Research Article
Folia Phoniatr Logop 2019;71:29–41
DOI: 10.1159/000493915
Effects of the Lidcombe Program and
Parent-Child Interaction Therapy on Stuttering
Reduction in Preschool Children
Bijan Shafiei a Salar Faramarzi a Ahmad Abedi a Ali Dehqan b
Ronald C. Scherer c  
a Psychology
of Education of Children with Special Needs Department, University of Isfahan, Isfahan, Iran;
b Health
Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran; c Department of
Communication Sciences and Disorders, Bowling Green State University, Bowling Green, OH, USA
Keywords
Stuttering · Preschool children · Parents · Treatment
outcomes · Single-subject design
Abstract
Purpose: The present study explored the effectiveness of the
Lidcombe Program, the parent-child interaction therapy
(PCIT) approach, and an integrated (Lid-PCIT) program on
the treatment of children who stutter. Methods: The present
research was a single-subject study with an alternative treat-
ment design. Participants were 6 preschool children who
were randomly assigned into three groups. Each group re-
ceived the entire indirect (PCIT), direct (Lidcombe), or inte-
grated (Lid-PCIT) program and were assessed through sever-
ity rating (SR), and percent stuttered syllables (%SS), and vid-
eo analysis. Results: For all children the SR and the %SS were
reduced but the percentage of non-overlapping data of the
three interventions showed that it was reduced more in the
Lidcombe and in the Lid-PCIT programs. Conclusions: This
study provided preliminary evidence that Lidcombe, PCIT,
and integrated programs were effective in reducing the SR
and the %SS in preschool children who stutter. These results
© 2018 S. Karger AG, Basel
E-Mail karger@karger.com
www.karger.com/fpl
Published online: December 12, 2018
 
are potentially important as both indirect and direct inter-
ventions in the primary years can help children who stutter
to overcome their disorder. © 2018 S. Karger AG, Basel
Introduction
Stuttering is a fluency of speech disorder, identified via
involuntary interruptions in the flow of speech [1]. This
disorder is successfully treated in 70% of children who are
diagnosed with it [2, 3] and the remaining 30% continue
to experience this problem in the long term [4]. The inci-
dence rate of this disorder is 5% among preschool chil-
dren and about 1% among adults [5]. Although the cause
of stuttering has not been identified, a multifactorial hy-
pothesis of stuttering has gained acceptance [6–9]. A
number of therapy programs have been developed for
children, aged 6 years or less, who stutter.
Treatment programs for children who stutter can be
divided into two types, direct and indirect. Direct pro-
grams may require the child to make specific changes,
such as reducing the speech rate or using soft consonant
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Salar Faramarzi
Stockholm University Library
Psychology of Education of Children with Special Needs Department
University of Isfahan, Hezarjerib St.
Isfahan 8173673441 (Iran)
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E-Mail s.faramarzi @ edu.ui.ac.ir
onsets, in his or her speech production [10]. They might
also use conditioning methods to reinforce fluent speech
through praise and acknowledgment and seek correction
of stuttered speech [11]. In general, such programs seek
to establish fluency initially at the level of single words
and then gradually increase utterance length while main-
taining fluency [10, 12]. Indirect programs advocate the
use of indirect methods of management, requiring par-
ents to make changes in their interaction style with the
aim of facilitating fluency in the child [13–17]. These pro-
grams seek to establish fluency at first with minimal in-
volvement of the child. Even when direct approaches may
be required at a later stage, many experts consider that the
initial use of an indirect approach provides a firm founda-
tion for direct therapy and gives parents long-term essen-
tial skills that will support the child’s speech [14, 17–20].
The Lidcombe Program is a direct treatment method
focusing on children’s speech for reducing stuttering in
preschool children [21]. There is significant clinical evi-
dence supporting the effectiveness of this treatment
method for preschool children [12, 22]. The Lidcombe
Program has been supported by clinical and basic re-
search that has indicated that stuttering can be controlled
via verbal contingencies. Research conducted in a ran-
domized controlled trial for the Lidcombe Program indi-
cated that the percentage of stuttered syllables (%SS) was
reduced from 7.5 to 1% over a 6.3-month period [23].
These studies have indicated changes in children’s speech
after treatment, including their articulation, and changes
in the relationship between the children and their parents
[24]. A number of benefits were reported by the parents
of children who stutter, including an increase of quality
time with their children, along with an improved bond
between them, and increased knowledge about stuttering,
despite some implementation problems such as finding
time to do the treatment, forgetting to do the treatment,
and managing siblings throughout the treatment [22].
Additionally, the data indicate considerable safety and
suitability of this treatment without negative psychologi-
cal consequences, such as children’s anxiety and damage
to parent-child attachment [25, 26]. Onslow et al. [25]
(2002) found the effectiveness of this treatment for an ex-
perimental group to be 7.7 times more than for a control
group. Bakhtiar and Packman [27] (2009) indicated the
effectiveness of the treatment on a bilingual (Persian-Bal-
uchi) child.
Indirect programs emphasize indirect methods, that
is, parents change the mode of their own interactions with
the goal of facilitating fluency in their children [13–17].
Generally speaking, indirect approaches are based on the
30 Folia Phoniatr Logop 2019;71:29–41
DOI: 10.1159/000493915
theoretical notion that stuttering is a multifactorial disor-
der [15, 16, 28] with “physiological, linguistic, psycho-
logical, and environmental factors influencing the onset,
impact, and prognosis of stuttering” [14]. The aim of the
program is to empower families with regard to managing
their children’s stuttering and increasing their self-confi-
dence in applying their skills for increasing children’s flu-
ency of speech. Rustin et al. [14] (1996) “believe that the
indirect approach of parent-child interaction therapy
(PCIT) is sufficient to help most children achieve fluen-
cy.” Those who practice PCIT assume that changes in the
interaction style of parents can be effective in changing
children’s fluency of speech [29, 30]. This method sup-
ports the mutual relationship between children’s stutter-
ing and parents’ interactions. In this approach, the family
is motivated to speak with children about stuttering. With
changes in interaction variables, such as reduction in the
speed of speech [31], an increase in delay in response
times [32], and taking turns in parents’ conversations
[33], the children’s number and severity of dysfluencies
decreases. PCIT has been modified in response to clinical
experiences. This indirect approach is flexible and suit-
able for responses to individual and family needs.
Studies indicate that the Lidcombe Program reduces
the incidence rate of stuttering in preschool children [21,
22, 34, 35]. In addition, research has emphasized the ef-
fectiveness of the PCIT in mitigating the severity of stut-
tering [4]. What is lacking is the comparison of these two
methods.
Not only is there a need for a comparison between the
Lidcombe approach and the PCIT approach, but there is
also a need to compare them to a reasonable combined
program featuring both methods. The current project re-
ports the creation of a new integrated program with using
principles of both the Lidcombe and the PCIT programs,
and compares the effects of the integrated program on
reducing children’s stuttering with the effects of the two
individual programs. The aim of the integration of the
two mentioned programs is to use positive aspects of both
the direct and indirect programs for modification of the
interaction of parents and children as well as reduction of
children’s stuttering over a shorter period of time.
So far in Iran, there has only been one study published
in Farsi on the treatment of stuttering of a preschool child
of Baluchi-Persian language using the Lidcombe method
[27]. The success of the method (the Lidcombe Program)
has little evidence of effectiveness for Iranian children,
and the other technique (PCIT) has even less evidence of
effectiveness in Farsi. Evidence for different languages
and cultures suggests that cultural and linguistic features
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Table 1. The participants’ characteristics and their stuttering before intervention and at the first baseline

