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To see or not to see

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  • M B
    Hello everyone. Would you see this child or monitor? 5, girl, dad has very mild stutter (successful word changer). Her stuttering first started when she was 3,
    Message 1 of 16 , Mar 4, 2005
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      Hello everyone. Would you see this child or monitor?

      5, girl, dad has very mild stutter (successful word
      changer). Her stuttering first started when she was 3,
      recovered, then worse at 4, then recovered, much worse
      last fall (avoidances, anxiety, frequent blocks,
      hiding mouth, etc.), but recovered nicely. Parents
      carried out communication environment changes at the
      time of this recovery and we're all wondering if this
      could have been so successful so quickly.

      Today, minimal stuttering observed (1.8 %SS) on video
      of home sample. SR=2. Some micro stutters and one
      unambiguous part word rep with struggle.

      I don't know whether to see them for treatment or not.
      The parents are inclined to wait and see if she
      becomes more disfluent, but I have time in my schedule
      now and might not later. Can I (or should I) do the
      Lidcombe program is there isn't any significant
      stuttering?

      Does anyone have an opinion on the issue?

      Regards,
      Michael

      ______________________________________________________________________
      Post your free ad now! http://personals.yahoo.ca
    • Michael Susca
      Michael, I generaly do not like to respond to these types of emails because they request an opinion, and opinions are too often interpreted as dogma. So
      Message 2 of 16 , Mar 5, 2005
      • 0 Attachment
        Michael,

        I generaly do not like to respond to these types of emails because they
        request an opinion, and opinions are too often interpreted as dogma. So
        please consider my response as only one person's opinion (of many, I
        hope) to add to your decision matrix.

        In brief: definitely enroll this kid in the Lidcomb program. My
        rationales:
        1) the time since initial onset: it's too long.
        2) The total absence of stuttering implied: even though it is
        epsiodic, you are not implying it has ever completely cleared (I am
        suspecting your "recovered" is "speaking at acceptably fluent
        levels--not necessarily stutter-free".)
        3) Family History of stuttering: DAD is still a stutterer:
        internalized/"closet" stutterer who is using unhelpful strategies to
        aid his communication (TREAT HIM!)
        4) Your observation of the use of congnitive (avoidances) and
        physical (hiding mouth) secondaries the child has used in the past...a
        simpler pattern of dad's being a "successful word changer"---that's not
        necessarily good modeling.
        5) Your suspiciion that enviornmental changes have positively
        influenced the fluency....that's what Lidcombe is all about!

        IMHO, you may be observing the "submersion" of the observable stuttering
        with this kid's experience of stuttering: a behavioral response perhaps
        modeled inadvertently by dad. If there is parental or child
        concerns/distresses about the speech fluency, DEFINITELY treat.

        Finally, Lidcomb is a preventative/corrective program (IMHO) that is
        clearly designed to "treat" kids like you describe.

        But take my comments as just one data point in making your decision. To
        me, it's a "no brainer".

        FWIW,

        Michael Susca (not be be confused with whoever you are)


        Michael Susca, Ph.D., C.C.C., BRS-FD
        Speech and Hearing Center
        University of the Pacific
        3601 Pacific Ave.
        Stockton, California 95211
        email: msusca@...
        Office: (209) 946-3232
        Fax: (209) 946-2647

        E-Mail Confidentiality Notice: Any private health information that
        may be contained in this e-mail is privileged and confidential under
        the Health Insurance Portability and Accountability Act (HIPPA) and
        is intended only for the use of the addressee(s) indicated above.
        Unauthorized use, disclosure, distribution, or copying of information
        e-mailed in error is expressly prohibited. If you have received this
        e-mail in error, please contact the sender and immediately delete the
        original message. Thank you.


        >>> mjbstudent02@... 03/04/05 14:45 PM >>>

        Hello everyone. Would you see this child or monitor?

        5, girl, dad has very mild stutter (successful word
        changer). Her stuttering first started when she was 3,
        recovered, then worse at 4, then recovered, much worse
        last fall (avoidances, anxiety, frequent blocks,
        hiding mouth, etc.), but recovered nicely. Parents
        carried out communication environment changes at the
        time of this recovery and we're all wondering if this
        could have been so successful so quickly.

        Today, minimal stuttering observed (1.8 %SS) on video
        of home sample. SR=2. Some micro stutters and one
        unambiguous part word rep with struggle.

