Success in changing stuttering attitudes: A retrospective analysis of 29 intervention studies

Time to talk about stuttering: A cross-sectional study about the beliefs and attitude of adolescents toward stuttering

INTRODUCTION

This study investigated the attitude of Belgian (Flemish) high school students of 15 years and older toward stuttering, compared them with international samples and evaluated the impact of an attitude program about stuttering.

METHOD

Nine schools participated in this study. The students completed the POSHA-S before and after the program. The program consisted of a class discussion guided by a PowerPoint presentation about six stuttering-related topics and the song Time To Talk, written for this project by Portland. The first questionnaire was filled out by N = 582. For N = 229, answers from pre- and post-intervention could be matched.

RESULTS

In general, female adolescents had a more positive attitude toward people who stutter, as did students from the highest education level. Catholic and atheist adolescents differed from Islamic adolescents, as well as adolescents who were born in Belgium from those who were born in another country, for one construct (cause of stuttering). The scores of the Belgian sample showed a similar variability as those of the other European samples and the POSHA-S database. A statistically significant attitude change was observed after the attitude program for helping people who stutter (Pre M = 37.35 versus Post M = 47.59, p < .001).

CONCLUSION

Mainly the variables sex and type of education explain observed attitude differences among the adolescents. Adding music to an attitude program about stuttering seems a viable way to increase better insight in how to help people who stutter in adolescents aged 15 and older.

Attitudes of Teachers, Students, and the Public Toward Stuttering in India: A Comparison

PURPOSE

People who stutter experience societal misconceptions and negative stereotypes due to cultural prejudices. The present study aimed to compare attitudes toward stuttering of Indian teachers, students, and members of the public and to further compare their attitudes to comparable samples regionally and internationally.

METHOD

Five hundred eighteen adults completed the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S), translated into Kannada, which was analyzed according to standard protocol. Summary and selected item scores were compared from samples of teachers (n = 125), students (n = 233), and the public (n = 160). Additionally, the scores were compared to those from South Asian samples and an international POSHA-S database.

RESULTS

Teachers in the current study had the most positive stuttering attitudes, followed by the public and then by students. The summary attitude scores obtained by all three groups were more positive attitudes compared to other South Asian samples and either similar to or slightly less positive than the international POSHA-S database average sample rating. Education and income were small but significant predictors of more-or less-positive attitudes, but gender, age, and familiarity with stuttering were not.

CONCLUSIONS

While teachers demonstrated a greater understanding of stuttering compared to the public and students, the lack of understanding among the latter groups highlights the need for increased awareness and education about stuttering across various segments of society. Negative social reactions toward stuttering, observed in different cultural contexts, further emphasize the need for awareness about stuttering.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.27855195.

Awareness and Knowledge of Stuttering among Malaysian School-Aged Children: An Exploratory Study

INTRODUCTION

Knowledge and awareness of stuttering are closely associated with attitudes toward stuttering. Few studies have been conducted on the knowledge and awareness of school-aged children, and none have been conducted in Malaysia. This study aimed to: (a) determine knowledge and awareness of stuttering among Malaysian school-aged children, and (b) determine whether there are differences between age group, gender, and people who stutter (PWS) exposure groups.

METHODS

A cross-sectional study was conducted among 192 Malay school-aged children (mean age = 9.47, SD = 1.781) recruited via email and social media platforms. They completed a Malay version of the questionnaire devised by van Borsel et al. (1999) on various aspects of stuttering, including prevalence, onset, gender distribution, occurrence in different cultures, cause, treatment, intelligence, and heredity of stuttering. The χ2 test of independence was performed to compare the distributions of survey responses by age group, gender, and PWS exposure group.

RESULTS

Around half of the school-aged children had met a person who stutters, but certain aspects of their knowledge were limited. Knowledge also differed according to age and gender. Girls were more knowledgeable about stuttering than boys. Regarding stuttering treatment, younger children had more positive attitudes than older children. Participants who did not know a PWS were more likely to consult their family doctor rather than a speech-language pathologist in relation to stuttering.

CONCLUSION

Knowledge and awareness of stuttering among Malaysian school-aged children were limited. Findings of this study could be used to develop a stuttering awareness program specific to children to increase their knowledge and awareness about stuttering.