Partici- Age, Gender Family TSO, Mean Mean Stuttering characteristics

pants years: history of months %SS SR score
months stuttering repetitions blocks pro- secondary
longations behaviors

1 3:06 male no 12 9 5 yes yes no no

2 3:06 female no 14 7 4 yes yes no yes
3 3:06 male yes 12 5 2 yes yes no no
4 4:03 male no 12 5 2 yes no no no
5 3:00 male no 13 5 3 yes no no yes
6 4:00 male yes 12 7 4 yes rare no no

As Table 1 shows, there were 6 participants, 5 male and 1 female, all of whom had SR scores >2, %SS >5%, and TSO ≥12 months.

can have an effect on stuttering and its treatment [36, 37].
Stuttering is a multifactorial issue and several investiga-
tions have examined the influence of culture on stuttering
development [38]. Consequently, the results of the ther-
apy may be different in various cultures, and this high-
lights the importance of studying the effectiveness of the
therapy techniques in different cultures. Therefore, con-
sidering the impact of culture and language on stuttering
and its treatment, there is a need for further study of the
use of the Lidcombe Program and the PCIT in the treat-
ment of stuttering preschool children who speak the Per-
sian language.
There are relatively few intervention studies of Farsi-
speaking preschool children who stutter, and further-
more the phonetic structure of the Farsi language is dif-
ferent from the English language, the language of most
studies in this area [39]. A motivation for the current
study is to fill this void of research. The goal of the current
research was to compare the effects of the Lidcombe ap-
proach, PCIT, and an integrated method of both methods
(Lid-PCIT) in relation to reducing the incidence of stut-
tering in preschool children.
Methods
from basic research on components in multiple schedule and re-
views [41, 42] and suggests that the effects, although reliable, are
small [43].
The design of the present research was conducted in six stages:
Stage 1: 4 baseline sessions (BL1) without intervention with a
1-week time interval.
Stage 2: in this stage all participants received 12 intervention
sessions of each of the three methods, Lidcombe (L), PCIT (P), and
Integrated (I), with 2 sequence sessions for each intervention (L,
P, and I) (i.e., in the LPI pattern, the first 2 sessions for the L, then
2 sessions for P, followed by 2 sessions for I) and then this pattern
(LPI) was repeated until 36 sessions of intervention were complet-
ed. The patterns of the sequence presentation of interventions
were LPI, PLI, and ILP patterns for the participants. Participant P1
and P4 received the LPI pattern, participants P2 and P5 received
the PLI, and participants P3 and P6 received the ILP program. The
time period for each session was 1 h.
Stage 3: the second 4 intervention-free (baseline) sessions
(BL2), with no interventions for a 1-week time interval.
Stage 4: 4 sessions using the best intervention (based on the
percentage of non-overlapping data [PND] of each program) sole-
ly with a 1-week interval for preventing the incidence of the ethical
problem of neglecting resources without treatment.
Stage 5: 4 follow-up sessions (follow-up 1) with a 1-week time
interval. In this stage all participants were evaluated without any
intervention for 4 sessions with 1 week between each session.
Stage 6: 4 follow-up sessions (follow-up 2) with a 1-week time
interval, 3 months after follow-up 1. In this stage all participants
were evaluated without any intervention for 4 sessions with 1 week
between each session.