        I don't know whether to see them for treatment or not.
        The parents are inclined to wait and see if she
        becomes more disfluent, but I have time in my schedule
        now and might not later. Can I (or should I) do the
        Lidcombe program is there isn't any significant
        stuttering?

        Does anyone have an opinion on the issue?

        Regards,
        Michael

        ______________________________________________________________________
        Post your free ad now! http://personals.yahoo.ca




        Yahoo! Groups Links
      • Mark Onslow
        Michael, Based on what information is available to me, in my view the only thing to do is to administer the Lidcombe Program. This girl needs an evidence based
        Message 3 of 16 , Mar 6, 2005
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          Michael,

          Based on what information is available to me, in my view the only
          thing to do is to administer the Lidcombe Program. This girl needs an
          evidence based treatment immediately, if only because there are few
          degrees of freedom of speech motor development (neurological
          "plasticity") available now to get her stutter-free before the school
          years. A possible-even probable-outcome of monitoring would be that
          you would observe another worsening of the stuttering. And the last
          thing you want is a child older than the preschool years in treatment.

          Data show that the outcome is going to be less than satisfactory if
          she gets much older unless you are really lucky. Data also show that
          there is some (unknown) chance she may recover naturally. But this is
          no time for a game of chance, considering the known effects of
          chronic stuttering during a lifetime, which is what the debt will be
          if you lose a gamble.

          For me, important information would be whether the parent/s thought
          that the stuttering you observed was what they had reported as
          "recovered" in the past. Quite possibly, this is not a case of
          recovery and relapse to stuttering, but a case of chronic childhood
          stuttering of an episodic nature.

          The case history of the father stuttering, incidentally, is not a
          consideration for me, incidentally.

          Regards,

          Mark.
          ______________________________________________________________________

          Professor Mark Onslow
          Principal Research Fellow
          National Health and Medical Research Council

          Director, Australian Stuttering Research Centre
          The University of Sydney

          PO Box 170 Lidcombe NSW 1825 Australia
          Phone: (Direct) 61-2-9351-9767 (Assistant) 61-2-9351-9061 Fax: 61-2-9351-9392

          http://www.fhs.usyd.edu.au/asrc
          _____________________________________________________________________

          >Hello everyone. Would you see this child or monitor?
          >
          >5, girl, dad has very mild stutter (successful word
          >changer). Her stuttering first started when she was 3,
          >recovered, then worse at 4, then recovered, much worse
          >last fall (avoidances, anxiety, frequent blocks,
          >hiding mouth, etc.), but recovered nicely. Parents
          >carried out communication environment changes at the
          >time of this recovery and we're all wondering if this
          >could have been so successful so quickly.
          >
          >Today, minimal stuttering observed (1.8 %SS) on video
          >of home sample. SR=2. Some micro stutters and one
          >unambiguous part word rep with struggle.
          >
          >I don't know whether to see them for treatment or not.
          >The parents are inclined to wait and see if she
          >becomes more disfluent, but I have time in my schedule
          >now and might not later. Can I (or should I) do the
          >Lidcombe program is there isn't any significant
          >stuttering?
          >
          >Does anyone have an opinion on the issue?
          >
          >Regards,
          >Michael
          >
          >______________________________________________________________________
          >Post your free ad now! http://personals.yahoo.ca
          >
          >
          >
          >
          >Yahoo! Groups Links
          >
          >
          >
          >


          --
        • Mark Onslow
          Hi Michael S, From my previous response to this issue, you can see that I am in broad agreement with you, based on the case history made available. I differ
          Message 4 of 16 , Mar 6, 2005
          • 0 Attachment
            Re: [LidcombeUSA] To see or not to see
            Hi Michael S,

            From my previous response to this issue, you can see that I am in broad agreement with you, based on the case history made available. I differ from your viewpoint, as I wrote in my message to Michael, about the pertinence of the father's stuttering and what model it may be providing for the child. Granted, the clinical issues for the father are likely to be more than behavioural. However, current evidence suggests that all that is needed to contemplate a child's plight at this age is a behavioural perspective. That is why it is useful that the Lidcombe Program is a behaviour therapy and that it has an evidence base. (A randomised controlled trial is in review at present, incidentally). Without exception, it appears that all non-behavioural correlates of stuttering just go when the stuttering goes, and no psychological ill effects remain after treatment. In fact, my interpretation of the literature on this point suggest the child improves on psychological measures post treatment.

