Clinician attitudes toward stuttering: A decade of change (1973–1983)

The attitudes of 674 speech-language pathologists toward stuttering, stutterers, stuttering therapy, parents of stutterers, and related issues were studied during the years 1973–1983. During that period, clinician attitudes were found to shift away from support of the John-sonian concepts, which suggest parental causality and dangers in early intervention. In addition, clinicians became less likely to perceive stutterers as possessing psychologic disorders and misperceptions of their problem and of their interpersonal relationships. However, a significant number of clinician's were found to continue to hold unsubstantiated beliefs regarding the personality of stutterers, their parents, and the efficacy of early intervention with very young stutterers. The results of the study were interpreted as suggesting the need to educate fluency specialists.     

Primary-school stutterers: Have attitudes changed?

How concerned are primary-school-aged stuttering children about their communication problem? What are the clinical implications of this concern?Fifteen years ago, Silverman (1970) suggested that primary-school-aged children who stuttered were not concerned about their disfluencies. A clinical implication of that report was that the interpreted lack of concern might negatively affect the children's motivation and desire for change in therapy. Scant research exists to support or refute this implication. While research is available on reactions to stuttering, pretherapeutic attitudes—especially those of children—have not been systematically reported. Guitar (1976) measured the pre-treatment attitudes of 38 adult stutterers and reported that, “those stutterers with more negative attitudes measured just prior to treatment, were most likely to have high levels of stuttering a year later, even though all subjects left therapy entirely fluent.” In related areas, research by Kolb, Winter, and Berlen (1968), McFall (1970), and McFall and Hammen (1971) has indicated that clients who are more motivated do better in behavior modification programs.Whether or not these findings may be generalized to children, in the midst of a developmental process, is purely speculative.     

The early history of the behavior modification of stuttering: From laboratory to clinic

The knowledge of and attitudes toward stuttering of 152 Alabama vocational rehabilitation counselors were studied using the Alabama Rehabilitation Counselors' Attitudes Toward Stuttering (ARCATS) Inventory consisting of 25 true- false statements designed to assess knowledge of stuttering and 15 statements designed to assess attitudes toward stuttering. Counselors were found to perceive stuttering as being significantly vocationally handicapping and amenable to therapy and to perceive stutterers as almost always benefiting from therapy and as being good candidates for vocational rehabilitation. It was concluded that the vocational rehabilitation counselors studied hold attitudes facilitative to the rehabilitation of stutterers.     

Patterns of regional cerebral blood flow during attempted reading aloud by stutterers both on and off haloperidol medication: Evidence for inadequate left frontal activation during stuttering

Two stutterers, both recent college graduates, were subjected to regional cerebral blood flow measurements while attempting to read aloud. Each one received two measurements, one of which was under the influence of haloperidol, 3 mg daily. Both subjects showed improvement on medication, allowing a stuttering versus essentially no stuttering comparisons for each subject. Both subjects showed higher Broca's area flow in the right compared to the left hemisphere, during stuttering. Both showed higher Wernicke's area flow in the left compared to the right hemisphere, however, during stuttering. During reading aloud without stuttering, however, the Brocas's area flows were reversed, now showing a left hemisphere advantage. The results were interpreted as consistent with H. M. Sussman and P. F. MacNeilage's (1975, Neuropsychologia, 13, 19–26) proposal that stutterers exhibit conventional left cerebral dominance for speech reception, but inadequate left cerebral dominance for speech production.     

Are mothers of stutterers different? An investigation of social-communicative integration

Many speech-language pathologists assume that parent-child communicative interactions are critical precipitating or maintaining factors in the onset and development of stuttering. Although parents are frequently counseled to alter their attitudes or behaviors, no studies have pinpointed specific parental behaviors as increasing children's disfluency. The purpose of this study was to analyze differences between 12 mothers of stutterers and 12 mothers of nonstutterers in their social-communicative interactions with their own child, an unfamiliar stutterer, and an unfamiliar nonstutterer. Ten minutes of free-play interaction between each mother and child were video recorded from behind a one-way mirror. Results indicate that the two groups of mothers differed significantly only in their use of routine statements. Other findings indicate that stuttering children used significantly more positive and imperative statements than nonstuttering children. All children asked significantly more questions of their own mothers than of unfamiliar mothers.     

