Stop Praising Fluent Speech – is Lidcombe Programe “The Monster Program”?
“Didn’t we, as a society, decide this is monstrous? Or does that only apply to fluent children?”
After performing a traumatizing study on orphans in 1939, Dr. Wendell Johnson and his student, Mary Tudor, left some non-stuttering children with scars. Johnson shelved the study and it was never published. The goal was to prove that by calling a child a stutterer, they would continue to stutter. And by ignoring the stutter, the child would not become a stutterer. It was a failure – I have a two-part podcast episode about it – and when it was released by a journalist in 2001, the public was horrified by what was said to non-stuttering orphans. It was dubbed “The Monster Study” due to its monstrous ethics concerns.
For an example of what was said to the 6 children who did not stutter, but were told that they were stutterers:
The staff has come to the conclusion that you have a great deal of trouble with your speech. The type of interruptions which you have are very undesirable.
These interruptions indicate stuttering. You have many symptoms of a child who is beginning to stutter. In fact, you are beginning to stutter. You must try to stop yourself immediately. Use your will power. Make up your mind that you are going to speak without a single interruption. It’s absolutely necessary that you do this.
Do anything to keep from stuttering, Try very hard to speak fluently and evenly. If you have an interruption, stop and begin over. Take a deep breath whenever you feel you are going to stutter, Don’t even speak unless you can do it right.
You see how (the name of a child who stutters in the institution) stutters, don’t you? Well, he undoubtedly started this very same way you are starting. Watch your speech every minute and try to do something to improve it. Whatever you do, speak fluently and avoid any interruptions whatsoever in your speech
This is pulled directly from the study.
This is what was told to the “teachers” (i.e. the caregivers, as these were teachers at the orphanage) about these children:
The staff has come to the conclusion that these children show definite symptoms of stuttering, The type of interruptions that they are having very frequently turn into stuttering… You should impress upon them the value of good speech, and that in order to have good speech one has to speak fluently. Watch their speech all of the time very carefully and stop them when they have interruptions; stop them and have them say it over. Don’t allow them to speak unless they can say it right. They should be made very conscious of their speech, and also they should be given opportunities to talk so that their mistakes can be pointed out.
Can we all agree that this is wildly unethical? The end result, by the way, was that this group of children did not begin to stutter. However, they believed themselves to be stutterers, and they DID have an increase in disfluencies (just not stuttering disfluencies). They tended to limit themselves from speaking as much as possible. They shut down soon.
Mary Tudor concluded that the experiment seemed to fail, but perhaps the issue was that the caregivers could not consistently remind the students to speak fluently/with a stutter.
… Yikes. Ok. Well.
What this study really proved, accidentally, is that poor stuttering therapy can traumatize even children who do not stutter. And that our self-stigma comes from external sources. We limit ourselves when others suggest that the way we speak is wrong – whether or not we actually have a stutter.
Isn’t it obvious, then, that we should stop telling children that stuttering is an incorrect or wrong way to speak?
You’d think.
Lidcombe Programe
In the 1990s, Mark Onslow and others created a stuttering (fluency treatment) treatment called the “Lidcombe Programe”. It began in Australia, where it is still very popular, and spread to Canada, the US, UK, and more. It is officially endorsed by several professional associations.
“Early Intervention” Myth
The program is intended for preschoolers who stutter, and works off the belief that there is a “window” of childhood in which “early intervention” can increase the likelihood of “recovery” from stuttering. This falsehood continues into 2024, despite research showing there is little evidence to suggest the “recovery rate” (kids who grow out of stuttering) is any higher for children who receive speech therapy than those who do not.
And as outlined by Franken et.al. in a 2018 study, “recovery” rates cannot be relied on when self-reporting data is not used. As they also pointed out, “recovery” does not mean effortless – someone may be working very hard to appear as though they do not stutter.
I want to stop calling this “recovery” because I hate the term, but the problem is that “recovery” captures two very different groups: 1) kids who grow out of stuttering and 2) kids who are hiding their stutter. So we will call it “appear to stop stuttering”.
The Treatment
Ok, so: the entire program was based around a falsehood. Even still, their research states that they produce more children who appear to stop stuttering than other methods.
This is done by using behavioral training. Lidcombe professionals teach parents how to respond to their child when they stutter or do not stutter. The latest treatment guide can be found online.
Lidcombe contains two parts: correction of stuttered speech, and praise for fluent speech. Let’s provide some examples:
Can you say it again? Can you say that smoothly? See if you can say it without the bump.
Wow, that was so smooth! Fantastic smooth talking. I’m loving your smooth speech.
Lidcombe puts all their eggs in one basket: a child who wants to make their parent happy.
The Impact
First things first, all cards on the table: I do not care about measuring fluency as a measure of “success” or not. Why? Well, the same reason I mentioned earlier. “Recovery” has two groups of people: those who naturally grow out of stutter, and those who hide their stutter.
Since the former is based off of brain makeup and gene compensation, and increase in “recovery” could very well mean an increase in “hiding”, as pointed out by the variance in self-reporting by Franken et.al.