            To dwell on a pedantic point, as we academics are prone to do, you state that

            Your suspicion that environmental changes have positively influenced the fluency....that's what Lidcombe is all about

            could be misconstrued to indicate that the Lidcombe Program is in the category of treatments that rely on multifactorial modelling of the onset and development of stuttering to derive a treatment method. This, of course, is not so. In fact, as my colleagues and I have argued elsewhere, the evidence in favour of the Lidcombe Program is a direct challenge to the veracity of multifactorial models of stuttering. It is true that the child's environment changes in the Lidcombe Program, but only to the extent that contingencies for stutter-free speech, unambiguous stutttering, and  correct self evaluation of stutter-free speech, are put in the environment. Those changes are not put in the environment in the interests of obviating the cause of stuttering, only in the interests of introducing contingencies known to ameliorate stuttering.

            An even more pedantic point, if I may,  concerns your statement that the LP is a preventative/corrective program. Technically, it cannot be a preventative program because you need stuttering to have begun for it to be implemented.

            Incidentally, what does IMHO stand for?

            Regards,

            Mark

            Michael,

            I generaly do not like to respond to these types of emails because they
            request an opinion, and opinions are too often interpreted as dogma.  So
            please consider my response as only one person's opinion (of many, I
            hope) to add to your decision matrix.  

            In brief: definitely enroll this kid in the Lidcomb program.  My
            rationales:
               1)  the time since initial onset:  it's too long. 
               2)  The total absence of stuttering implied: even though it is
            epsiodic, you are not implying it has ever completely cleared (I am
            suspecting your "recovered" is "speaking at acceptably fluent
            levels--not necessarily stutter-free".)
                3)  Family History of stuttering: DAD is still a stutterer:
            internalized/"closet" stutterer  who is using unhelpful strategies to
            aid his communication (TREAT HIM!)
               4) Your observation of the use of congnitive (avoidances) and
            physical (hiding mouth) secondaries the child has used in the past...a
            simpler pattern of dad's being a "successful word changer"---that's not
            necessarily good modeling.
                5) Your suspiciion that enviornmental changes have positively
            influenced the fluency....that's what Lidcombe is all about!

            IMHO, you may be observing the "submersion" of the observable stuttering
            with this kid's experience of stuttering: a behavioral response perhaps
            modeled inadvertently by dad.  If there is parental or child
            concerns/distresses about the speech fluency, DEFINITELY treat. 
            Finally, Lidcomb is a preventative/corrective program (IMHO) that is
            clearly designed to "treat" kids like you describe. 

            But take my comments as just one data point in making your decision.  To
            me, it's a "no brainer".

            FWIW,

            Michael Susca (not be be confused with whoever you are)


            Michael Susca, Ph.D., C.C.C., BRS-FD
            Speech and Hearing Center
            University of the Pacific
            3601 Pacific Ave.
            Stockton, California 95211
            email: msusca@...
            Office: (209) 946-3232
            Fax: (209) 946-2647

            E-Mail Confidentiality Notice: Any private health information that
            may be contained in this e-mail is privileged and confidential under
            the Health Insurance Portability and Accountability Act (HIPPA) and
            is intended only for the use of the addressee(s) indicated above.
            Unauthorized use, disclosure, distribution, or copying of information
            e-mailed in error is expressly prohibited. If you have received this
            e-mail in error, please contact the sender and immediately delete the
            original message. Thank you.


            >>> mjbstudent02@... 03/04/05 14:45 PM >>>

            Hello everyone. Would you see this child or monitor?

            5, girl, dad has very mild stutter (successful word
            changer). Her stuttering first started when she was 3,
            recovered, then worse at 4, then recovered, much worse
            last fall (avoidances, anxiety, frequent blocks,
            hiding mouth, etc.), but recovered nicely. Parents
            carried out communication environment changes at the
            time of this recovery and we're all wondering if this
            could have been so successful so quickly.

            Today, minimal stuttering observed (1.8 %SS) on video
            of home sample. SR=2. Some micro stutters and one
            unambiguous part word rep with struggle.

