Lexipontix is the first structured intervention programme for school-age children who stutter. It was developed in Greece by two Greek fluency clinicians, George Fourlas and Dimitris Marousos.
The therapy programme is based on principles and practices of Cognitive Behavioural Therapy, Parent-Child Interaction Therapy, Solution Focused Brief Therapy, Fluency Shaping and Stuttering Modification Therapy. Therapy is about exploring, understanding, experimenting, finding alternative ways of management, and aims at communication restructuring. Parents are actively involved throughout the programme.
“Lexipontix” is a naughty mouse. Its name is a combination of the words “lexis” and “pontix” (mouse). It means the mouse of the words or the lexicon.
Therapy makes sense: The factory of Mind
“Lexipontix” intrudes into the “factory of mind” in order to “invade” the factory or “sabotage” the factory machines. There are four interrelated factory components that work synergistically in communication. “The machine of thoughts”, the “lab of emotions”, the “body sensors” and the “machine of actions and words”. The concept of the “Factory of Mind” and its illustration helps the school age child become aware and explore his own cognitive, emotional, physical and behavioural cycle of reactions.
Components in the factory of mind correspond to the well known Beck’s Cognitive Behavioural Therapy concepts: “Thoughts”, “Emotions”, “Somatic reactions”, and “Behaviours”. The factory is regulated by the “control centre”. This is the central control panel of the machines. It continuously receives and sends information, keeping all factory components in equilibrium.
Stuttering occurs when Lexipontix:
- Attempts to intrude into the factory of mind (this corresponds to the anticipation of a stuttering event).
- Sabotages any of the factory machines (this corresponds to the experience of a stuttering event).
- Invades the control centre of the factory (this is the communicative outcome of a stuttering event such as an overt stuttering characteristic or the avoidance of a word or the fear associated with a speaking situation).
Lexipontix is a well known “visitor” representing both internal and external “threats”. The former corresponds to the organic and personal factors of stuttering the latter to the impact of environmental and communicative variables on fluency.
Therapy builds up confidence & competence: The superhero & his powers
Against Lexipontix is a superhero, the child who stutters. As therapy progresses the child is empowered to identify her own “super” role in therapy, her “super powers”, potentials and skills which she uses against “Lexipontix”. Like most super-heroes the child has a supporting network of friends or co-workers. This is the therapeutic alliance which the child gradually builds and broadens. Parents, as part of the alliance, are allocated their own cognitive, emotional and behavioural therapy aims. They are empowered to:
- achieve a shared understanding of their child’s difficulty (cognitive level)
- empathize by recognizing child’s thoughts and emotions (emotional level)
- act as fluency and communication facilitators (behavioural level)
Therapy develops as a role game between the Alliance and Lexipontix. Lexipontix is to be kept under control rather than being fought or eliminated. This aim is compatible to the nature of stuttering and the CBT orientation of the programme.
Both, the elicitation of “super powers” and the support received by the “alliance network”, build up resilience and bouncing back.
Therapy rewrites client’s narrative about stuttering: Towards Communication Restructuring
Lexipontix program aims at Communication Restructuring, that is the person:
- to reconstrue his communicative role,
- to alter the definition of communicative success and failure and
- respond in a functional and meaningful way to the demands of a communicative event
Through communication restructuring, the child gradually experiences a rationalized and harmonious relationship with his stuttering and stuttering is not a worrying threat anymore.
Therapy is minimal, adaptable & individualized: Core & Modular Structures
Following a period of repeated clinical trials, Lexipontix programme ended up in the current 3rd version with the structure shown at the following diagramme:
The programme consists of two phases. Phase-A last for 12 weeks plus a consolidation period of one month. At the end of phase-A, progress is assessed and the outcomes are discussed in a closing session (13th session). Additional therapy may be recommended according to individual needs and this is considered as the phase-B of the programme. If there is no need of further therapy, follow up sessions will be scheduled in 3, 6 and 12 months post therapy.
The programme consists of a Core Structure and several optional Modules which constitute the Modular Structure. Modules are distinct entities adjacent to the Core Structure that are activated from session 6 onwards. This adaptable modular structure provides the programme with the necessary flexibility to meet individual needs.
Therapy is goal directed & Solution Focused
Solution Focused Brief Therapy (SFBT) is the framework for problem free, solution focused talk in all sessions. SFBT questions are systematically used as the method of helping the child and the family to notice everyday instances of success and, based on their successful past, to move towards their preferred future: What they already do that it is helpful to make more of. Therapy is considered to be in the responses of the experts in stuttering experience, i.e. the child and her parents. The therapist takes the role of a facilitator, who facilitates therapy by formulating questions in order to elicit and amplify answers that activate the resources of the child and the child system.
Evidence based clinical practices
In Lexipontix we combined, theories and clinical practices that are commonly used and have been proved effective in Stuttering Therapy. There are 3 components in the programme PCI therapy, CBT, and Speech control (block modification and fluency shaping) which are the pillars of the programme. Beyond these pillars, it is the client and her system who drives therapy. It is everything that the child carries in her backpack.
Addressing the overall stuttering experience instead of “shrinking” pathology: the Formulation Chart
As a guide for data collection the programme uses the “Formulation Chart”. The formulation chart is an adaptation of the ICF model for the purposes of the Lexipontix program, based on Yaruss and Quesal (2004). During assessment phase, data collected are recorded in a blank formulation chart to keep a record of the child’s abilities and strengths as well as needs.
Specific informal assessment protocols for the assessment of “body functions” (that includes overt stuttering characteristics, oro-motor coordination, language, executive functions and temperament). We make use of specifically designed structured interviews for collecting information from parents and child. We also use formal assessments such as the OASES-S, CAT and Palin PRS, for data collection. Similar procedures are followed on the 12th week of the programme to monitor change.
The formulation chart gives the flexibility to the clinician to select his own assessment instruments as long as the boxes in the formulation chart are filled in, with the necessary information.
Therapy is fun: card-games, board-games & Alliance Missions
Kids and parents love treatment. Module board games, missions, experiments and allies give rise, role, progressive structure and motivation to the child to participate and achieve targeted change. Parents are strengthened assuming the role of the “ally” alongside their child.
Evidence on therapy effectiveness
There are two ways to consider therapy effectiveness of the Lexipontix Programme:
- Evidence based theoretical princliples and clinical practices
- The programme is based on evidenced based theories and clinical practices.
- The programme is using clinical practices to build therapeutic relationships, to trigger extratherapeutic factors and to empower the client to move towards his expectations and hopes.
- Efficacy research – two studies
- Effects of the Lexipontix programme on children’s overall stuttering experience. Fourlas, G. & Ntourou, K., (2020; 2021).
- Exploring parental perspectives, expectations, and experiences with Lexipontix. Fourlas, G., Ntourou, K., Spyridis, I., Batzifoti, V. (2021)
The manuals of the programme published in Greek Language, one for the assessment process and one for treatment, as well as the official training and supervision provided to therapists, ensure precision in the implementation of the programme. Both manuals are accompanied with the necessary material in an electronic form.