving Lidcombe program recover from stuttering, and it appears that the recovery rates with treatment beat the estimated recovery rates for natural recovery (that is, waiting to see if the child recovers without treatment). For this reason, many people hold Lidcombe up as the primary (or only) evidence-based approach.
This is not actually the case, however. Other approaches, including the RESTART DCM therapy, the Palin PCI therapy, and the "comprehensive" therapy that I use all have some degree of support—not the same amount of research as can be found in support of the Lidcombe program, but there is at least some preliminary evidence in favor of these and others approaches to therapy.
Interestingly, the available research suggests that the success rates for all of these various therapies are roughly equivalent. Although more work must be done on the question, it appears that children are more likely to recover from stuttering regardless of which of the major therapy approaches is selected. Nearly all—though not all—young children who stutter ultimately recover, either on their own or through the use of one of these common therapy approaches.
What this means is that we have options when it comes to selecting therapy for early childhood stuttering. I personally think that this is terrific, because each specific therapy approaches are likely to be more appropriate for some children and their families and less appropriate for other children and their families.
Our job as clinicians, then, is not to adhere to or advocate for a particular therapy approach but rather to draw upon the available literature to develop individualized therapy approaches for each child and family. That way, we can fulfil the promise of evidence-based practice and provide effective, evidence-based, individualized therapy that meets each client’s unique needs.
In a future post, I’ll talk about the child or family characteristics that help me match a particular therapy to a particular child.