            I don't know whether to see them for treatment or not.
            The parents are inclined to wait and see if she
            becomes more disfluent, but I have time in my schedule
            now and might not later. Can I (or should I) do the
            Lidcombe program is there isn't any significant
            stuttering?

            Does anyone have an opinion on the issue?

            Regards,
            Michael

            ______________________________________________________________________
            Post your free ad now! http://personals.yahoo.ca



             
            Yahoo! Groups Links



             






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            -- 
            
            ______________________________________________________________________

            Professor Mark Onslow
            Principal Research Fellow
            National Health and Medical Research Council

            Director, Australian Stuttering Research Centre
            The University of Sydney

            PO Box 170 Lidcombe NSW 1825 Australia
            Phone: (Direct) 61-2-9351-9767 (Assistant) 61-2-9351-9061  Fax: 61-2-9351-9392

            http://www.fhs.usyd.edu.au/asrc
            _____________________________________________________________________
          • Michael Susca
            Hello Mark, IMHO= in my humble opinion. And yes, the father s stutteing in and of itself is not sufficient to be a contributor to the child s stuttering. But
            Message 5 of 16 , Mar 6, 2005
            • 0 Attachment
              Hello Mark,

              IMHO= in my humble opinion.

              And yes, the father's stutteing in and of itself is not sufficient to be
              a contributor to the child's stuttering. But my concern was that the
              child may be learning accessory behaviors/strategies to cope with the
              stuttering as opposed to managing what she's doing in the process of
              stutter-free speaking. That was my major concern regarding the child's
              perceptions of how dad deals with the stuttering. Assuming, of course,
              children learn from their parents.

              In NO WAY did I mean to imply or construe that the Lidcombe Program had
              anything to do with multifactorial models---I know better than that!
              Although you do purport that the program is "atheoretical", it does seem
              to be influenced a bit by learning theory.

              Finally, I understand what you mean by the preventative statement and I
              stand corrected. But some time when we share a conference again let's
              discuss those kids who are episodic, have factors or conditions that
              bode to the likelihood of developing stuttering, but are fluent when you
              see them: but treat to give the parents tools to
              inhibit/eliminate/respond to the stuttering episodes when they do occur.
              I think Lidcombe is helpful in this context and thus might "prevent"
              stuttering from becoming a life issue. (yeah, I know, how do you prove
              something that hasn't happened is going to...)

              FWIW (for what it's worth),
              Thanks for your note.

              Mike

              Michael Susca, Ph.D., C.C.C., BRS-FD
              Speech and Hearing Center
              University of the Pacific
              3601 Pacific Ave.
              Stockton, California 95211
              email: msusca@...
              Office: (209) 946-3232
              Fax: (209) 946-2647

              E-Mail Confidentiality Notice: Any private health information that
              may be contained in this e-mail is privileged and confidential under
              the Health Insurance Portability and Accountability Act (HIPPA) and
              is intended only for the use of the addressee(s) indicated above.
              Unauthorized use, disclosure, distribution, or copying of information
              e-mailed in error is expressly prohibited. If you have received this
              e-mail in error, please contact the sender and immediately delete the
              original message. Thank you.


              >>> M.Onslow@... 03/06/05 15:43 PM >>>
              Hi Michael S,

              From my previous response to this issue, you can see that I am in
              broad agreement with you, based on the case history made available. I
              differ from your viewpoint, as I wrote in my message to Michael,
              about the pertinence of the father's stuttering and what model it may
              be providing for the child. Granted, the clinical issues for the
              father are likely to be more than behavioural. However, current
              evidence suggests that all that is needed to contemplate a child's
              plight at this age is a behavioural perspective. That is why it is
              useful that the Lidcombe Program is a behaviour therapy and that it
              has an evidence base. (A randomised controlled trial is in review at
              present, incidentally). Without exception, it appears that all
              non-behavioural correlates of stuttering just go when the stuttering
              goes, and no psychological ill effects remain after treatment. In
              fact, my interpretation of the literature on this point suggest the
              child improves on psychological measures post treatment.