Opportunities and Challenges for Audiology and Speech-Language Pathology Services in Arabic-Speaking Middle East Countries

Purpose

This article outlines opportunities and challenges pertaining to service delivery faced by audiologists and speech-language pathologists/therapists working in Arabic-speaking Middle Eastern nations. Among the most diverse regions in the world, the Middle East is a region characterized by rapid development in a number of sectors relevant to audiology and speech-language pathology, including education and health care. Despite these developments, there remains a number of challenges, including growing service demands, awareness of the scope of practice of audiologists and speech-language pathologists/therapists, regulation of clinical practice, and shortages of clinicians and evidence-based clinical resources.

Conclusion

Developments to address these challenges, as well as strategies that may enhance service delivery, will be presented.

Disfluency-Affirming Therapy for Young People Who Stutter: Unpacking Ableism in the Therapy Room

PURPOSE

Ableist messages are conveyed early in the life of a stutterer and are amplified throughout the school-age years. Increased recognition of the benefits of acceptance-based therapies for positive long-term outcomes has changed the narrative about stuttering and stutterers. Speech-language therapists are resonating with the ideas that "it is okay to stutter," socioemotional aspects of stuttering must be considered, and support and community are valuable. Despite the shift in understanding, messages conveyed to students and parents commonly encourage suppression of stuttering and masking of one's stuttering identity. The purpose of this article was to (a) expose unintentional ableist messages that perpetuate stigma and feeling "othered" in the therapy relationship and (b) offer suggestions for congruent messaging in stuttering therapy.

CONCLUSIONS

Ableism in stuttering therapy contributes to the physical struggle and socioemotional challenges experienced by stutterers. The author offers ideas for revisioning therapy outcomes, language, and messaging to students to encourage a congruent, disfluency-affirming culture in schools and community. Introspection and advocacy by both therapists and the broader professional community, in collaboration with young people who stutter, will serve to reduce the stigma that fuels many of the daily challenges faced by school-age children who stutter.

Public attitudes toward stuttering in Malaysia

PURPOSE

This study aims to: (a) measure public attitudes toward stuttering in Malaysia using the Public Opinion Survey of Human Attitudes-Stuttering [POSHA-S], (b) determine how reported attitudes and knowledge related to stuttering compare to existing data, and (c) determine whether there are differences between groups for identified variables.

METHOD

A total of 250 adults (mean age = 29 years; range = 19-60 years) completed the POSHA-S in English. We compared this sample's attitudes toward stuttering to POSHA-S data from other global samples. General linear modeling examined differences in overall stuttering score, beliefs, and self reaction subscores for demographic variables such as age, gender, marital status, parenting, education, employment status, prior exposure to a person who stutters, multilingual, race, and religion.

RESULTS

The Malaysian participants' overall stuttering score and the beliefs and self reactions subscores were all considerably lower (i.e., less positive) than the other samples around the world from the POSHA-S database median values. Being male, receiving a higher education, and knowing someone who stutters were linked to having more positive self reactions, but none of those factors was linked to positive or negative beliefs. Those who had previously been exposed to stuttering scored significantly higher than those who had not.

CONCLUSION

Malaysians may have less positive attitudes toward stuttering than Westerners. More needs to be done to make society more accepting of people who stutter. Future research should aim to find ways to educate and to raise public awareness about stuttering.

Development of a short Japanese version of the Self-Stigma of Stuttering Scale (4S-J-16): Translation and evaluation of validity and reliability

PURPOSE

This study aims to develop a short Japanese version of the Self-Stigma of Stuttering Scale (4S), which assesses the self-stigma of adults who stutter (AWS) in a self-completed form, and evaluate its psychometric properties and reliability and validity.

METHODS

After translating the original 4S scale into Japanese (4S-J) through a forward-backward translation process, it was administered to 123 Japanese adults who stutter. A short version of the 4S-J was developed through factor analysis and eliminating items with low loadings to original factors. Reliability was verified by calculating internal consistency and test-retest reliability. Participants also completed the Japanese-translated version of the Rosenberg Self Esteem Scale, General Self-Efficacy Scale, and Subjective Happiness Scale to verify construct validity. As a secondary analysis, our results regarding psychological properties of the short version of the 4S were then compared to those of studies from other countries.

