Assessment of stigma associated with stuttering: development and evaluation of the self-stigma of stuttering scale (4S)

Evaluating Stuttering Self-Stigma and Its Relationship to Adverse Impact in Children and Adolescents With the Child Stuttering Self-Stigma Scale

PURPOSE

Self-stigma occurs when a person internalizes and applies stereotypes, prejudice, and discrimination to themselves. For adults who stutter, self-stigma is linked to negative outcomes and reduced quality of life. The development of self-stigma in people who stutter is not well understood. The aim of this study is to evaluate stuttering self-stigma in school-age children and adolescents and explore potential relationships to stuttering's overall adverse impact.

METHOD

One hundred one children and adolescents who stutter, aged 10-18 years, completed the Overall Assessment of the Speaker's Experience of Stuttering (OASES), a measure of adverse impact related to stuttering, and the Childhood Self-Stigma of Stuttering Scale (Child 4S), our novel adapted version of the Self-Stigma of Stuttering Scale (4S) created for this study. The Child 4S comprises three subscales measuring three stages of self-stigma: Awareness, Agreement, and Application. Each stage was evaluated for relationships with child age and the adverse impact of stuttering.

RESULTS

We found a range of self-stigma scores among children and adolescents who stutter. Child age did not correlate with Awareness and Agreement; however, older children and adolescents reported greater Application. All stages of self-stigma strongly predicted adverse impact as measured by the OASES, and latter stages of the model were stronger predictors than earlier stages.

CONCLUSIONS

Children as young as 10 years old may experience stuttering self-stigma, and the application of self-stigma increases in adolescence, a critical period in the development of personal identity. Importantly, all stages of self-stigma predicted adverse impact related to stuttering, with latter stages being stronger predictors than earlier ones consistent with the progressive model of self-stigma being tested. The findings highlight the need for targeted, early intervention to mitigate downstream effects of stuttering self-stigma.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26352556.

Major discrimination due to stuttering and its association with quality of life

PURPOSE

This study aimed to identify what types of major discrimination have been experienced by adults who stutter throughout their lives, and investigate the association between the number of different types of major discrimination events experienced and quality of life.

METHODS

Measures of quality of life (Kemp Quality of Life Scale) and major discrimination (adapted Major Experiences of Discrimination Scale) were completed by 303 adults who stutter. Correlational and regression analyses were conducted with these variables.

RESULTS

A majority (56%) of the participants had experienced at least one episode of major discrimination due to stuttering during their lives. The major discrimination experiences most commonly reported included not being hired for a job and being discouraged by a teacher or advisor from pursuing certain careers or jobs because of stuttering. There was a significant negative relationship between quality of life and major discrimination. Increased major discrimination predicted lower quality of life even after taking into account demographic variables and severity of physical speech disruption.

CONCLUSIONS

The findings of a negative association between major discrimination and quality of life add support to the notion that reducing societal stigma related to stuttering should be a priority of the field. Discriminatory practices of listeners constitute a social-environmental barrier to communicative participation and quality of life in people who stutter and should be addressed by professionals in the field of speech-language pathology and other stakeholders.

How perceived communication skills needed for careers influences vocational stereotyping of people who stutter

PURPOSE

Prior research has revealed people who stutter experience role entrapment in which they are discouraged from pursuing certain careers over others. The Vocational Advice Scale (VAS; Gabel et al., 2004) is a reliable survey previously used to investigate this phenomenon. This study used the VAS to determine if communication skills required for careers influences reports of role entrapment.

METHOD

An online survey which included the VAS and perceptions of communication skills needed for each career listed on the VAS was distributed. Correlations between items on the two surveys were completed to investigate how communication skills influences the presence of role entrapment. In addition, a one-way analysis of variance was completed to explore differences between individuals who regularly provide career advice with those who do not.

RESULTS

Analysis found a significant correlation between perceived communication skills required for a career and the advice provided. As the perceived communication skills needed for a career increases, the likelihood of someone advising a person who stutters to pursue that career decreases. A one-way analysis of variance further revealed participants who regularly provide career advice did not differ from those participants who do not.

CONCLUSION

Perceived communication abilities needed for a career is a significant indicator of role entrapment towards people who stutter. Results agree with previous studies which found differences in advisability of certain careers over others for people who stutter, especially those which require communication within challenging situations (e.g., judge, attorney).

Evaluation of an Integrated Fluency and Acceptance and Commitment Therapy Intervention for Adolescents and Adults Who Stutter

PURPOSE

Developmental stuttering is a complex and multifaceted neurodevelopmental disorder that may cause pervasive negative consequences for adults who stutter (AWS). Historically, intervention for AWS has primarily addressed speech fluency, with less focus on the covert psychosocial aspects of the disorder. The purpose of this article is to report on a feasibility trial evaluating a novel integrated intervention that combines traditional stuttering management techniques with Acceptance and Commitment Therapy (ACT) for AWS.