              To dwell on a pedantic point, as we academics are prone to do, you state
              that

              Your suspicion that environmental changes have positively influenced
              the fluency....that's what Lidcombe is all about

              could be misconstrued to indicate that the Lidcombe Program is in the
              category of treatments that rely on multifactorial modelling of the
              onset and development of stuttering to derive a treatment method.
              This, of course, is not so. In fact, as my colleagues and I have
              argued elsewhere, the evidence in favour of the Lidcombe Program is a
              direct challenge to the veracity of multifactorial models of
              stuttering. It is true that the child's environment changes in the
              Lidcombe Program, but only to the extent that contingencies for
              stutter-free speech, unambiguous stutttering, and correct self
              evaluation of stutter-free speech, are put in the environment. Those
              changes are not put in the environment in the interests of obviating
              the cause of stuttering, only in the interests of introducing
              contingencies known to ameliorate stuttering.

              An even more pedantic point, if I may, concerns your statement that
              the LP is a preventative/corrective program. Technically, it cannot
              be a preventative program because you need stuttering to have begun
              for it to be implemented.

              Incidentally, what does IMHO stand for?

              Regards,

              Mark

              >Michael,
              >
              >I generaly do not like to respond to these types of emails because they
              >request an opinion, and opinions are too often interpreted as dogma.
              So
              >please consider my response as only one person's opinion (of many, I
              >hope) to add to your decision matrix.
              >
              >In brief: definitely enroll this kid in the Lidcomb program. My
              >rationales:
              > 1) the time since initial onset: it's too long.
              > 2) The total absence of stuttering implied: even though it is
              >epsiodic, you are not implying it has ever completely cleared (I am
              >suspecting your "recovered" is "speaking at acceptably fluent
              >levels--not necessarily stutter-free".)
              > 3) Family History of stuttering: DAD is still a stutterer:
              >internalized/"closet" stutterer who is using unhelpful strategies to
              >aid his communication (TREAT HIM!)
              > 4) Your observation of the use of congnitive (avoidances) and
              >physical (hiding mouth) secondaries the child has used in the past...a
              >simpler pattern of dad's being a "successful word changer"---that's not
              >necessarily good modeling.
              > 5) Your suspiciion that enviornmental changes have positively
              >influenced the fluency....that's what Lidcombe is all about!
              >
              >IMHO, you may be observing the "submersion" of the observable
              stuttering
              >with this kid's experience of stuttering: a behavioral response perhaps
              >modeled inadvertently by dad. If there is parental or child
              >concerns/distresses about the speech fluency, DEFINITELY treat.
              >
              >Finally, Lidcomb is a preventative/corrective program (IMHO) that is
              >clearly designed to "treat" kids like you describe.
              >
              >But take my comments as just one data point in making your decision.
              To
              >me, it's a "no brainer".
              >
              >FWIW,
              >
              >Michael Susca (not be be confused with whoever you are)
              >
              >
              >Michael Susca, Ph.D., C.C.C., BRS-FD
              >Speech and Hearing Center
              >University of the Pacific
              >3601 Pacific Ave.
              >Stockton, California 95211
              >email: msusca@...
              >Office: (209) 946-3232
              >Fax: (209) 946-2647
              >
              >E-Mail Confidentiality Notice: Any private health information that
              >may be contained in this e-mail is privileged and confidential under
              >the Health Insurance Portability and Accountability Act (HIPPA) and
              >is intended only for the use of the addressee(s) indicated above.
              >Unauthorized use, disclosure, distribution, or copying of information
              >e-mailed in error is expressly prohibited. If you have received this
              >e-mail in error, please contact the sender and immediately delete the
              >original message. Thank you.
              >
              >
              >>>> mjbstudent02@... 03/04/05 14:45 PM >>>
              >
              >Hello everyone. Would you see this child or monitor?
              >
              >5, girl, dad has very mild stutter (successful word
              >changer). Her stuttering first started when she was 3,
              >recovered, then worse at 4, then recovered, much worse
              >last fall (avoidances, anxiety, frequent blocks,
              >hiding mouth, etc.), but recovered nicely. Parents
              >carried out communication environment changes at the
              >time of this recovery and we're all wondering if this
              >could have been so successful so quickly.
              >
              >Today, minimal stuttering observed (1.8 %SS) on video
              >of home sample. SR=2. Some micro stutters and one
              >unambiguous part word rep with struggle.
              >
              >I don't know whether to see them for treatment or not.
              >The parents are inclined to wait and see if she
              >becomes more disfluent, but I have time in my schedule
              >now and might not later. Can I (or should I) do the
              >Lidcombe program is there isn't any significant
              >stuttering?
              >
              >Does anyone have an opinion on the issue?
              >
              >Regards,
              >Michael
              >
              >______________________________________________________________________
              >Post your free ad now! http://personals.yahoo.ca
              >
              >
              >
              >
              >Yahoo! Groups Links
              >
              >
              >
              >
              >
              >
              >
              >
              >
              >
              >
              >
              >Yahoo! Groups Links
              >
              >
              >
              >