RESULTS

Sixteen items were selected for the short version of the scale (4S-J-16), and confirmatory factor analysis verified the original structure of the 4S. We obtained good internal consistency and test-retest reliability. Regarding construct validity, our results showed similar correlation with the other selected scales. The value of all scores on the stigma scale in the Japanese cohort was significantly higher than that in the foreign cohort.

CONCLUSIONS

Overall, the 4S-J-16 has good internal consistency, test-retest reliability, and construct validity with a three-factor structure of self-stigma in Japanese AWS. The findings suggest that Japanese cultural background increases the stigma scores, thereby enabling us to briefly assess the psychosocial issues of AWS.

Improving young children's stuttering attitudes in Poland: Evidence for a cross-cultural stuttering inclusion program

BACKGROUND

Young, nonstuttering children around the world have been shown to hold negative stuttering attitudes characterized by limited knowledge about stuttering and how to be a helpful listener. Educational programming using the Attitude Change & Tolerance program (Weidner, 2015, InterACT) has shown promise in improving American children's stuttering attitudes (Weidner, St. Louis, & Glover, 2018), but the utility of the program in other countries is unknown. The purpose of this study was to examine the efficacy of the InterACT program among nonstuttering Polish children.

METHOD

This study was a replication of Weidner et al. (2018). Participants included 43 nonstuttering preschool and first grade Polish children. Children's stuttering attitudes were measured using the Public Opinion Survey of Human Attributes-Stuttering/Child (Weidner & St. Louis, 2014) before and after participating in the Polish translation of the InterACT program.

RESULTS

Pre-post results showed statistically significant improvements in children's overall stuttering attitudes. Most notably, children became more knowledgeable about how to be a supportive listener.

CONCLUSION

This study provides further evidence that young children worldwide have uninformed or negative stuttering attitudes, which are amenable to improvement. It also provides support for the translatability and cultural relevance of the InterACT program.

The Effects of Written Stuttering Disclosure on the Perceptions of a Child Who Stutters

Purpose This study measured between-groups differences in perceived speech skills and personality characteristics of a 12-year-old male child who stutters (CWS) as a function of a written factual stuttering disclosure statement, delivered by the CWS, his "mother," or his "teacher." Method Four hundred twenty-four college-age adults were assigned to one of four groups, including three experimental groups (i.e., written self-disclosure, mother-written disclosure, and teacher-written disclosure) and a control group (no written disclosure). Participants in the control conditions viewed a brief video of the CWS. In the experimental conditions, participants read a brief written disclosure statement for 30 s, followed by the same video used in the control condition. After viewing the video, all participants completed surveys relative to their perceptions of the CWS speech skills and personality characteristics. Results Results reveal that a written stuttering disclosure statement provided by the mother correlated with select significant desirable perceptual differences of the CWS, while a written disclosure statement provided by the CWS yielded insignificant or even undesirable perceptual differences of the CWS. Written stuttering disclosures provided by a "teacher" did not yield any significant between-groups differences in the perception of a CWS. Gender affiliation was found to be a source of covariance in a number of perceived speech skills and personality characteristics. Conclusions Written stuttering disclosure statements provided by the "mother" correlated with select favorable perceptual differences of speech skills and personal characteristics of a CWS. Clinically, the application of novel methods (written and oral disclosure statements) and sources (i.e., CWS advocates such as "mother" and "teacher") of stuttering disclosure statement can be integrated into a systematic therapeutic program, creating an innovative approach of scaffolding self-advocacy via stuttering disclosure in CWS. Supplemental Material https://doi.org/10.23641/asha.15505857.

Australian attitudes towards stuttering: A cross-sectional study

BACKGROUND

Negative reactions experienced by people who stutter often stem from unfounded attitudes and beliefs in the community.

PURPOSE

There is a need to better understand current public attitudes towards stuttering in Australia. The purpose of this study was to: (a) explore the attitudes and knowledge of a large sample of the Australian public using the Public Opinion Survey of Human Attitudes-Stuttering [POSHA-S], (b) identify how the reported attitudes towards, and knowledge of, stuttering compare to existing data, and (c) identify differences between groups for variables identified.

