Packman Ann, Onslow Mark
Int J Speech Lang Pathol. 2012 Oct;14(5):467-70. doi: 10.3109/17549507.2012.689861. Epub 2012 Jul 2.
This paper addresses optimal intervention intensity in stuttering with reference to the Lidcombe Program of early stuttering intervention. This is an operant program in which the parent provides the actual treatment, for proscribed periods each day, in the child's everyday environment. The parent learns how to do this during weekly visits with the child to the speech-language pathologist. This program was chosen because it is supported by considerable research evidence. This evidence includes randomized controlled trials and file audits. Individual children vary in the time taken to reach the program criteria, with children with milder stuttering taking less time than children whose stuttering is more severe. Hence, the dose depends largely on stuttering severity. Other service delivery models for the Lidcombe Program have been investigated, including telehealth (distance delivery) and group delivery. While telehealth delivery was as efficacious as face-to-face delivery, 3-times more clinician hours were needed to achieve this. Group delivery of the program was also as efficacious as face-to-face delivery but required 30% less clinician time. The fact that treatment is delivered by parents but is directed by the speech-language pathologist raises interesting issues about what constitutes dose.
本文参照早期口吃干预的利德combe计划探讨口吃的最佳干预强度。这是一个操作性计划，家长在孩子的日常环境中，每天在规定的时间段内进行实际治疗。家长在每周带孩子去看语言病理学家时学习如何进行治疗。选择这个计划是因为它有大量的研究证据支持。这些证据包括随机对照试验和档案审计。每个孩子达到计划标准所需的时间各不相同，口吃较轻的孩子比口吃较严重的孩子所需时间更少。因此，剂量在很大程度上取决于口吃的严重程度。还研究了利德combe计划的其他服务提供模式，包括远程医疗（远程提供）和小组提供。虽然远程医疗提供与面对面提供一样有效，但实现这一目标需要多3倍的临床医生时间。该计划的小组提供也与面对面提供一样有效，但所需的临床医生时间少30%。治疗由家长进行但由语言病理学家指导这一事实引发了关于什么构成剂量的有趣问题。