              --
              ______________________________________________________________________

              Professor Mark Onslow
              Principal Research Fellow
              National Health and Medical Research Council

              Director, Australian Stuttering Research Centre
              The University of Sydney

              PO Box 170 Lidcombe NSW 1825 Australia
              Phone: (Direct) 61-2-9351-9767 (Assistant) 61-2-9351-9061 Fax:
              61-2-9351-9392

              http://www.fhs.usyd.edu.au/asrc
              _____________________________________________________________________
            • Mark Onslow
              Michael, I never would have guessed what IMHO meant! I guessed, of course, that any connection in what you wrote between the LP and MF models would have been
              Message 6 of 16 , Mar 6, 2005
              • 0 Attachment
                Michael,

                I never would have guessed what IMHO meant! I guessed, of course,
                that any connection in what you wrote between the LP and MF models
                would have been an accidental implication rather than what you
                intended. But I wanted to be absolutely clear for the benefit of
                others in the group.

                I have been invited to give a paper at ASHA this year, and I may be
                able to accept the invitation, so we may get to have that chat.

                Regards,

                Mark.
                ______________________________________________________________________

                Professor Mark Onslow
                Principal Research Fellow
                National Health and Medical Research Council

                Director, Australian Stuttering Research Centre
                The University of Sydney

                PO Box 170 Lidcombe NSW 1825 Australia
                Phone: (Direct) 61-2-9351-9767 (Assistant) 61-2-9351-9061 Fax: 61-2-9351-9392

                http://www.fhs.usyd.edu.au/asrc
                _____________________________________________________________________