METHODS

A cross-sectional population study using the POSHA-S was conducted in Melbourne, Australia. Comparisons of the attitudes towards stuttering of this sample were made with data from other worldwide samples on the POSHA-S database. The influence on attitudes to stuttering of variables including age, gender, education level, country of birth, employment status and number of languages spoken was explored.

RESULTS

The Overall Stuttering Score (OSS) of the Australian sample was higher than the median score on the POSHA-S database. This suggests that the Australian public holds more positive attitudes than those other countries represented in the database. Being younger, more educated, employed, female, monolingual, born in Australia and not familiar with people who stutter were related to more positive attitudes for this sample. Some negative stereotypes towards stuttering were noted; people who stutter were identified as 'shy and fearful', and 'nervous and excitable'.

CONCLUSIONS

While the Australian public has generally positive attitudes towards stuttering, these attitudes still reflect some 'stuttering stereotypes'.

Changing Polish university students' attitudes toward cluttering

PURPOSE

This quasi-experimental design study in Poland explored the extent to which attitudes toward cluttering of university students could be changed or improved after a series of activities dedicated to attaining deeper recognition of problems associated with fluency disorders.

METHOD

University students were assigned to either an Experimental or a Control group, with 39 in each (total = 78). They all completed the Polish version of the Public Opinion Survey of Human Attributes-Cluttering (POSHA-Cl) on two occasions up to eight weeks apart. Participants in the Experimental group attended the following intervention activities: watching and discussing an educational video on cluttering, participating in a workshop on the nature of cluttering, and watching and discussing a documentary on the life experiences of people struggling with fluency disorders. The Experimental group also filled out an open-ended questionnaire at the end of the study.

RESULTS

Pre-intervention comparisons indicated that participants assigned to either of the Experimental or Control groups differed significantly on 2 of the 15 summary ratings (13 %) of their pre-POSHA-Cl attitudes toward cluttering. For the Experimental group, the intervention resulted in significant positive changes in cluttering attitudes on 8 of the 15 summary ratings (53 %). In contrast, pre- and post- POSHA-Cl scores for the Control group were essentially unchanged (0 of 15 ratings).

CONCLUSIONS

This quasi-experimental study demonstrated that it is possible to positively modify the cluttering attitudes of university students. This has implications for the length, content, and experiential components of interventions designed to improve public attitudes toward fluency disorders.

Public attitudes toward people who stutter in the workplace: A questionnaire survey of Japanese employees

PURPOSE

Negative attitudes toward stuttering by people in their work roles have been previously reported. These attitudes could differ depending on whether or not someone knows a person or has been in contact with a person who stutters. This study aimed to elucidate public attitudes toward people who stutter at work.

METHODS

A web-based questionnaire survey of 730 adults drawn from the general public throughout Japan was conducted. It gathered information on respondents' demographics, contact experience with people who stutter, knowledge of stuttering, and attitudes and experiences toward stuttering at work, using a Likert-type scale. To investigate the factors associated with their attitudes and experiences toward stuttering at work, respondents' demographic information and contact experience were entered into a multivariable model using ordinal logistic regression analysis.

RESULTS

We analyzed the data of 671 respondents, of whom 77.2 % were company employees; 41.3 % knew a person who stutters at their workplace, among their friends, and/or in their family, and 34.7 % had been in the position of hiring any individual. Respondents perceived the employment of people who stutter to be somewhat positive overall. Regression analysis revealed that only the factor of workplace contact experience to be significantly positively associated with the respondents' attitudes toward stuttering. That is, knowing a person who stutters in one's workplace was significantly associated with more positive attitudes.

CONCLUSION

Previous studies have reported widespread negative public attitudes toward stuttering. Our results can supplement this literature, especially regarding attitudes in the workplace. Our findings suggest that the main factor that is associated with people's positive attitudes is their contact experience with people who stutter in their workplace.