The research used a single-subject alternative treatment design Participants

(ATD) [40]. In an ATD the effects of sequence are controlled by
counterbalancing (e.g., ABBAAB). This is made possible by rapid
alteration, which allows more administrations of A and B in a
shorter period of time than is possible with the standard A-B de-
sign where phases may last days or weeks. The counterbalancing
also allows statistical analysis of ATDs for those who so desire. The
induction phenomenon is a positive transfer between treatments
with the behavior during one treatment more closely approximat-
ing the behavior during a second treatment than would occur if the
treatments were applied individually. This phenomenon emerges
Participants in the present study included randomly selected
children (aged 3–6 years) (Table 1) with developmental stuttering,
who had been referred to speech therapy clinics in Isfahan, Iran.
Inclusion criteria included the following: the children (1) pro-
duced more than 5% of their syllables with stuttering (%SS >5%);
(2) did not have a diagnosed mental disorder, as determined by the
implementation of the Leiter International Performance Scale; (3)
did not have a severe motor problem, as determined by their med-
ical profiles; (4) were not taking anti-anxiety drugs during the
study according to parents’ reports and their referred profiles; (5)
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were not involved in any treatment program during the study; and
(6) had no diagnosed psychological disorder, such as hyperactivity
or autism, as determined by their medical profiles; and (7) parental
consent was obtained for their child’s participation in the study.
The exclusionary criteria included being absent for more than 3
sequential sessions and suffering from special diseases during the
study. Prior to the initiation of the study, the participants’ families
were informed regarding the aims and procedures of the study and
signed the written consent forms. The study was approved in terms
of observing moral codes by the Ethics Committee of the Univer-
sity of Isfahan.
Participant 1 (P1) was male, aged 3:06 (years; months), with a
time since onset (TSO) of 12 months and no family history of stut-
tering. He had a younger brother and attended preschool 5 morn-
ings per week. His %SS was 9% and his stuttering severity rating
(SR) score was 6.
Participant 2 (P2) was female, aged 3: 06, with a TSO of 14
months and no family history of stuttering. She had a younger sis-
ter and attended preschool 5 mornings per week. Her %SS was 7%
and her SR score was 5.
Participant 3 (P3) was male, aged 5:06, with a TSO of 12 months
and a family history of recovered stuttering. He had a younger
brother and attended preschool 5 mornings per week. His %SS was
5% and his SR score was 3.
Participant 4 (P4) was male, aged 4:03, with a TSO of 12 months
and no family history of stuttering. His %SS was 5% and his SR
score was 3.
Participant 5 (P5) was male, aged 3:00, with a TSO of 13 months
and no family history of stuttering. His %SS was 5% and his SR
score was 3.
Participant 6 (P6) was male, aged 4:00, with a TSO of 12 months
and a family history of recovered stuttering. His %SS was 7% and
his SR score was 3.
The participants’ characteristics and their stuttering before in-
tervention and at the first baseline are presented in Table 1.
Data Collection
Two samples of spontaneous everyday conversation with at
least 300 syllables were obtained. In addition, two samples of spon-
taneous conversation with the parents were video-recorded at
home [44]. The %SS was calculated and SR scores were determined
from the recordings. Criteria for diagnosing stuttering were repeti-
tion of one-syllable words, repetition of sounds and syllables, the
existence of audible or inaudible prolonged articulation of sounds,
and blocking on sounds [9, 45]. The %SS was obtained by dividing
the number of stuttered syllables by the total number of syllables,
multiplied by 100. The SR values were obtained from the parents
after training by the therapists, where the SR scale ranged from 1
(“no stuttering”) to 10 (“extremely severe stuttering”) [21]. When
there were potential differences between scores for each of the par-
ents, the higher score was considered as the value for the evalua-
tion. The parents and the therapist used this scale for determining
changes emerging in children’s stuttering during the intervention
and follow-up sessions.
Study Procedure
After selecting the participants, the video-recorded oral con-
versations of the children with their mothers in their real-life situ-
ations were used to determine the children’s stuttering ratings, the
calculation of the %SS, and the SR scores. Treatment sessions were
32 Folia Phoniatr Logop 2019;71:29–41
DOI: 10.1159/000493915
held weekly. Before the beginning of treatment, %SS and SR scores
in oral speech were obtained for all participants in the presence of
the mothers in both the clinic and the home. After the first baseline
condition, according to the ATD design, each participant received
2 sessions of each individual intervention of L, P, and I with the
sequence of the considered model, 12 sessions for each of these
interventions, with a total of 36 treatment sessions for the three
interventions. %SS and SR scores of each participant were obtained
and recorded weekly. Given that the three different types of treat-
ment interventions were the Lidcombe Program (L), PCIT (P), and
the integrated intervention of Lidcombe Program and PCIT (I), in
the present study, the three models of different treatment interven-
tions were delivered in the following order: LPI, PLI, and ILP.
Moreover, regarding the fact that the present study was con-
ducted with 6 participants, each 2 participants received a similar
intervention model randomly. It should be noted that all partici-
pants received all treatment methods used in the present study.
However, due to the fact that the model used for performing this
study was the ATD design [44], with the investigation of the effect
of the presenting treatment programs on the number and severity
of stuttering of these children, the sequence and model of receiving
the treatment programs for participants were presented as LPI,
PLI, and ILP. A video of at least 150–500 syllables was recorded out
of the spontaneous oral speech of each participant with his or her
mother in the clinic and at home to evaluate participants in the
treatment stages in each session. To investigate and analyze the
parents’ and children’s behaviors and to determine the changes of
the children’s SR, the therapist trained the parents in the process
of conducting the programs and estimating the children’s SR.
Moreover, parents made video samples of all sessions at home and
delivered them to the therapist. In the intervention-free stage
(BL2), four samples of the video-recorded spontaneous speech of
each participant, without receiving any intervention, with his/her
mother over 4 continuous weeks recorded in the clinics and at
home were investigated. %SSs and SRs were evaluated and calcu-
lated blindly by an experienced speech therapist. After determin-
ing the 4-session intervention-free stage, according to the PND
obtained in the intervention stage, the best intervention was iden-
tified and conducted for 4 sessions on each individual subject. For
each participant, the best intervention was the program that could
reduce the number and severity of the child’s stuttering based on
the decrease of the SR score during the intervention more than in
the others. To identify the best intervention, we calculated and
compared the PND for each program. For each child, the program
with the highest PND was the best intervention for him/her. Fi-
nally, after conducting the best treatment for 4 follow-up sessions
(follow-up 1 stage), an evaluation without any intervention was
conducted to investigate the stability of the obtained results after
4 months (follow-up 2 stage).
Intervention Approaches
Lidcombe Program. parents were trained to score their chil-
dren’s SR daily on a scale of 1–10. In addition, the therapist elic-
ited a self-motivated spontaneous speech sample from the children
and rated the SR from 1 to 10 with the cooperation of the parents
at the beginning of each session [21]. The ratio of feedback for flu-
ent speech to overt stuttering for each child was identified during
the treatment stage. The treatment started each day with sessions
of 10–15 min. In these daily exercise sessions, speeches without
stuttering and positive verbal feedback by parents were dominant
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goals. The first stage of the intervention ended when the number Table 2. Principles employed in the Lid-PCIT Program as an inte-
and severity of the child’s stuttering, based on the parents’ SR grated program
scores for the home sessions and the therapist’s SR in the clinic