                >Hello Mark,
                >
                >IMHO= in my humble opinion.
                >
                >And yes, the father's stutteing in and of itself is not sufficient to be
                >a contributor to the child's stuttering. But my concern was that the
                >child may be learning accessory behaviors/strategies to cope with the
                >stuttering as opposed to managing what she's doing in the process of
                >stutter-free speaking. That was my major concern regarding the child's
                >perceptions of how dad deals with the stuttering. Assuming, of course,
                >children learn from their parents.
                >
                >In NO WAY did I mean to imply or construe that the Lidcombe Program had
                >anything to do with multifactorial models---I know better than that!
                >Although you do purport that the program is "atheoretical", it does seem
                >to be influenced a bit by learning theory.
                >
                >Finally, I understand what you mean by the preventative statement and I
                >stand corrected. But some time when we share a conference again let's
                >discuss those kids who are episodic, have factors or conditions that
                >bode to the likelihood of developing stuttering, but are fluent when you
                >see them: but treat to give the parents tools to
                >inhibit/eliminate/respond to the stuttering episodes when they do occur.
                >I think Lidcombe is helpful in this context and thus might "prevent"
                >stuttering from becoming a life issue. (yeah, I know, how do you prove
                >something that hasn't happened is going to...)
                >
                >FWIW (for what it's worth),
                >Thanks for your note.
                >
                >Mike
                >
                >Michael Susca, Ph.D., C.C.C., BRS-FD
                >Speech and Hearing Center
                >University of the Pacific
                >3601 Pacific Ave.
                >Stockton, California 95211
                >email: msusca@...
                >Office: (209) 946-3232
                >Fax: (209) 946-2647
                >
                >E-Mail Confidentiality Notice: Any private health information that
                >may be contained in this e-mail is privileged and confidential under
                >the Health Insurance Portability and Accountability Act (HIPPA) and
                >is intended only for the use of the addressee(s) indicated above.
                >Unauthorized use, disclosure, distribution, or copying of information
                >e-mailed in error is expressly prohibited. If you have received this
                >e-mail in error, please contact the sender and immediately delete the
                >original message. Thank you.
                >
                >
                >>>> M.Onslow@... 03/06/05 15:43 PM >>>
                >Hi Michael S,
                >
                > From my previous response to this issue, you can see that I am in
                >broad agreement with you, based on the case history made available. I
                >differ from your viewpoint, as I wrote in my message to Michael,
                >about the pertinence of the father's stuttering and what model it may
                >be providing for the child. Granted, the clinical issues for the
                >father are likely to be more than behavioural. However, current
                >evidence suggests that all that is needed to contemplate a child's
                >plight at this age is a behavioural perspective. That is why it is
                >useful that the Lidcombe Program is a behaviour therapy and that it
                >has an evidence base. (A randomised controlled trial is in review at
                >present, incidentally). Without exception, it appears that all
                >non-behavioural correlates of stuttering just go when the stuttering
                >goes, and no psychological ill effects remain after treatment. In
                >fact, my interpretation of the literature on this point suggest the
                >child improves on psychological measures post treatment.
                >
                >To dwell on a pedantic point, as we academics are prone to do, you state
                >that
                >
                >Your suspicion that environmental changes have positively influenced
                >the fluency....that's what Lidcombe is all about
                >
                >could be misconstrued to indicate that the Lidcombe Program is in the
                >category of treatments that rely on multifactorial modelling of the
                >onset and development of stuttering to derive a treatment method.
                >This, of course, is not so. In fact, as my colleagues and I have
                >argued elsewhere, the evidence in favour of the Lidcombe Program is a
                >direct challenge to the veracity of multifactorial models of
                >stuttering. It is true that the child's environment changes in the
                >Lidcombe Program, but only to the extent that contingencies for
                >stutter-free speech, unambiguous stutttering, and correct self
                >evaluation of stutter-free speech, are put in the environment. Those
                >changes are not put in the environment in the interests of obviating
                >the cause of stuttering, only in the interests of introducing
                >contingencies known to ameliorate stuttering.
                >
                >An even more pedantic point, if I may, concerns your statement that
                >the LP is a preventative/corrective program. Technically, it cannot
                >be a preventative program because you need stuttering to have begun
                >for it to be implemented.
                >
                >Incidentally, what does IMHO stand for?
                >
                >Regards,
                >
                >Mark
                >
                >>Michael,
                >>
                >>I generaly do not like to respond to these types of emails because they
                >>request an opinion, and opinions are too often interpreted as dogma.
                >So
                >>please consider my response as only one person's opinion (of many, I
                >>hope) to add to your decision matrix.
                >>
                >>In brief: definitely enroll this kid in the Lidcomb program. My
                >>rationales:
                >> 1) the time since initial onset: it's too long.
                >> 2) The total absence of stuttering implied: even though it is
                >>epsiodic, you are not implying it has ever completely cleared (I am
                >>suspecting your "recovered" is "speaking at acceptably fluent
                >>levels--not necessarily stutter-free".)
                >> 3) Family History of stuttering: DAD is still a stutterer:
                >>internalized/"closet" stutterer who is using unhelpful strategies to
                >>aid his communication (TREAT HIM!)
                >> 4) Your observation of the use of congnitive (avoidances) and
                >>physical (hiding mouth) secondaries the child has used in the past...a
                >>simpler pattern of dad's being a "successful word changer"---that's not
                >>necessarily good modeling.
                >> 5) Your suspiciion that enviornmental changes have positively
                >>influenced the fluency....that's what Lidcombe is all about!
                >>
                >>IMHO, you may be observing the "submersion" of the observable
                >stuttering
                >>with this kid's experience of stuttering: a behavioral response perhaps
                >>modeled inadvertently by dad. If there is parental or child
                >>concerns/distresses about the speech fluency, DEFINITELY treat.
                >>
                >>Finally, Lidcomb is a preventative/corrective program (IMHO) that is
                >>clearly designed to "treat" kids like you describe.
                >>
                >>But take my comments as just one data point in making your decision.
                >To
                >>me, it's a "no brainer".
                >>
                >>FWIW,
                >>
                >>Michael Susca (not be be confused with whoever you are)
                >>
                >>
                >>Michael Susca, Ph.D., C.C.C., BRS-FD
                >>Speech and Hearing Center
                >>University of the Pacific
                >>3601 Pacific Ave.
                >>Stockton, California 95211
                >>email: msusca@...
                >>Office: (209) 946-3232
                >>Fax: (209) 946-2647
                >>
                >>E-Mail Confidentiality Notice: Any private health information that
                >>may be contained in this e-mail is privileged and confidential under
                >>the Health Insurance Portability and Accountability Act (HIPPA) and
                >>is intended only for the use of the addressee(s) indicated above.
                >>Unauthorized use, disclosure, distribution, or copying of information
                >>e-mailed in error is expressly prohibited. If you have received this
                >>e-mail in error, please contact the sender and immediately delete the
                >>original message. Thank you.
                >>
                >>
                >>>>> mjbstudent02@... 03/04/05 14:45 PM >>>
                >>
                >>Hello everyone. Would you see this child or monitor?
                >>
                >>5, girl, dad has very mild stutter (successful word
                > >changer). Her stuttering first started when she was 3,
                >>recovered, then worse at 4, then recovered, much worse
                >>last fall (avoidances, anxiety, frequent blocks,
                >>hiding mouth, etc.), but recovered nicely. Parents
                >>carried out communication environment changes at the
                >>time of this recovery and we're all wondering if this
                >>could have been so successful so quickly.
                >>
                >>Today, minimal stuttering observed (1.8 %SS) on video
                >>of home sample. SR=2. Some micro stutters and one
                >>unambiguous part word rep with struggle.
                >>
                >>I don't know whether to see them for treatment or not.
                >>The parents are inclined to wait and see if she
                >>becomes more disfluent, but I have time in my schedule
                >>now and might not later. Can I (or should I) do the
                >>Lidcombe program is there isn't any significant
                >>stuttering?
                >>
                >>Does anyone have an opinion on the issue?
                >>
                >>Regards,
                >>Michael
                >>
                >>______________________________________________________________________
                >>Post your free ad now! http://personals.yahoo.ca
                >>
                >>
                >>
                >>
                >>Yahoo! Groups Links
                >>
                >>
                >>
                >>
                >>
                >>
                >>
                >>
                >>
                >>
                >>
                >>
                >>Yahoo! Groups Links
                >>
                >>
                >>
                >>
                >
                >
                >--
                >______________________________________________________________________
                >
                >Professor Mark Onslow
                >Principal Research Fellow
                >National Health and Medical Research Council
                >
                >Director, Australian Stuttering Research Centre
                >The University of Sydney
                >
                >PO Box 170 Lidcombe NSW 1825 Australia
                >Phone: (Direct) 61-2-9351-9767 (Assistant) 61-2-9351-9061 Fax:
                >61-2-9351-9392
                >
                >http://www.fhs.usyd.edu.au/asrc
                >_____________________________________________________________________
                >
                >
                >
                >
                >Yahoo! Groups Links
                >
                >
                >
                >


