Developing a Stand-alone Internet Version of the Lidcombe Program for Early Stuttering

Abstract

The Lidcombe Program is an evidence-based program and is the preferred intervention option in Australia to treat preschool age children who stutter. Speech pathologists help parents to implement the program at home by training them during regular visits at the clinic. Parents learn how to identify stuttering, rate stuttering severity and provide verbal contingencies during conversations. However, the Lidcombe Program is not accessible to all families that need it. Known obstacles that hinder access to the Lidcombe Program, delivered according to the Lidcombe Program Treatment Guides (Onslow, Packman & Harrison, 2003; Packman et al., 2014), are work or time restrictions of speech pathologists due to heavy caseload, and distance for families who live remotely (Rousseau, Packman, Onslow, Dredge & Harrison, 2002; Wilson, Lincoln & Onslow, 2002). The construction of a stand-alone Internet-based intervention, that is, an intervention that does not require the physical involvement of a speech pathologist when delivered, has the potential to overcome these obstacles. This thesis presents the construction and trialling of the first part of an Internet version of the Lidcombe Program, and the construction of a problem-solving tool for parents who do the program. The thesis is presented in six sections. Section I provides an overview of early stuttering, including its onset, cause and course. Potential impacts on social development and intervention for different age groups are discussed and an overview of treatment options for preschool age children is given. Subsequently the Lidcombe Program is introduced, as well as evidence that supports it. Different delivery formats of the Lidcombe Program are explained and insight in how the Lidcombe Program translates into everyday practice is provided. Section II explores theoretical issues that may need to be taken into consideration when developing the Internet Lidcombe Program. First, an overview of telehealth interventions in speech pathology is given, which results in understanding some practical issues related to its application. Aspects of other Internet-based health interventions are then discussed, to identify potential issues for the development of the Internet Lidcombe Program. The literature on adult learning and Internet-based learning is then reviewed, because the Lidcombe Program is directed towards parents of preschool age children who stutter and therefore it is essential to understand how they learn. Next, the design of the Internet Lidcombe Program is explained, including the necessary adaptations of the clinic-based Lidcombe Program components. It becomes clear that the Internet Lidcombe Program needs to be separated into two parts. Part 1 consists of a Parent Training (hereafter called Internet Parent Training), in which parents are introduced to the Lidcombe Program components, and Part 2 consists of Treatment (hereafter called Internet Treatment), in which parents start treating their child. Section III identifies the need for problem-solving support throughout the Internet Lidcombe Program and describes the qualitative problem-solving study conducted to (1) identify treatment problems that can emerge during the course of the Lidcombe Program and (2) develop potential solutions to solve them. This study was conducted in two parts. In Part I of the study, template analysis was applied to identify the treatment problems. Template analysis is based on the construction of a template through an iterative process of collecting and analysing data. Data were collected using various sources, including a brainstorming meeting, Lidcombe Program publications, reports of participants at different sites and in-depth interviews with expert speech pathologists. Part II of the study provided solutions through interviews with seven speech pathologists experienced with the Lidcombe Program. A summary structured around the main themes is given in this thesis. The findings of this study are reported in a qualitative description, organised in the template. They support the development of the Internet Lidcombe Program and the construction of a problem-solving tool for the program. Section IV illustrates how the findings of the problem-solving study are incorporated and how the identified theoretical issues related to Internet-based health interventions and adult education are addressed in the Internet Parent Training. Section V reports the feasibility study of the Internet Parent Training. Six parents of preschool age children who were about to commence the Lidcombe Program in a clinic completed the Internet Parent Training. Outcome measures were participants’ knowledge, skills, experiences and usage data, and the reports of participants and treating speech pathologists about starting the clinic-based Lidcombe Program after completing the Internet Parent Training. Results indicated that the Internet Parent Training could be optimised with a few small modifications, but overall it seemed to provide the training in stuttering and Lidcombe Program components for which it was constructed. Section VI discusses the implications of the problem-solving study and the feasibility study of the Internet Parent Training, and explores the future directions of the Internet Lidcombe Program.