METHOD

Twenty-nine AWS participated in the feasibility trial. All participants successfully completed a combined fluency and ACT intervention, titled the fluency and Acceptance and Commitment Therapy for Stuttering (fACTS) Program. As this was a feasibility study, no control group was included. Intervention was administered by two certified practicing speech-language pathologists, over eight 60- to 90-min sessions.

RESULTS

Generalized linear mixed modeling was used to determine change from pre- to post-intervention and follow-up. Significant pre- and post-intervention improvements in self-efficacy, psychosocial functioning, and psychological flexibility were observed, along with significant reductions in observable stuttering behaviors (i.e., stuttered speech frequency). Intervention gains for all variables of interest were maintained 3 and 6 months post-intervention.

CONCLUSIONS

The fACTS Program was created to be a holistic and flexible intervention to promote self-efficacy beliefs and address stuttering-related psychosocial impacts and speech fluency goals of AWS. Preliminary results indicated positive improvement in all psychosocial outcomes (i.e., self-efficacy, psychosocial impact, and psychological flexibility) and observable speech fluency following completion of the program. Future clinical trials of the fACTS Program with an included control group will further investigate the mechanisms of change for the positive effects observed.

Relationships Between Psychological Distress and Affective, Behavioral, and Cognitive Experiences of Stuttering

PURPOSE

People who stutter (PWS) are vulnerable to the development of various psychopathological symptoms, although prevalence data are mixed and less clarity exists about factors that potentially influence their occurrence. The current study sought to shed light on the prevalence of self-reported psychopathology in PWS and aimed to identify relationships between affective, behavioral, and cognitive (ABC) experiences of stuttering and psychological distress (PD).

METHOD

Forty-four PWS were administered the Behavior Assessment Battery (BAB) for Adults who Stutter and the Brief Symptom Inventory-18. The prevalence of clinically significant PD was calculated via BSI-18 global severity index t-score cutoffs. Regression analyses examined relationships between ABC variables of stuttering and PD.

RESULTS

Participants' BAB scores approximated normative values, while the PD score distribution was similar to that of a nonclinical sample. Nine percent of participants met thresholds for clinically significant PD. All ABC correlates of stuttering significantly and positively correlated with PD scores, capturing considerable amounts of shared variance.

CONCLUSIONS

Levels of PD in PWS approximate those of the general community, highlighting the existence of psychologically distressed subgroups of PWS. Speech situation-specific anxiety had the strongest relationship to PD, followed closely by one's report of situation-specific speech disruption. To a lesser but still significant extent, PWS' frequency to which they engage in various avoidance/escape behaviors, as well as their communication attitude, predicted levels of psychopathology. These data inform diagnostic and clinical decision making, drawing attention to factors that should be attended to in treatment.

Turkish adaptation of the self-stigma of stuttering scale (4S): Study of validity and reliability (4S-TR)

PURPOSE

This study aimed to adapt the Self-Stigma of Stuttering Scale (4S) into Turkish and evaluate its factor structure, reliability, and validity in Turkish culture.

METHODS

The original 4S scale was translated into Turkish (4S-TR) using a forward-backward translation technique and was administered to 350 adults who stutter (AWS). To discover latent variables evaluated on the scale, two-factor analyses were performed. Internal consistency and temporal stability were calculated to ensure reliability. Test-retest reliability correlation scores were calculated with multiple applications of the scale within about two weeks. To verify construct validity, participants also completed the Turkish versions of the Self-Esteem Rating Scale-Short Form (BSDÖ-KF) and the Satisfaction with Life Scale(YDÖ).

RESULTS

The explanatory factor analysis showed three factors explaining 74.76 % of the total variance. The findings were also validated by confirmatory factor analysis. High levels of internal consistency (r = .89) and test-retest reliability (r = .96) were obtained. In terms of construct validity, our findings revealed that self-stigma has a significant negative correlation with self-esteem (r = -.41) and life satisfaction (r = -.38) as was predicted.

CONCLUSIONS

The findings demonstrate preliminary evidence that the 4S-TR is a viable and valid instrument for self-stigma evaluation in three domains (stigma awareness, stereotype agreement, and self-concurrence). The 4S-TR can be applied for research and clinical purposes in Turkish.