                --
              • M B
                Thank you Dr. Susca and Dr. Onslow for your replies. I know what to do now AND I learned much more about the program. Best regards, Michael B. (S-LP from
                Message 7 of 16 , Mar 7, 2005
                • 0 Attachment
                  Thank you Dr. Susca and Dr. Onslow for your replies. I
                  know what to do now AND I learned much more about the
                  program.

                  Best regards,
                  Michael B.
                  (S-LP from central Alberta)



                  ______________________________________________________________________
                  Post your free ad now! http://personals.yahoo.ca
                • Mark Onslow
                  My pleasure. Mark. ______________________________________________________________________ Professor Mark Onslow Principal Research Fellow National Health and
                  Message 8 of 16 , Mar 7, 2005
                  • 0 Attachment
                    My pleasure.

                    Mark.
                    ______________________________________________________________________

                    Professor Mark Onslow
                    Principal Research Fellow
                    National Health and Medical Research Council

                    Director, Australian Stuttering Research Centre
                    The University of Sydney

                    PO Box 170 Lidcombe NSW 1825 Australia
                    Phone: (Direct) 61-2-9351-9767 (Assistant) 61-2-9351-9061 Fax: 61-2-9351-9392

                    http://www.fhs.usyd.edu.au/asrc
                    _____________________________________________________________________

                    >Thank you Dr. Susca and Dr. Onslow for your replies. I
                    >know what to do now AND I learned much more about the
                    >program.
                    >
                    >Best regards,
                    >Michael B.
                    >(S-LP from central Alberta)
                    >
                    >
                    >
                    >______________________________________________________________________
                    >Post your free ad now! http://personals.yahoo.ca
                    >
                    >
                    >
                    >
                    >Yahoo! Groups Links
                    >
                    >
                    >
                    >


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