Profiles of stutterers' and nonstutterers' affective, cognitive, and behavioral communication attitudes

The purposes of this investigation were 1) to profile the affective, cognitive, and behavioral attitudinal dimensions of stutterers' and nonstutterers' communication attitudes and 2) to describe membership characteristics of each profile. To this end, 76 stutterers and 81 nonstutterers completed the Inventory of Communication Attitudes. This self-report inventory obtained ratings of different types of speaking situations, using five response scales reflecting behavioral, affective, and cognitive aspects of attitudes. Exploratory cluster analysis identified six attitudinal clusters or profiles. Some profiles were more typical either of stuttering respondents or of nonstuttering respondents, whereas one profile reflected attitudes of proportionately equal numbers of stutterers and nonstutterers. Examination of profile membership characteristics revealed two significant discriminators, classification as a stutterer or nonstutterer and an overall speech rating. Nondiscriminatory characteristics included sex, age, education, therapy experiences, stuttering severity self-rating, onset of stuttering, total therapy time, current therapeutic status, and familial history.     

Vocal changes in stutterers and nonstutterers during monotoned speech

For years, reports have circulated that stutterers experience marked decrements in their stuttering when they speak or read in monotone. Wingate has suggested that the ameliorative effects of various novel speaking conditions on stuttering can be attributed to modifications in vocalization induced by such conditions. The present study was conducted to see whether this explanation would extend to monotoned speech as well. Ten teenage and adult stutterers and 10 normal speakers were tested in control and monotone reading conditions. Dependent measures were the frequencies of disfluency and stuttering, fundamental frequency, fundamental frequency standard deviation, vocal SPL, vocal SPL standard deviation, and fluent reading rate. Only within-group statistical comparisons were made, because members of the two groups could not be matched pairwise along critical vocal parameters. The major findings of this study indicated that across the two conditions, both groups significantly reduced their fundamental frequency, fundamental frequency standard deviation, vocal SPL and vocal SPL standard deviation. Only the stutterers exhibited a significant decrement in disfluency and stuttering. The normals did not evince enough disfluency in the control condition for a reduction to occur during monotoning. Neither group effected a reduction in fluent reading rates. These and other findings and interpretations are discussed relative to Wingate's modified vocalization hypothesis.     

Stuttering following brain damage

This paper describes the neurological, language, and speech status of seven brain-damaged patients with symptoms of cortical stuttering. We compare data from our seven patients to data presented on other brain-damaged stutterers, review theories of cortical stuttering's etiology, advance alternative hypotheses about mechanisms underlying such dy sfluencies, and compare cortical stuttering to stuttering in childhood.     

Clinician attitudes toward stuttering in the United States and Great Britain: A cross-cultural study

The attitudes toward stutterers and stuttering of 702 speech-language clinicians in the United States and Great Britain were studied. Three hundred seventy-one clinicians from six states in the U.S. and 331 clinicians from England and Wales completed the Clinician Attitudes Toward Stuttering (CATS) Inventory. Results of the study were analyzed in terms of differences and similarities in attitudes between the two groups with respect to the etiology of stuttering, early intervention, the effectiveness of stuttering therapies, various therapy techniques, stutterers and their personality, parents of stutterers, clinicians, and reactions of others to stutterers.     

Clinical notes: Masking devices and The Edinburgh Masker—Clinical applications within a prison setting

This paper outlines portions of the writer's therapeutics in the field of stuttering with emphasis upon use of masking the hearing of stutterers as a part of a total therapeutic approach. Commencing with devices providing continuous noise to override the voice of the stutterer so that he cannot hear himself and, thus, eliciting fluency. Described is the use of the voice actuated Edinburgh Auditory Masker within an intensive stuttering program in a prison setting since September 1978. It is concluded that the use of masking and the Edinburgh device has been helpful and productive with severe stutterers.     