With that said, their own 2020 study shows Lidcombe’s method does not prove to lead to success and results are inconclusive. (Donaghy, et.al) It’s not saying it definitely doesn’t work, but it is not clear that Lidcombe Program is getting any special results.
But more to the point, what I care more about is the WHY someone may appear to no longer stutter. What if it is more about hiding? Lidcombe promotes this because they measure fluency %s as their measure of success or not.
Asking for “correction” of speech sends one message and one message only: stuttering is wrong, and you need to try again to get it right. “Correction” as a tool isn’t unique to Lidcombe, as “cancellation” is a common speech therapy technique by all SLPs. (Stop. Try again.)
This is a use of shame to get the results you want from children. Does it sound any different from what Mary Tudor said to those orphans? Didn’t we, as a society, decide that was monstrous to say? Or does that only apply to fluent children?
Some advocates of Lidcombe have seen the shame produced by the correction, and they drop that portion. They say to focus on the praise, on the fluency. Children love praise! It can’t do harm, can it?
“The ‘joy’ of a moment of fluency is in direct inverse to the shame of the next stuttering moment after it.”
Except – what is the message?
If you praise, “That was so smooth! I am loving your smooth talking!” what does that mean?
As an adult who stutters, I have strangers compliment my moments of fluent speech more often than you’d like to think. This is what it tells me:
You are not listening to a thing I say.
You prioritize how I speak instead of what I say.
When I stutter on the word the next time, you will be disappointed.
It would be foolish to think children do not feel this as well.
Dori Lenz Holte, author of the books Voice Unearth and VoiceS Unearthed, is a parent who was given similar messaging to do with her child who stutters. Like many parents of children who stutter, she went by the advice of speech therapists, the “professionals”. Although she did not participate in Lidcombe, she connects with parents who have and shares experiences. Due to the lack of awareness, she has dedicated herself to ensure parents know that there is a harm risk in fluency-focused therapy.
In this second book (VoiceS Unearthed), she interviews dozens of other parents and young stutterers who did various “early intervention” programs – including Lidcombe. Of those she interviewed, every individual who had “early intervention focused on fixing” reported negative impacts in their life, whether or not the stuttering increased or decreased for a time.
In addition to the shame felt by children who stutter, parents accidentally cause harm and can ruin their relationships with their children. What did I say about the stranger? What message was I receiving when they praised my fluent moment? “You are not listening to a thing I say. You prioritize how I speak rather than what I say. When I stutter on the word next time, you will be disappointed.”
Lidcombe Program actively teaches parents to create this dynamic with their child.
Yes, their guidebook states two things: this is not to be done with EVERY stutter (unless the child has a minor stutter, and then needs must), and the children should be enjoying themselves!
To which I say, 1) Mary Tudor complained that messaging wasn’t happening often enough. It still negatively hurt these children. And 2) the joy of a moment of fluency is in direct inverse to the shame of the next stuttering moment after it.
So, in short, if you “just focus” on praising fluent speech, you will create shame around stuttering. If you make a child repeat themselves when they stutter to try to get the sound fluent, you will create shame around stuttering.
Take it from my lived experience: my mom never once praised my fluent moments. Success, in her book, was simply if I spoke when I wanted to speak – stutter or no stutter. I thank my mom constantly that she did not celebrate fluency. She celebrated me: her stuttering little child.
She told me, “Other people can wait. If someone has a problem with it, that’s their issue. You deserve to talk just as much as anyone else – who cares if you stutter doing it? So what? It’s just a stutter! People can get over it. Don’t ever let those bullies stop you from speaking.”
Other adults who stutter ask me how I was such a resilient kid. How I came to accept my stutter after years of self-hatred.
And I always say: I had a safe place where I did never had to think about the way I spoke. When someone was rude to me, when a teacher skipped over my raised hand, I went home and I told my mom. I knew that to treat me poorly due to my stutter was wrong, because my own mom was quite clear that my stutter had no impact on the way she listened to me.
References
Donaghy, M., O'Brian, S., Onslow, M., Lowe, R., Jones, M., & Menzies, R. G. (2020). Verbal Contingencies in the Lidcombe Program: A Noninferiority Trial. Journal of speech, language, and hearing research : JSLHR, 63(10), 3419–3431. https://doi.org/10.1044/2020_JSLHR-20-00155
Holte, Doreen Lenz. VoiceS Unearthed: The Impact of Early Intervention on Those Who Continue to Stutter. …, 2023.
Marie-Christine J.P. Franken, Simone P.C. Koenraads, Carike E.M. Holtmaat, Marc P. van der Schroeff. (2018). Recovery from stuttering in preschool-age children: 9 year outcomes in a clinical population. Journal of Fluency Disorders: 58, 35-46. https://doi.org/10.1016/j.jfludis.2018.09.003
Yairi, E., Ambrose, N. (2013). Epidemiology of stuttering: 21st century advances. Journal of Fluency Disorders: 38(2), 66-87. https://doi.org/10.1016/j.jfludis.2012.11.002