sessions during the previous week, were 1–2, and the therapist’s Selected treatment principles PCIT Lidcombe
measurement of %SS was zero for 3 sequential visits.
Parent-Child Interaction Program (PCIT). In session 1, feed- ⚫
Conducting special time activities at home
back from the consultation was reviewed, and “Special Time” was ⚫
Conducting 10–15 min of homework
negotiated [14]. Sessions 2 through 6 began with a review of the ⚫
Following children’s procedures in play
Special Time feedback form and a review of progress during the ⚫ ⚫
Following children’s model in play
week. This program was conducted in six 1-h sessions per week at ⚫ ⚫
Reducing parent’s speech speed
home for the experiment. In the program, parents recorded videos ⚫
Using shorter and less conversation turns
of themselves playing with their children. In the first session of this ⚫
program, a 5-minute segment was introduced and developed for More listening
Increasing sensual encouragements ⚫
parents. During the performance of the Special Time program, ⚫
parents concentrated on applying desired strategies with the aim Rewards
Observing turn taking in families ⚫ ⚫
of helping their children’s speech fluency. They were asked to pay
attention only to their children, not to any other activities, such as Behavioral management ⚫
cooking. The PCIT program was not started until the Special Time Using suggestions instead of questions ⚫
program was established. Applying parents’ verbal praises ⚫
After ensuring the achievement of the specific aims related to Asking for self-evaluation of speech ⚫
reforming the usual family program, “talking about stuttering” be- Informing speech without stuttering ⚫
gan. In this stage, based on strategies of the PCIT (talking about Informing certain stuttering ⚫
stuttering, rebuilding the confidence of the child, respecting turns, Asking for self-correction of certain
addressing feelings of children, high standards, sleeping problems, stuttering ⚫
behavior management, common programs for life, lifestyle, etc.), Using exercises in the organized stage ⚫
discussion about stuttering started and necessary advice was pre- Using exercises in the unorganized stage ⚫
sented to the families in 6 sessions; the establishment period was
conducted over a 6-week period. After that, the parents were re-
ferred to the clinic with their children for probing and discussing
the children’s advancement. The therapist used them at the begin-
ning of each session for determining the stuttering rating of the centage interrater agreement was based on point-by-point agree-
children by assigning a score from 1 to 10. ment for the presence of stuttering in each syllable [49]. Interrater
The Integrated Lidcombe and PCIT (Lid-PCIT) Program. Due agreement was calculated using the percentage agreement index
to effective positive points in the Lidcombe and parent-child pro- [50]; i.e., the number of agreements divided by the sum of the
grams, the goal of the integrated approach was to target children’s number of agreements and the number of disagreements, multi-
stuttering directly and also to reduce it via parents’ verbal feedback plied by 100. Interrater agreement turned out to be 96.6%.
[5], motivation and encouragement, searching for methods of
stuttering correction [11], and modifying and improving family
and child performance [46] for creating rational support for chil-
dren, deleting anxiety from children’s everyday lives, and monitor- Results
ing their damaging behaviors [47]. The aim of creating warm and
responsive relations was to better manage the children and to re- The families of all participants reported that the stut-
duce parents’ over-controlling behaviors [48]. In this approach, tering rating of their children reduced as a response to the
families are motivated to speak openly about stuttering with their implementation of the strategies of the present study and
children. Rustin et al. [14] (1996) suggest that the indirect PCIT
suffices for helping children to achieve fluency in speech. this reduction continued up to the end of the follow-up
For developing and selecting the desired principles for employ- period. The results of %SSs and SRs evaluating partici-
ing this suggested program, the points of three experienced thera- pants in the follow-up stage indicated that participants
pists who were expert in both the Lidcombe and PCIT children’s P3, P4, and P6 achieved complete improvement (without
stuttering treatments were used. Each of the three experienced stuttering) and the stuttering of participants P1, P2, and
therapists proposed the most effective principles of each of the Lid-
combe and PCIT interventions in reducing stuttering. Then the set P5 significantly decreased and necessitated the continua-
of the most effective principles that had higher than 80% agree- tion of treatment. All evaluations were conducted at the
ment by the experienced therapists were approved as the Lid-PCIT end of each week by the families.
program and employed in this study. The approved principles of
the Lid-PCIT are indicated in Table 2. Individual Analysis of the Subjects’ Stuttering Ratings
Interrater Reliability The analysis of visual charts, descriptive statistics, and
The transcriptions from one point in each stage of the study effect size of the PND were used for the analysis of the
were randomly selected for blind analysis by a second rater. Per- data. The data of first baseline, intervention, interven-
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9
5
SR
0
1 3 5 7 9 11
Baseline  Therapy Intervention
free
Baseline Lidcombe
Fig. 1. The results of 6 stages of severity rating (SR) evaluations for participant 1 (P1). The SRs of P1 reduced af-
ter intervention in the second baseline, the best therapy stage, and the first follow-up.
tion-free, the best-conducted treatment, and follow-up
are presented on a chart for each individual participant
(Fig. 1–6). Then, using the trend and stability index, the
degree of stability and direction of the trend of data were
identified. Finally, employing intra- and intersituation
analysis, the effectiveness of independent variables on the
dependent variable (stuttering rating) of the participants
was measured.
In the charts for participants P1–P6, the vertical axis
(y axis), ranging from 1 to 10, indicates the stuttering rat-
ing and the horizontal axis (x axis) indicates the session’s
number per week during the study. The stages and time
frame of sessions conducted during intervention were 4
weeks for the first baseline (BL1), 12 weeks for treatment
interventions for each individual program (L, P, and I), 4
weeks for the intervention-free stage (BL2), 4 weeks for
conducting the best treatment based on calculating the
PND, 4 weeks for the first follow-up, and 4 weeks for the
second follow-up (3 months after the first follow-up).
Evaluations of the %SS and SR were conducted at the end
of each week and the SRs for the participants were con-
sidered as the criterion of evaluation. Participants re-
ceived no intervention during the second follow-up, ex-
cept the considered program in the study.
P1: At the end of the first follow-up stage, the %SS and
SR of P1 reduced significantly at home in conversation
with parents and in the clinic with his mother and the
34 Folia Phoniatr Logop 2019;71:29–41
DOI: 10.1159/000493915
Color version available online
P1 with LPI pattern
13 15 17 19 21 23 25 27
Best  Follow-up
therapy 1    
PCI Lid-PCI The best therapy Follow-up
therapist. The %SS reduced from 9 to 1% and SR fell from
6 to 2. The results of the evaluation at the end of the sec-
ond follow-up indicated that %SS = 1 and SR = 2; this
treatment continued.
P2: At the end of the first follow-up stage, the %SS and
SR of P2 reduced significantly at home in conversation
with parents and in the clinic with his mother and the
therapist. The %SS reduced from 7 to 1% and SR fell from
4 to 1. The results of the evaluation at the end of the sec-
ond follow-up indicated that %SS = 0 and SR = 1; this
treatment continued.
P3: At the end of the first follow-up stage, the %SS and
SR of P3 reduced significantly at home in conversation
with parents and in the clinic with his mother and the
therapist. The results of the evaluation at the end of the
second follow-up indicated that the %SS reduced from 5
to 0% and SR fell from 3 to 1.
P4: At the end of the first follow-up stage, the %SS and
SR of P4 reduced significantly at home in conversation
with parents and in the clinic with his mother and the
therapist. The results of the evaluation at the end of the
second follow-up indicated that the %SS reduced from 5
to 0% and SR fell from 3 to 1.
P5: At the end of the first follow-up stage, the %SS and
SR reduced significantly at home in conversation with
parents and in the clinic with his mother and the thera-
pist. The results of the evaluation at the end of the second
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 Color version available online
P2 with PLI pattern 
9

