JCPSLP Vol 21 No 3 2019

parent severity rating at week 1 of treatment ( p = 0.04), and clinician %SS at week 1 of treatment ( p = 0.07). A Fisher exact test suggested an effect for stuttering type ( p = 0.02). Treatment process issues Figure 3 shows that this analysis suggested some treatment process issues that differentiated between the Slow Response group and the Rapid Response group in the domains of child-related behaviour, parent skill, adherence to the practice session regime, and whether a sibling had been treated with the Lidcombe Program previously. The Slow Response group seemed to be associated with file reports, indicating that parents had difficulty learning Lidcombe Program procedures for various reasons. Examples of such file entries included: [4 months after treatment began] Practiced stutter identification as mother missed prolongations. [20 months after treatment began] Father not praising. Started praising after a prompt and then forgot again. [9 months after treatment began] Mother demonstrated therapy. Not structured enough in activity. Figure 3 also suggests that there was a difference between the groups regarding parental ability to manage the recommended practice sessions. While the Rapid Response group had no files indicating that parents found it difficult to achieve successful practice sessions, the Slow Response group included seven files with such codings. These codings were found multiple times in the seven files. The parents of these children had therefore not completed the requirements of the Lidcombe Program every week. Examples of such file entries included: Mother reported she finds it difficult to keep control of the activity for the full 15 minutes as [he] “loses it”. [She was] refusing to participate after approximately 3 minutes. Therapy only 3/7 days due to mother working on other days. Mother reported when he chats more he’s bored and it’s hard to get him back on track. [Father] reported that [his] attention span was not very long, as ++ distractions and [he] walked away to eat/ watch TV etc. Exploratory data analyses confirmed the impression conveyed by Figure 3. A Fisher exact test suggested an effect for problems with the practice session regime ( p = 0.003). A Fisher exact test suggested an effect for whether an older sibling had been treated with the Lidcombe Program ( p = 0.02). Stage 2 Figure 4 suggests overall that the Slow Response group, although requiring six to seven times more clinic visits (and weeks) to complete Stage 1, were as clinically stable as the Rapid Response group during Stage 2. Clinician %SS scores and parent severity ratings at the start and at the end of Stage 2 seemed equivalent overall. Discussion The study of case variables that may influence Lidcombe Program treatment time is potentially useful to guide

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Figure 3. Treatment process issues. The numbers on the bars represent the number of file entries recorded for each treatment process issue. LP = Lidcombe Program

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treatment planning and administration. The present study established groups of the most rapid and the slowest clinical responders from a clinical caseload with the intention of maximising the chance of identifying any differences between them. Findings need to be interpreted and translated to other caseloads cautiously due to the small sample size, the lack of prospective methodology, and the treating clinicians being highly experienced in delivering treatment to children who stutter. Results were consistent with previous research by associating pretreatment stuttering severity with treatment time. Overall, based on clinician severity ratings and percentage syllables stuttered at assessment, the Slow Response group was 30–40% more severe than the Rapid Response group (see Figure 2). It is clinically useful information that children with more severe stuttering in a caseload will require more treatment time. Also useful is the Figure 4. Clinical stability during Stage 2 Note: Since conducting this study, the severity rating (SR) scale changed from 1–10 to 0–9 (Bridgman et al., 2011). Consequently, the treatment targets changed from SR 1–2 to SR 0–1, respectively. This graph describes treatment with the former targets.

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JCPSLP Volume 21, Number 3 2019

Journal of Clinical Practice in Speech-Language Pathology