Clinical and Psychosocial Predictors of Post-Event Processing in Adults Who Stutter

PURPOSE

Post-event processing, defined by self-critical rumination following a stressful communication event, is significantly associated with reduced quality of life. However, despite its relevance to the stuttering experience, to date, only a few studies have investigated post-event processing among adults who stutter, and no study has identified clinical and psychosocial predictors of post-event processing. The purpose of this study was to determine the contributions of clinical markers of stuttering and psychosocial variables to post-event processing.

METHOD

Adults who stutter (N = 96) participated in two virtual sessions. After completing the Trier Social Stress Test, a standardized social stress task in Session 1, participants completed measures of post-event processing, clinical markers of stuttering (i.e., the experience of stuttering, self- and observer-rated stuttering severity), and psychosocial characteristics (i.e., self-perceived performance, self-esteem, social anxiety, trait, and state self-compassion) in Session 2.

RESULTS

Hierarchical linear regression models indicated that a more negative experience of stuttering, higher self-rated stuttering severity, and greater social anxiety predicted more post-event processing. Greater self-perceived performance and state self-compassion predicted less rumination. Observer-rated severity, self-esteem, and trait self-compassion were not significantly associated with post-event processing behavior.

CONCLUSION

Findings reveal clinical and psychosocial variables to consider in the assessment and mitigation of post-event processing behavior in adults who stutter, and to bolster resiliency to social stress.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24223213.

There is more to cluttering than meets the eye: The prevalence of cluttering and association with psychological well-being indices in an undergraduate sample

BACKGROUND

Cluttering is a fluency disorder characterized by an abnormally fast or irregular speech delivery rate along with disfluencies that are frequent but are not judged to be stuttering. Data on cluttering prevalence in the general population are scarce, as well as its association with psychological well-being indices, such as anxiety, and depressive symptoms.

AIMS

To estimate cluttering prevalence among undergraduates, as well as its relationship with psychological and well-being indicators.

METHODS & PROCEDURES

To address these issues, a large sample (n = 1582) of undergraduates completed a questionnaire that provided a lay definition of cluttering and were asked to identify themselves as clutterers (SI-Clut), as well as to indicate the presence of several psychological and mental well-being indices.

OUTCOMES & RESULTS

A total of 276 respondents (23%) self-identified as clutterers (now or in the past), with 55.1% of those being male. Only 56 respondents (3.5% of the total sample; about 21% of SI-Clut) reported having received speech therapy for cluttering. Relative to students self-identifying as non-clutterers, self-identification of cluttering was associated with higher levels of psychosomatic symptoms, depressive symptoms and stress, indicating a tendency toward internalizing psychopathology, along with lower self-esteem, and lower subjective happiness.

CONCLUSIONS & IMPLICATIONS

The current findings point to the high prevalence of students self-identifying as clutterers, along with a significant link between cluttering and mental distress. Therefore, it is important to increase public awareness of cluttering, its diagnosis and treatment. From the clinical perspective, the elevated levels of somatic complaints, anxiety and depression may represent internalizing psychopathology, associated with more covert rather than overt symptomatology. Such symptom manifestation calls for special attention from the speech-language pathologists providing cluttering therapy, using designated well-being or mental health screening tools. Although data on standard cluttering treatment are limited, it should be customized to the client's unique difficulties. Speech-language pathologists' understanding of cluttering, which includes both speech characteristics as well as psychological and social aspects of well-being, may assist them in implementing effective treatments.

WHAT THIS PAPER ADDS

What is already known on the subject Cluttering is a fluency disorder characterized by an abnormally fast or irregular speech rate, along with various disfluencies and articulatory imprecision. It may co-occur with other disorders, such as learning disabilities, and attention-deficit/hyperactivity disorder. Data on cluttering prevalence and its association with psychological well-being indices, such as anxiety and depression, are limited. What this paper adds to existing knowledge A total of 276 undergraduates (23%) self-identified as clutterers, of whom 55.1% were males. A total of 56 respondents (3.5% of the total sample, and about 21% of undergraduates self-identified as clutterers) reported having received speech therapy for cluttering. Psychosomatic symptoms, depressive symptoms and stress levels were higher among these students, suggesting a tendency toward internalizing psychopathology, along with a lower sense of self-esteem and subjective happiness. What are the potential or actual clinical implications of this work? The high prevalence of students self-identifying as clutterers, along with the low percentage of respondents who received speech therapy for cluttering, emphasize the need to raise public awareness of the problem, its diagnosis and treatment (Reichel et al., 2010). The association between cluttering and mental distress requires speech-language pathologists to be aware that cluttering may have covert symptomatology, similar to stuttering, which should be addressed in therapy.