5
SR

0
1 3 5 7 9 11 13 15 17 19 21 23 25 27
                
Baseline  Therapy Intervention Best  Follow-up
free therapy 1    
Baseline Lidcombe PCI Lid-PCI The best therapy Follow-up

Fig. 2. The results of 6 stages of severity rating (SR) evaluations for participant 2 (P2). The SRs of P2 reduced af-
ter intervention in the second baseline, the best therapy stage, and the first follow-up.

Color version available online

P3 with ILP pattern
9
8
7
6
5
SR

4
3
2
1
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27
                
Baseline  Therapy Intervention  Best  Follow-up
free therapy 1  
Baseline Lidcombe PCI Lid-PCI The best therapy Follow-up

Fig. 3. The results of 6 stages of severity rating (SR) evaluations for participant 3 (P3). The SRs of P3 reduced af-
ter intervention in the second baseline, the best therapy stage, and the first follow-up; P3 was totally cured.

follow-up indicated that the %SS reduced from 5 to 0%
and SR fell from 3 to 1.
P6: At the end of the first follow-up stage, the %SS and
SR of P6 reduced significantly at home in conversation
with parents and in the clinic with his mother and the
therapist. The %SS reduced from 7 to 1% and SR fell from
4 to 1. The results of the evaluation at the end of the sec-
ond follow-up indicated that %SS = 0 and SR = 1.
To compare the effectiveness of the Lidcombe, PCIT,
and Lid-PCIT programs, the mean effect size of the three
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Interventions on Childhood Stuttering DOI: 10.1159/000493915

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 Color version available online
P4 with LPI pattern
9

5
SR

0
1 3 5 7 9 11 13 15 17 19 21 23 25 27
Baseline 
                 Therapy Intervention  Best  Follow-up
free therapy 1    
Baseline Lidcombe PCI Lid-PCI The best therapy Follow-up

Fig. 4. The results of 6 stages of severity rating (SR) evaluations for participant 4 (P4). The SRs of P4 reduced af-
ter intervention in the second baseline, the best therapy stage, and the first follow-up; P4 was totally cured.

