In Australia, there is near consensus among speech pathologists that the Lidcombe Program is the most effective treatment for pre-schoolers who stutter – especially amongst those of us who were trained at Sydney University. The Lidcombe Program is safe and, in clinical trials here and overseas – as well as in clinical practice out in the real world – it’s been proven to work for most children, time after time.
But what if it doesn’t? Is there another evidence-based option for families to consider?
Yes: the Westmead Program, known colloquially as Robot Talking.
Syllable-timed speech techniques (STS) like the Westmead Program have been used (in different forms) for hundreds of years. They involve speaking with very little difference in stress across syllables. This is achieved by saying each syllable with equal stress to a rhythmic beat – almost like – you guessed it – a robot. The Westmead Program is different from some of the older STS treatments in that it doesn’t require:
- any props, e.g. metronomes, to set or maintain the beat;
- the child to speak very slowly or in a monotone voice (children are instead encouraged to speak at a near-normal normal rate with pitch variation); or
- the child to start with single sounds, syllables and words and work slowly up to conversation in several pre-programmed steps.
As with the Lidcombe Program, the Westmead Program has two stages and is administered by parents or other carers who measure average stuttering severity daily using the Lidcombe Program’s 0-9 scale. In line with the clinical trials, children learn and then practice the technique 4-6 times a day, for 5-10 minutes each time, until stuttering is eliminated or almost eliminated. This is followed by a period of maintenance where the treatment is slowly withdrawn under the supervision of a speech pathologist to minimise relapse risk.
Also like the Lidcombe Program, we’re not sure why the Westmead Program works. The latest theory is that syllable stress variations in natural speech are a stuttering “trigger” in those with a vulnerable speech motor system. It is thought that, in children, STS may induce long-term improvements in stuttering severity before their neural pathways for speech are established (Trajkovski et al., 2009). Incidentally, the effects of STS are usually temporary for adults who stutter.
The Westmead Program does not – yet – have the same level of evidence to support its effectiveness as the Lidcombe Program, but its research base is growing. In 2011, a phase II study of a clinical trial of the Westmead Program was published (see key source citation below). The trial was conducted with 17 Australian pre-school children aged between 3 and 4.5 years of age. The key results were as follows:
- Only 8 of 17 children completed the program – less than 50%. Nine dropped out for various reasons, including satisfaction with early speech gains and problems completing the program because both parents worked full-time. The researchers commented that families tended to withdraw at the point when low-level stuttering severity had been attained, but not stabilised.
- For the 8 children who completed stage 1, mean stuttering severity before treatment was 6% syllables stuttered. After the treatment and at 12 months post-stage 2 entry, the mean stuttering severity had decreased to 0.2% syllables stuttered, a mean reduction of 96%.
These results, including the dramatic improvements in fluency, need to be interpreted with care because of the small sample size and the lack of randomisation and other controls. Out in the real world, the Westmead Program can be very challenging for families, particularly for time-poor parents who are both working. But it is an option, particularly for families that have been through several rounds of the Lidcombe Program without success, and for children who have been treated successfully but have relapsed.
Key source: Trajkovski, N., Andrews, C., Onslow, M., O’Brian, S., Packman, A., Menzies, R. (2011). A phase II trial of the Westmead Program: Syllable-timed speech treatment for pre-school children who stutter. International Journal of Speech-Language Pathology, 13(6): 500-509.
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