Internet searches conducted by people who stutter: association with speech-language therapy and severity of stuttering

Stuttering is a fluency disorder that is multidimensional because it involves more than speech difficulties. People who stutter can use the Internet to find out more about their condition and connect with other people in the same position, yet in Croatia, there are not nearly as many online sources on stuttering or as many possibilities to connect with other people who stutter as in the USA or Great Britain. If one does not speak English well, a lot of information about stuttering will simply be denied to them, especially to those who have never received speech therapy. The present study, the first of its kind in Croatia, was conducted in order to understand how often and for what reasons people who stutter search for Internet resources related to their condition. The study also assessed whether Internet use depended on age, experience with speech-language therapy, self-reported satisfaction with such therapy, and self-assessed severity of stuttering. An online questionnaire integrating the 9-Point Stuttering Severity Scale was developed for this study and administered to 51 individuals aged 18 years and older in Croatia. All collected data and findings on the internet searches come from the questionnaire. Age did not significantly affect the frequency or purpose of Internet searches. Individuals who were not attending speech therapy were more likely to search online sources about stuttering than those who received it before. People who rated their stuttering as severe were more likely to search online sources for stuttering than those who rated their condition as mild. These results suggest that there is a need for more useful, high-quality online content and materials in Croatian for people who stutter. Such resources would offer people who stutter a new world of support, mutual understanding, shared experiences and knowledge, and ways for them to help themselves.

Self-Stigma of Stuttering: Implications for Communicative Participation and Mental Health

PURPOSE

The purpose of this study was to determine if self-stigma-related variables predicted communicative participation and mental health in adults who stutter. A progressive model of self-stigma was theorized and tested.

METHOD

Adults who stutter (N = 344) completed a survey that included measures of communicative participation, global mental health, and a variety of self-stigma-related variables including perceived enacted stigma, stigma awareness, anticipated stigma, felt stigma, stereotype agreement, and stigma application, in addition to demographic and speech-related variables. Hierarchical regression was performed to test whether self-stigma-related variables progressively explained significant variance in both communicative participation and global mental health.c Results: After controlling for demographic and speech-related variables, stigma-related variables were found to be significant predictors of both communicative participation and global mental health among adults who stutter. Most self-stigma-related variables entered later in the model predicted additional unique variance in the outcome variables than the self-stigma-related variables entered in previous steps, thus supporting the trickle-down and progressive nature of the self-stigma model theorized.

CONCLUSIONS

Accounting for self-stigma in the assessment and treatment of individuals who stutter may identify and ultimately reduce environmental and personal barriers to communicative functioning and well-being in people who stutter. The self-stigma terminology and model described in this study will help practitioners, researchers, and the public better understand the process of self-stigma and how it may be associated with adverse outcomes experienced by people who stutter.

Understanding the Broader Impact of Stuttering: Suicidal Ideation

PURPOSE

Suicide and suicidal ideation are topics that have a long but limited history in stuttering research. Clinicians and clinical researchers have discussed personal and therapeutic experiences with clients who have attempted suicide, died by suicide, or struggled with suicidal thoughts. This study sought to (a) explore the occurrence of suicidal ideation in a sample of adults who stutter; (b) evaluate the relationship between adverse impact related to stuttering and suicidal ideation; and (c) document respondents' thoughts related to suicide, stuttering, and their intersection.

METHOD

One hundred forty adults who stutter completed the Suicide Behavior Questionnaire-Revised (SBQ-R). Of these, 70 participants completed the Perseverative Thinking Questionnaire (PTQ), and 67 completed the Overall Assessment of the Speaker's Experience of Stuttering (OASES). Participants who indicated at least some tendency for suicidal thoughts on the SBQ-R (n = 95) were then asked a set of follow-up questions to explore their experiences of suicidal ideation related to stuttering.

RESULTS

Quantitative data indicated that the majority of adults who reported experiencing suicidal ideation associated these experiences with stuttering (61.2%, n = 59). Individuals with higher Total Scores on the PTQ and OASES were predicted to experience significantly higher rates of suicidal ideation and, in particular, a higher likelihood of having more frequent suicidal ideation in the past year. Qualitative analyses revealed that suicidal ideation intersects meaningfully with the experience of stuttering.

CONCLUSIONS

Data from this study highlight the importance of considering broader life consequences of stuttering that some adults may experience, including suicidal ideation. By being cognizant that clients may develop such thoughts, speech-language pathologists can play a valuable role in identifying and providing necessary support for at-risk individuals.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23699688.

The experience of Polish individuals who stutter based on the OASES outcomes

BACKGROUND

Prior research has shown that stuttering is a complex and individualized condition. The Overall Assessment of the Speaker's Experience of Stuttering (OASES; Yaruss & Quesal, 2016) is a well-researched tool that measures the impact of stuttering on an individual's life. This study has used the Polish version of the OASES to examine the experience of stuttering among Polish people who stutter.