Color version available online

P5 with PLI pattern
9

5
SR

0
1 3 5 7 9 11 13 15 17 19 21 23 25 27
Baseline 
                 Therapy Intervention  Best  Follow-up
free therapy 1    
Baseline Lidcombe PCI Lid-PCI The best therapy Follow-up

Fig. 5. The results of 6 stages of severity rating (SR) evaluations for participant 5 (P5). The SRs of P5 reduced af-
ter intervention in the second baseline, the best therapy stage, and the first follow-up; P5 was totally cured.
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DOI: 10.1159/000493915
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9
5
SR
0
1 3 5 7 9 11
Baseline  Therapy
Baseline Lidcombe
Fig. 6. The results of 6 stages of severity rating (SR) evaluations for participant 6 (P6). The SRs of P6 reduced af-
ter intervention in the second baseline, the best therapy stage, and the first follow-up.
methods on the 6 participants was investigated. The effect
size of the PND was 70.6 in the Lidcombe Program, 58.3
in the PCIT, and 69.5 in the Lid-PCIT. The PNDs of the
three approaches are relatively equal, and the differences
between their effect sizes are not significant. On the other
hand, in this study all of the approaches decreased the
number and severity of stuttering to the same degree.
Discussion
The present study was conducted with the aim of in-
vestigating and comparing the effectiveness of the direct
Lidcombe Program, indirect PCIT, and the integrated
Lid-PCIT program, with reliance on the use of some of
the principles of the two programs on reducing the stut-
tering severity of 6 Iranian preschool children who stut-
ter. The results indicated that the %SS and the SR of par-
ticipants P3, P4, and P5 reduced to 0 and 1, respectively,
at the end of the first and second follow-up stages. The
%SS and SR of P1 were reduced to 1 and 1, respectively,
at the end of the first and second follow-up stages, and for
participants P2 and P6, the %SS and SR were reduced to
1 and 1, respectively, at the end of the first follow-up
stage. At the end of the second follow-up, their %SS and
Effects of Lidcombe and PCI
Interventions on Childhood Stuttering
Color version available online
P6 with ILP pattern
13 15 17 19 21 23 25 27
Intervention  Best Follow-up
free therapy 1    
PCI Lid-PCI The best therapy Follow-up
SR were reduced to 0 and 1, respectively. All in all, the
results show that all participants showed significant
changes in their %SS and SR at the end of the follow-up
stages compared to baseline. The results are consistent
with those of Goodhue et al. [22] (2010), Packman et al.
[21] (2014), Harris et al. [34] (2002), and Jones et al. [35]
(2005). Although it is possible that these results show
spontaneous improvement of stuttering in participants
during intervention, spontaneous improvement most
likely cannot occur in such a short time span [8].
Moreover, the results obtained from the present study
in the Iranian preschool children indicated that in the
case of P3 by presenting the ILP intervention model, in
the case of P4 by presenting the LPI, and in the case of P5
by presenting the PLI, all three types of order of present-
ing interventions resulted in improvement. In other
words, the order of presenting interventions had equal
effects on participants in reducing %SS and SR. The oth-
er result of the present research is that even when ap-
proaches were mixed, the children improved and the
number and severity of stuttering were decreased. Al-
Khaledi et al. [51] (2009) reported use of the Lidcombe
Program on 4 Kuwaiti preschool children who stutter.
They showed that significant changes in the speech of all
4 children were noted, reaching %SS below 1.0. The treat-
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ment was completed in a median of 10.5, 1-h clinic ses-
sions, and a median of 136.5 days from commencement
of the treatment program. Their results are consistent
with the results of the present research but the difference
is that they used only the Lidcombe Program and in the
present research we used three approaches for the treat-
ment of preschool children who stutter. Conture and
Menelik [19] (1999) found a discharge rate of 70% of chil-
dren due to the indirect treatment program and Yaruss et
al. [17] (2006) observed that the stuttering of 12 out of 17
children (about 70%) reduced to 3% or lower. Millard et
al. [4] (2008) reported that 4 out of 6 children in their
study (60%) were “cured” and discharged through indi-
rect PCIT. The consistency of the results of this study with
the previous studies supports more powerfully the use of
indirect treatment programs for these groups of children
[52, 53].
In the case of P1 with the LPI intervention model, al-
though the %SS and SR reduced significantly in the first
and second follow-up stages compared to the first base-
line, the treatment needed to be continued. In the case of
P2 with the PLI intervention method, and P6 with the ILP
intervention method, the evaluations in the second fol-
low-up stage indicated a reduction in %SS to 0 and SR to
1. The repeated evaluation of the participants’ stuttering
during the program caused the obtained data of %SS and
SR to have high validity. Although the data had fluctua-
tions in the first baseline, the analysis of data in the inter-
vention stage indicated systematic reduction in stutter-
ing. These results increase the confidence that the chang-
es imposed during intervention were more than a
spontaneous and natural improvement.
Since the speech therapist evaluating stuttering had no
information about the model of treatment intervention
for each of the participants up to the end of the study, the
data of the study had high reliability. The participants
who had a %SS of 0 and SR of 1 (P3, P4, and P5) after the
end of the follow-up stage entered the establishment stage
of the treatment and those with %SS of 1 or 2 and SR of 1
(P1, P2, and P6) were introduced to more treatment.
P1 experienced a significant reduction in the frequen-
cy of his stuttering with both parents and therapist during
the therapy stage; the SR of his stuttering reduced from 6
to 1. P1 continued in therapy after the second follow-up.
The beginning of his stuttering was concurrent with the
birth of his brother, and he was sensitive to him and had
continuous conflict with him; this made the mother anx-
ious and she punished him, which might have been asso-
ciated with the continuation of his stuttering. In the study
of Menzies et al. [54] (2009), “living with individuals with
38 Folia Phoniatr Logop 2019;71:29–41
DOI: 10.1159/000493915
stuttering causes emotional problems for parents and
other family members, most common of which are in
forms of stress, anxiety, disappointment, and a reduction
in life quality” [51]. This state most likely causes an in-
crease in children’s stuttering. Although significant dif-
ferences were observed in the %SS and SR compared to
the first baseline, the participant had experienced a driv-
ing accident with his family during the intervention, and
an increase in his stuttering in sessions 2 and 3 of the
parent-child intervention and sessions 6, 9, and 10 of the
Lidcombe Program may be due to these events. The re-
sults of the first and second follow-up stages indicated
that his treatment needed to be continued; thus, P1 con-
tinued therapy after the end of the study.
P2 experienced a significant reduction in his stuttering
with both parents and therapist by the end of the therapy
stage; the SR of her stuttering reduced from 5 to 1. She
was discharged after the second follow-up stage of the
study. The results after the first follow-up stage indicated
a significant difference from the first baseline. Therefore,
in spite of conducting treatment interventions during the
study helping to modify her relationship with her sister
and mother, this state appeared to fuel her mother’s anger
and the intensification of her stuttering because she did
not have a good relationship with her younger sister. In
fact, the most common emotional reaction of parents to
children’s stuttering is anxiety. The highest parental anx-
iety in relation to the effect of stuttering on children is in
not having self-confidence, appropriate social relations,
and efficiency of their conversations. This anxiety has a
role in keeping and intensifying children’s stuttering.
Parents usually become anxious when they observe con-
flicts of their children in speaking with their peers in spite
of the fluency in the speech of their peers [55, 56]. The
results of the evaluation of the second follow-up stage in-
dicated that the %SS was 0 and SR was 1.
In the case of P6, the result of the evaluation at the end
of the first follow-up stage indicated a significant differ-
ence compared to the first baseline stage, but the mother’s
speech speed was fast and she had anxiety because of her
depression. Conducting treatment interventions during
the study could have reduced the speech rate of the moth-
er, but she was not able to control it completely. The re-
sults of the evaluation in the second follow-up stage indi-
cated that the %SS was 0 and SR was 1.
If we accept that the change of parents’ behavior is an
integral part of treatment, then parents of children who
had significant achievement (P3, P4, and P5) may have
been able to achieve appropriate behavioral aims. How-
ever, it can be stated that the parents of P1, P2, and P6
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required more time to achieve these aims; the results of
the evaluation of the second follow-up in P4 and P6 con-
firmed this issue. Moreover, the difference in achieving
results from the programs is due to whether parents re-
ally have the ability to maintain their behavioral changes.
Another issue is that since direct and indirect interven-
tion programs claim to be flexible depending on the chil-
dren’s conditions and their family, it could be that they
actually have similar effects on children’s speech fluency
[24, 57].
Despite the differences of the three approaches in this
study, the differences of their size effects were negligible
and showed that all of them were useful in reducing the
number and severity of stuttering in the participants. Spe-
cifically, the results of the present research showed that
the combination of Lidcombe and PCIT did not result in
effects that were much different from Lidcombe or PCIT
alone. It can be said that the Lidcombe Program tried to
reduce children’s stuttering successfully through target-
ing children’s stuttering directly and applying strategies
such as praising and asking for self-evaluation of speech
without stuttering, providing information about speech
with and without stuttering, and asking for self-correc-
tion of stuttering. Experimental and clinical research
studies, such as those of Wilson et al. [58] (2004), Fran-
ken et al. [59] (2005), Lewis et al. [60] (2008), Lattermann
et al. [5] (2007), and Miller and Guitar [61] (2009), indi-
cate that stuttering can be controlled via this method. Ac-
cording to the model of Al-Khaledi et al. [51], direct treat-
ments focus on stuttering triggers (the second factor in
this model). The Lidcombe Program is based on princi-
ples of the factor of conditioning [21] and target the
change of articulating speech without presenting particu-
lar principles for children on how to change their speech.
The results of this study showed that use of the Lidcombe
Program for Iranian preschool children can decrease the
stuttering rate and this decrease in severity of stuttering
can remain stable.
PCIT has long-term effects on stuttering via manipu-
lating environmental variables, particularly parents’ in-
teraction patterns [4]. There is no evidence to infer the
beginning of stuttering is due to parents’ interaction pat-
terns. There are no significant differences in the rate of
speech of parents of children with and without stuttering
[62, 63], the delay in responding [63], disturbing behav-
iors [64], brevity and responsibility [65], and interaction
patterns [66]. However, there is evidence indicating that
children’s stuttering can have effects on parents’ interac-
tion patterns [29, 30]. In a longitudinal research study
conducted on 93 children investigating the occurrence of
Effects of Lidcombe and PCI
Interventions on Childhood Stuttering
stuttering, it turned out that there was no significant dif-
ference in the behavior of mothers of children with and
without stuttering [67], which supports the viewpoint of
the lack of the function of interaction patterns in the ini-
tiation of stuttering. However, 4 years later, those moth-
ers of children without stuttering changed their interac-
tion patterns [2], and used the return alternatives, more
demand for information, and positive justification. Find-
ings indicated that mothers changed their behavioral pat-
terns in response to children’s stuttering. Evidence indi-
cating the effect of the changes in parents’ interaction pat-
terns on children’s fluency of speech usually describes a
mutual relationship between stuttering and parents’ in-
teraction. Via manipulations in interaction variables,
stuttering rating reduces by lowering the parents’ speech
speed [34], increasing the delay in responding [35], and
observing organized turns [33]. Therefore, PCIT can be
effective in reducing children’s stuttering. In the present
study, the results showed that changing and modifying
the interaction between the parents and the child reduced
the stuttering rate of preschool children and this stutter-
ing decrease remained stable.
Regarding the integrated Lid-PCIT Program, referring
to effective positive points in both the Lidcombe and par-
ent-child programs, the goal of the integrated approach
was to target children’s stuttering directly and also to re-
duce it via parents’ verbal feedbacks [5], motivation and
encouragement, searching for methods of stuttering cor-
rection [14], and modifying and improving family and
child performance [46] for creating rational supports for
children, deleting anxiety from children’s everyday lives,
and monitoring their damaging behaviors [47]. Creating
warm and responsive relations had the aim of better man-
agement of children and reducing parents’ over-control-
ling behaviors [48]. Previous findings about PCIT, on the
reduction in children’ stuttering rating, state that changes
in the interaction style of parents can be effective in chil-
dren’s fluency in speech [29, 30] and indicate the mutual
relationship between children’s stuttering and parents’
interactions. The study also found that improving the in-
teraction between the parents and the child in the Iranian
families, as well as in other countries, through improving
the parents’ verbal feedback, can be effective in reducing
stuttering of preschool children. With changes in interac-
tion variables, such as reducing the rate of speech [31],
increasing the delay in responding [32], and observing
parents’ turns for speaking [39], children’s stuttering re-
duces. The aim of the program is, as the evidence shows,
to empower families in managing their children’s stutter-
ing and to increase their self-confidence in applying their
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DOI: 10.1159/000493915
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skills for increasing their children’s speech fluency. Rus- Statement of Ethics
tin et al. [14] (1996) believes that the indirect PCIT suf-
This study was approved by the Ethics Committee of the Uni-
fices for helping children in achieving fluency in speech. versity of Isfahan (Ethics approval code 1152183, available at www.
irandoc.ac.ir).

Acknowledgments
Disclosure Statement
The present study was supported spiritually by the Faculty of
Educational Sciences, University of Isfahan. We are grateful to the
The authors have no conflicts of interest to declare.
Ahoora Speech Therapy Clinic for introducing us to cases with
stuttering and appreciate the sincere cooperation of Mrs. Leila Ali
Nia, Ms. Samira Tavakol, Somayeh Aghamohammadi, and Prof.
Terry Saenz. We also deeply appreciate the kind cooperation of
families and children with stuttering who participated in the pres-
ent study. This research was supported by the University of Isfahan.