Comparing and Predicting Public Attitudes Toward Stuttering, Obesity, and Mental Illness

Purpose Extensive research on public attitudes has documented stigma toward stuttering, obesity, and mental illness; however, most studies have focused on only one of these conditions. This study sought to compare public attitudes toward stuttering, obesity, and mental illness as well as to identify the predictive potential of four ratings relating to these and other neutral or desirable conditions. Method Five hundred respondents who were selected from each of three international databases filled out the Public Opinion Survey of Human Attributes (POSHA) for stuttering, obesity, or mental illness. The POSHA surveys were as similar as possible, and all contained four general items asking respondents' "impression" of the attribute, extent to which he or she "wants to be/have" that attribute, "amount known" about the attribute, and "persons known" who manifest the attribute, for stuttering, obesity, and mental illness plus two others, namely, left-handedness and intelligence. The POSHA surveys also had the same summary scores, Beliefs, Self-Reactions, and an Overall Score. Results Summary scores for the three POSHA surveys in the 500-respondent samples revealed negative attitudes toward all three conditions, the most positive being toward obesity, followed by stuttering and then by mental illness. Stepwise regression analysis indicated that various general items had significant prediction potential not only of attitudes for the same condition but also of attitudes for other conditions. The greatest other condition predictions were between stuttering and mental illness. Conclusions Stuttering is regarded as less stigmatizing than mental illness but more stigmatizing than obesity. Additionally, positivity toward one condition results in limited positivity toward the others. Impressions and knowledge of-as well as experience with-stigmatized conditions can inform public awareness campaigns and individual clinical programs dealing with stigma. Supplemental Material https://doi.org/10.23641/asha.12860939.

The perceived impact of fluency on personalities of adults who stutter: implicit evidence of self-stigma

PURPOSE

The NEO-FFI is an extensively used instrument that has been used to identify personality differences between those who stutter and matched controls or group norms. The goal of this study was to use the NEO-FFI to implicitly capture and quantify self-stigma related to personality in persons who stutter (PWS).

METHODS

Thirty PWS completed the NEO-FFI twice; once as themselves and once while mentalizing (using theory of mind) to respond as though they did not stutter and had never stuttered, thus comparing their true personality to their perceived personality if they were fluent speakers. Compared to their true personalities, PWS perceived their fluent counterparts to be significantly less neurotic and more extroverted.

RESULTS

The differences observed are somewhat analogous, though considerably larger in magnitude than personality differences that have previously been reported when comparing PWS to fluent controls or norms. Differences were interpreted to be due to "contrast effects" influencing the comparison. That is, PWS cognitively separated themselves from their fluent counterparts, seeing their true selves in a negative light compared to their fluent counterparts. This "us" vs. "them" separation is considered evidence of self-stigma related to personality in PWS.

CONCLUSIONS

The finding that the perceived differences were in the domains of Neuroticism and Extraversion is consistent with prevailing stereotypes about PWS and exemplifies how public stigma can become internalized. Clinical implications are discussed with respect to how similar theory of mind/social comparison exercises can be used in cognitive behavioral therapy to help identify and restructure negative thoughts and beliefs about stuttering.

Social Judgments of Digitally Manipulated Stuttered Speech: Cognitive Heuristics Drive Implicit and Explicit Bias

Purpose People who stutter are susceptible to discrimination, stemming from negative stereotypes and social misattributions. There has been a recent push to evaluate the underlying explicit and implicit cognitive mechanisms associated with social judgments, moving away from only evaluating explicit social bias about people who stutter. The purpose of the current study was to evaluate how listeners change their implicit and explicit social (mis)attributions after hearing a people who stutter produce disfluent speech. Method The current project was an adaptation of the Byrd et al. (2017) study to evaluate listener implicit/explicit social judgments of stuttered speech across five categories (i.e., confidence, friendliness, intelligence, distractibility, and extroversion) before and after a stuttering self-disclosure. This was done by implementing a modified version of the Ferguson et al. (2019) computer mouse-tracking paradigm. Results Consistent with previous findings, participants made more explicit positive social judgments of confidence, friendliness, extroversion, and intelligence after a stuttering self-disclosure, but the distractedness category was resistant to change. Also consistent with previous findings, participants experienced a higher degree of cognitive competition (i.e., higher area under the curve) shortly after self-disclosure, which lessened over time. Conclusions Explicit and implicit biases exist, but self-disclosure significantly impacts the cognitive system of listeners. Specifically, self-disclosure may reduce explicit bias through experience and explicit belief updating, but when cognitive heuristics are strong, implicit bias may be slower to change.