A test of the distraction explanation of disfluency modification in stuttering

The distraction explanation of changes in stuttering rate was examined in the present experiment. Twelve stutterers were compared with 12 nonstutterers who were matched for age, sex, and level of education. Subjects were tested for disfluency production under conditions designed to reflect the dimension of distraction. These conditions were: (a) over attention to speech (counting speaking errors). (b) “normal” conditions (no additional task), and (c) distraction (pursuit tracking of an irregular target). The results showed no effect on stuttering rate that could be attributed to the distraction conditions. However, stutterers rated the difficulty of these conditions in concordance with the distraction theory. It was suggested that, while stutterers' perceptions may account for the popularity of the distraction explanation, evidence supporting the theory is lacking.     

Teacher perceptions of stuttering

The attitudes of 521 teachers in the Tuscaloosa, Alabama City School (82% of the teacher population) toward stuttering were assessed using the Teachers' Perceptions of Stuttering Inventory (TPSI). The TPSI consists of five teacher identification questions and 10 attitudinal statements about which teachers are asked to indicate their strength of agreement. Results indicated that a significant number of teachers hold unsubstantiated beliefs concerning the etiology of stuttering and the personality characteristics of stutterers. Teachers having experience with stutterers or having had course work in speech disorders indicated more realistic attitudes toward stutterers and expressed more demanding attitudes toward stutterers in the classroom situation. In view of the potential positive role teachers can play in assisting stutterers, the results were interpreted as suggesting a need for teachers to receive either preservice or inservice instruction with respect to the problem of stuttering.     

Controversies about stuttering therapy

Current controversies with respect to (1) the need to attend to the feelings and attitudes of stutterers; (2) the teaching of controlled stuttering as opposed to shaping fluency; (3) criteria for determining successful therapy; (4) the problem of relapse; and (5) therapy for the young stutterer are briefly discussed. It is noted that while there may be many controversies in the area of stuttering therapy, the author presently believes that the issue of whether or not to attent to the feelings and attitudes of stutterers is the most important and that the proliferation on the market of exclusively behavior-oriented therapy programs may be fostering the training of technicians without the skills necessary to assist others in identifying and handling feelings and attitudes.     

The use of self-efficacy scaling in training student clinicians: Implications for working with stutterers

A scaling technique developed by Bandura for determining an individual's personal performance expectations (self efficacy) was applied to student clinicians working with stutterers. The self-efficacy scores of clinicians conducting treatment increased significantly while the scores of clinicians without treatment experience showed no significant change. As the student clinicians gained clinical experience there appeared to be a corresponding reduction in fear and avoidance of the treatment situation. Clinician fear concerning stuttering treatment appeared to have little relation to performance in treatment as rated by supervisors. The results indicate that self-efficacy scaling may be used to indicate clinician avoidance of working with stuttering clients.     

The effect of metronome pacing on selected aerodynamic patterns of stuttered speech: Some preliminary observations and interpretations

The purpose of this investigation was to provide some preliminary data regarding the effects of metronome pacing on physiological aspects of speech during stuttering. Five aerodynamic measures were chosen as dependent variables: (a) peak intraoral air pressure, (2) intraoral air pressure onset duration, (3) intraoral air pressure offset duration, (4) total intraoral air pressure duration, and (5) peak air flow rate. Five adult stutterers and five adult nonstutterers read a prose passage containing 12 English consonants, each in three syllable-initial stressed positions, during a control condition and experimental condition. In the experimental condition the subjects read the passage while synchronizing one word per beat at 60 beats per minute. The results demonstrated that both stutterers and normals evidenced lower peak pressures and greater pressure durations during metronome pacing. Air flow rates increased for normal subjects and decreased for stutterers in the experimental condition. Dysfluencies recorded during the control condition were observed to have much more rapid intraoral air pressure onsets when compared with fluent counterparts in the experimental reading. These results were interpreted with reference to Wingate's (1969) modified vocalization hypothesis and Van Riper's (1971) altered timing concept.     