References
  1 Guitar B. Stuttering: An integrated approach
to its nature and treatment. 4th ed. Philadel-
phia: Lippincott Williams & Wilkins; 2014
  2 Kloth SA, Kraaimaat FW, Janssen P, Brutten
GJ. Persistence and remission of incipient
stuttering among high-risk children. J Fluen-
cy Disord. 1999;24(4):253–65.
  3 Yairi E, Ambrose NG. Early childhood stut-
tering I: persistency and recovery rates. J
Speech Lang Hear Res. 1999 Oct;42(5):1097–
112.
  4 Millard SK, Nicholas A, Cook FM. Is parent-
child interaction therapy effective in reducing
stuttering? J Speech Lang Hear Res. 2008 Jun;
51(3):636–50.
  5 Lattermann C, Euler HA, Neumann K. A ran-
domized control trial to investigate the im-
pact of the Lidcombe Program on early stut-
tering in German-speaking preschoolers. J
Fluency Disord. 2008 Mar;33(1):52–65.
 6 Ward D. Stuttering and cluttering: frame-
works for understanding and treatment. 1st
ed. New York: Psychology Press; 2006.
  7 Packman A. Theory and therapy in stuttering:
a complex relationship. J Fluency Disord.
2012 Dec;37(4):225–33.
  8 Dehqan A, Bakhtiar M, Panahi SS, Ashayeri
H. Relationship between stuttering severity in
children and their mothers speaking rate. Sao
Paulo Med J. 2008 Jan;126(1):29–33.
  9 Craig A. The developmental nature and effec-
tive treatment of stuttering in children and
adolescents. J Dev Phys Disabil. 2000; 12(3):
173–86.
10 Meyers SC, Woodford LL. The Fluency De-
velopment System for Young Children. Buf-
falo: United Educational Services; 1992.
11 Onslow M, Packman A, Harrison E. The Lid-
combe Program of early stuttering interven-
tion. Austin: Pro-Ed; 2003.
12 Ryan BP. Programmed therapy for stuttering
in children and adults. 2nd ed. Springfield:
Thomas; 2001.
13 Guitar B. Stuttering: An integrated approach
to its nature and treatment. 3rd ed. Philadel-
phia: Lippincott Williams & Wilkins; 2006.
14 Rustin L, Botterill W, Kelman E. Assessment
and therapy for young dys-fluent children:
Family interaction. London: Whurr; 1996.
15 Starkweather CW, Gottwald SR. The de-
mands and capacities model II: Clinical ap-
plications. J Fluency Disord. 1990;15(3):143–
57.
16 Wall MJ, Myers FL. Clinical management of
childhood stuttering. 2nd ed. Austin: Pro-Ed;
1995.
17 Yaruss JS, Coleman C, Hammer D. Treating
preschool children who stutter: description
and preliminary evaluation of a family-fo-
cused treatment approach. Lang Speech Hear
Serv Sch. 2006 Apr;37(2):118–36.
18 Conture E. Stuttering: Its nature, diagnosis
and treatment. Boston: Allyn & Bacon; 2001.
19 Conture EG, Melnick KS. Parent-child group
approach to stuttering in preschool children.
In: Onslow M, Packman A, editors. The hand-
book of early stuttering intervention. London:
Singular; 1999. p. 17–52.
20 Kelman E, Nicholas A. Practical intervention
for early childhood stammering: Palin PCI
approach. Milton Keynes: Speechmark; 2008.
21 Packman A, Onslow M, Webber M, Harrison
E, Arnott S, Birdgeman K, Carey B, Sheedy S,
O’Brian S, MacMillan V, Lioyd W; Lidcombe
Program Trainers Consortium. The Lid-
combe Program Treatment Guide. 2016.
22 Goodhue R, Onslow M, Quine S, O’Brian S,
Hearne A. The Lidcombe program of early
stuttering intervention: mothers’ experiences.
J Fluency Disord. 2010 Mar;35(1):70–84.
23 Onslow M, O’Brian S, Packman A, Menzies R.
Stuttering. In: Sturmey P, Hersen M, editors.
Handbook of Evidence-Based Practice in
Clinical Psychology. Volume 1. Child and
Adolescent Disorders. Hoboken: Wiley; 2012.
p. 185–207.
24 Bonelli P, Dixon M, Ratner NB, Onslow M;
Phyllis Bonelli, Maria Dixon, Nan B. Child
and parent speech and language following the
Lidcombe Programme of early stuttering in-
tervention. Clin Linguist Phon. 2000; 14(6):
427–46.
25 Onslow M, Stocker S, Packman A, McLeod S.
Speech timing in children after the Lidcombe
Program of early stuttering intervention. Clin
Linguist Phon. 2002 Jan-Feb;16(1):21–33.
26 Woods S, Shearsby J, Onslow M, Burnham D.
Psychological impact of the Lidcombe Pro-
gram of early stuttering intervention. Int J
Lang Commun Disord. 2002 Jan-Mar; 37(1):
31–40.
27 Bakhtiar M, Packman A. Intervention with
the Lidcombe Program for a bilingual school-
age child who stutters in Iran. Folia Phoniatr
Logop. 2009;61(5):300–4.
28 Smith A, Kelly E. Stuttering: A dynamic, mul-
tifactorial model. In: Curlee R, Siegel GM, ed-
itors. Nature and treatment of stuttering: New
directions. 2nd ed. Boston: Allyn & Bacon;
1997. p. 204–16.
29 Meyers SC, Freeman FJ. Interruptions as a
variable in stuttering and disfluency. J Speech
Hear Res. 1985a Sep;28(3):428–35.
30 Meyers SC, Freeman FJ. Mother and child
speech rates as a variable in stuttering and dis-
fluency. J Speech Hear Res. 1985b Sep; 28(3):
436–44.
31 Guitar B, Schaefer HK, Donahue-Kilburg G,
Bond L. Parent verbal interactions and speech
rate: a case study in stuttering. J Speech Hear
Res. 1992 Aug;35(4):742–54.
32 Newman LL, Smit AB. Some effects of varia-
tions in response time latency on speech rate,
interruptions, and fluency in children’s
speech. J Speech Hear Res. 1989 Sep; 32(3):
635–44.
33 Winslow M, Guitar B. The effects of struc-
tured turn-taking on dis-fluencies: A case
study. Lang Speech Hear Serv Sch. 1994;25(4):
251–7.
130.237.165.40 - 12/14/2018 5:54:35 PM

40 Folia Phoniatr Logop 2019;71:29–41 Shafiei/Faramarzi/Abedi/Dehqan/Scherer

Stockholm University Library

DOI: 10.1159/000493915
Downloaded by:
34 Harris V, Onslow M, Packman A, Harrison E,
Menzies R. An experimental investigation of
the impact of the Lidcombe Program on early
stuttering. J Fluency Disord. 2002;27(3):203–
13.
35 Jones M, Packman A, Williams S, Ormond T,
Schwarz T, Gebski V. Randomized controlled
trial of the Lidcombe programme of early
stuttering intervention. BMJ. 2005 Sep;
331(7518):659–61.
36 Cooper E, Cooper C. Multicultural consider-
ations in the assessment and treatment of
stuttering. In: Battle D, editor. Communica-
tion disorders in multicultural populations.
2nd ed. Boston: Butterworth-Heinemann,
1998. p. 192–273.
37 Ogundare AA. Multicultural stuttering and
treatment: a cross cultural analysis [thesis].
Carbondale (IL): Southern Illinois University;
2012.
38 Blood G, Blood I, Kreiger J, O’Connor S,
Qualls C. Double jeopardy for children who
stutter: race and coexisting disorders. Com-
mun Disord Q. 2009;30(3):131–41.
39 Dehqan A, Yadegari F, Blomgren M, Scherer
RC. Formant transitions in the fluent speech
of Farsi-speaking people who stutter. J Flu-
ency Disord. 2016 Jun;48:1–15.
40 Gast DL, Ledford JR. Single Subject Research
Methodology in Behavioral Sciences. New
York: Routledge; 2010.
41 Onslow M, Packman A, Harrison E. The Lid-
combe Program of early stuttering interven-
tion. Austin: Pro-Ed; 2003.
42 Dunham PJ. Contrasted conditions of rein-
forcement. A selective critique. Psychol Bull.
1968 May;69(5):295–315.
43 Freeman BJ. Behavioral contrast: reinforce-
ment frequency or response suppression. Psy-
chol Bull. 1971;75(5):347–56.
44 Ulman JD, Sulzer-Azaroff B. Multielement
baseline design in applied behavior analysis.
Symposium presentation at the annual meet-
ing of the American Psychological Associa-
tion, Montreal, 1973.
45 Yaruss JS, LaSalle LM, Conture EG. Evaluat-
ing stuttering in young children: diagnostic
data. Am J Speech Lang Pathol. 1998;7(4):62–
76.
Effects of Lidcombe and PCI
Interventions on Childhood Stuttering
46 Foote R, Eyeberg SM, Schuhmann E. Parent-
Child Interaction Approaches to the Treat-
ment of Child Behavior Disorders. In: Ollen-
dick TH, Prinz RJ, editors. Advances in Clin-
ical Child Psychology. Boston: Springer;
1998. vol. 20. p. 125–151. https://doi.
org/10.1007/978-1-4757-9038-2_4
47 Nixon RD, Sweeney L, Erickson DB, Touyz
SW. Parent-child interaction therapy: a com-
parison of standard and abbreviated treat-
ments for oppositional defiant preschoolers. J
Consult Clin Psychol. 2003 Apr; 71(2): 251–
60.
48 Chorpita BF, Brown TA, Barlow DH. Per-
ceived Control as a Mediator of Family Envi-
ronment in Etiological Models of Childhood
Anxiety - Republished Article. Behav Ther.
2016 Sep;47(5):622–32.
49 Hubbard CP, Yairi E. Clustering of disfluen-
cies in the speech of stuttering and nonstut-
tering preschool children. J Speech Hear Res.
1988 Jun;31(2):228–33.
50 Suen HK, Ary D. Analyzing quantitative be-
havioral observation data. Mahwah: Erlbaum;
1989.
51 Al-Khaledi M, Lincoln M, McCabe P, Pack-
man A, Alshatti T. The attitudes, knowledge
and beliefs of Arab parents in Kuwait about
stuttering. J Fluency Disord. 2009 Mar;34(1):
44–59.
52 Muma JR. The need for replication. J Speech
Hear Res. 1993 Oct;36(5):927–30.
53 Pring T. Research methods in communica-
tion disorders. London: Whurr; 2005.
54 Menzies RG, Onslow M, Packman A, O’Brian
S. Cognitive behavior therapy for adults who
stutter: a tutorial for speech-language pathol-
ogists. J Fluency Disord. 2009 Sep;34(3):187–
200.
55 Langevin M, Packman A, Onslow M. Parent
perceptions of the impact of stuttering on
their preschoolers and themselves. J Com-
mun Disord. 2010 Sep-Oct;43(5):407–23.
56 Ntourou K, Conture EG, Walden TA. Emo-
tional reactivity and regulation in preschool-
age children who stutter. J Fluency Disord.
2013 Sep;38(3):260–74.
Folia Phoniatr Logop 2019;71:29–41
DOI: 10.1159/000493915
57 Zebrowski PM, Weiss AL, Savelkoul EM,
Hammer CS. The effect of maternal rate re-
duction on the stuttering, speech rates and
linguistic productions of children who stut-
ter: evidence from individual dyads. Clin Lin-
guist Phon. 1996;10(3):189–206.
58 Wilson L, Onslow M, Lincoln M. Telehealth
adaptation of the Lidcombe Program of Early
Stuttering Intervention: five case studies. Am
J Speech Lang Pathol. 2004 Feb;13(1):81–93.
59 Franken MC, Kielstra-Van der Schalk CJ,
Boelens H. Experimental treatment of early
stuttering: a preliminary study. J Fluency Dis-
ord. 2005;30(3):189–99.
60 Lewis C, Packman A, Onslow M, Simpson JM,
Jones M. A phase II trial of telehealth delivery
of the Lidcombe Program of early stuttering
intervention. Am J Speech Lang Pathol. 2008
May;17(2):139–49.
61 Miller B, Guitar B. Long-term outcome of the
Lidcombe Program for early stuttering inter-
vention. Am J Speech Lang Pathol. 2009 Feb;
18:42–9.
62 Yaruss JS, Conture EG. Mother and child
speaking rates and utterance lengths in adja-
cent fluent utterances: preliminary observa-
tions. J Fluency Disord. 1995;20(3):257–78.
63 Zebrowski PM. Temporal aspects of the con-
versations between children who stutter and
their parents. Top Lang Disord. 1995; 15(3):
1–17.
64 Kelly EM, Conture EG. Speaking rates, re-
sponse time latencies, and interrupting be-
haviors of young stutterers, nonstutterers,
and their mothers. J Speech Hear Res. 1992
Dec;35(6):1256–67.
65 Weiss AL, Zebrowski PM. Patterns of asser-
tiveness and responsiveness in parental inter-
actions with stuttering and fluent children. J
Fluency Disord. 1991;16(2-3):125–41.
66 Embrechts M, Ebben H. A comparison be-
tween the interactions of stuttering and non-
stuttering children and their parents. J Flu-
ency Disord. 2000 Sep;25(3):174.
67 Kloth S, Janssen P, Kraaimaat FW, Brutten
GJ. Child and mother variables in the devel-
opment of stuttering among high-risk chil-
dren: A longitudinal study. J Fluency Disord.
1998 Nov;23(4):217–30.
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