Stuttering and fluency: Exclusive events or points on a continuum?

In recent years, several studies have been conducted in which the fluency of stutterers was compared with that of normal speakers. These investigations have been of two basic types, some involving objective measures of physiologic, aerodynamic, or acoustic features of the subjects' fluent speech signal, and others involving experiments performed in which listeners attempted to distinguish the fluency produced by stutterers from that generated by normal speakers. The body of literature pertaining to each of these two types of investigations is reviewed and interpreted. The interpretations offered are then developed in an effort to shed further light on both fluency and stuttering. Implications for further research, as well as for the evaluation, treatment, and post-therapy assessment of stutterers are drawn.     

Reaction time for voiced and whispered /a/ in stutterers and nonstutterers

Recent research reviewed in this article suggests that stutterers' inability to initiate phonation promptly could be a significant factor in the occurence of stuttering. Since stuttering is either completely absent or markedly reduced in frequency during whisper, the present study tested the hypothesis that stutterers do not significantly differ from nonstutterers in reaction time (RT) for the initiation of whispered/a/, whereas the two groups differ significantly in RT for the initiation of voiced /a/. Ten adult stutterers and an equal number of comparable nonstutterers produced prolonged versions of the vowel /a/ using voice and whisper in response to tone stimuli. The results showed that stutteres and nonstutterers did not differ in RT for either voiced or whispered /a/. The stutterers, however, exhibited significantly longer RT to produce voiced /a/ than whispered /a/.     

Electromyographic indications of laryngeal-area activity during stuttering expectancy

Using surface electrodes, mean microvolt values of laryngeal-area muscle activity were determined for 13 male and 6 female stutterers during 10-sec periods in which single words were silently read and stuttering expectancy was indicated. No significant differences in levels of laryngeal-area muscle activity were found between periods of fluency expectancy and stuttering expectancy preceding both fluent and stuttered speech. The results were interpreted as being nonsupportive of the hypothesis that a breakdown in stutterers' laryngeal-area muscle activity occurs during moments of stuttering expectancy. In addition, the results suggest that the most common rationale for the utilization of laryngeal biofeedback procedures to enhance fluency should be questioned.     

Fluency-related behaviors and attitudes of 178 young stutterers

An item-by-item analysis was made of the scores of 178 five- to eighteen-year-old stutterers on the 27-item Cooper Chronicity Prediction Checklist for School-Aged Stutterers and a stuttering frequency estimate form. Results were interpreted as suggesting that male stutterers generally possess a more complex stuttering pattern than do females and that the definition as to what constitutes stuttering continues to vary significantly between parents, clinicians, and individuals labeled as stutterers.     

Changing adolescent attitudes toward stuttering

Purpose

Live oral or recorded video presentations on stuttering were delivered to high school students in order to determine the extent to which their attitudes toward stuttering could be improved.

Methods

A classroom teacher administered the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) to two health classes before and after an oral live presentation by a person who stutters. She also gave the POSHA-S to two other similar classes before and after a True Life^®: I Stutter video presentation. The stuttering person in the oral condition was one of three people featured in the video. Also, following the video condition, students filled out the POSHA-S a third time after a short oral presentation by the same person who stutters.

Results

Measured attitudes improved overall on the POSHA-S and on selected items.

Conclusions

High school students hold similar attitudes toward stuttering and stutterers as adults, and these attitudes can be improved, at least temporarily, by a presentation on stuttering but more via a live presentation than a professionally prepared video.Educational objectives: (1) The reader will identify different ways to improve attitudes toward stuttering in high school students. (2) The reader will list advantages and disadvantages of live oral presentations and recorded video presentations as strategies to change attitudes toward stuttering. (3) The reader will identify characteristics of a speaker that can assist in attitude changes of high school students.