METHOD

The original, English version of the OASES was translated into Polish. Reliability and validity for the Polish version were evaluated. Comparisons were made between samples from Poland and the United States for all of the sections and for the overall results of the OASES-S, OASES-T, and OASES-A. To explore the structure of the stuttering experience, a factor structure of the OASES was conducted.

RESULTS

Like other versions of the OASES, the OASES-Polish (OASES-PL) demonstrated good reliability and validity. Cross-cultural comparisons have shown that Polish school-age children had significantly lower knowledge and awareness of stuttering than children in the United States (USA). Factor analysis further revealed that the structure of the experience of stuttering is similar across all age groups, but the importance of the particular aspects of stuttering varies at different stages of life.

CONCLUSION

The OASES-PL is a reliable and valid instrument for measuring the impact of stuttering on Polish people who stutter and can therefore be used as a clinical tool. Polish results were relatively similar to those from the USA, though there were subtle cross-cultural differences that are worthy of further exploration.

EDUCATIONAL OBJECTIVES

After reading the article, the participant will be able: (1) to describe the diverse experiences of Polish people who stutter at different ages, (2) to explain the importance of quality of life analysis in diagnosis and speech therapy with people who stutter, and (3) to explain the breadth of the stuttering phenomenon among Polish individuals who stutter.

Exploring the Relationship Between Resilience and the Adverse Impact of Stuttering in Children

PURPOSE

People who stutter often experience significant adverse impact related to stuttering. However, it is unclear how adverse impact develops in children who stutter (CWS) and whether there are protective factors that may mitigate its development. This study examined the relationship between resilience, a potentially protective factor, and stuttering's adverse impact in CWS. Resilience comprises external factors, such as family support and access to resources as well as personal attributes, making it a comprehensive protective factor to explore.

METHOD

One hundred forty-eight CWS aged 5-18 years completed the age-appropriate version of the Child and Youth Resilience Measure (CYRM) and the Overall Assessment of the Speaker's Experience of Stuttering. Parents completed a caregiver version of the CYRM and a behavioral checklist for their child. The adverse impact of stuttering was modeled as a function of resilience (external, personal, and total), controlling for child age and behavioral checklist score. We also estimated correlations between child-report and parent-report CYRM measures to assess rater agreement.

RESULTS

Children reporting greater external, personal, or total resilience were more likely to experience lower degrees of adverse impact related to their stuttering. We documented stronger correlations between younger child and parent ratings of resilience and weaker correlations between older child and parent ratings.

CONCLUSIONS

These results yield valuable insight into the variability of adverse impact experienced by CWS and offer empirical support for strength-based speech therapy approaches. We discuss the factors that contribute to a child's resilience and provide practical suggestions for how clinicians can incorporate resilience-building strategies into intervention for children experiencing significant adverse impact from their stuttering.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23582172.

Communicative participation with public authorities: Experiences of people with aphasia, people who stutter, and employees of public authorities

INTRODUCTION

Several studies have examined the communicative participation of people with communication disorders (PWCD). Hindering and facilitating factors were analyzed in different population groups considering various private and public communication contexts. However, knowledge about (a) the experiences of persons with different communication disorders, (b) communication with public authorities, and (c) the perspective of communication partners in this area remains limited. Therefore, this study aimed to explore the communicative participation of PWCD with public authorities. We analyzed communicative experiences (hindering and facilitating factors) and suggestions for improving communicative access described by persons with aphasia (PWA) and persons who stutter (PWS) as well as by employees of public authorities (EPA).

METHODS

In semi-structured interviews, PWA (n = 8), PWS (n = 9), and EPA (n = 11) reported specific communicative encounters with public authorities. The interviews were analyzed using qualitative content analysis, focusing on hindering/facilitating experiences and suggestions for improvement.

RESULTS

The personal experiences of the participants during authority encounters were represented by the interwoven themes of familiarity and awareness, attitudes and behavior, and support and autonomy. The perspectives of the three groups overlap in several areas; however, the results also indicate specific differences between PWA and PWS as well as between PWCD and EPA.

CONCLUSION

The results indicate a need to improve awareness/knowledge about communication disorders and communicative behavior in EPA. Moreover, PWCD should actively engage in encounters with authorities. In both groups, awareness must be raised about how each communication partner can contribute to successful communication, and avenues to achieve this goal must be demonstrated.

Fostering Positive Stuttering Identities Using Stutter-Affirming Therapy

PURPOSE

School-age children and adolescents frequently have difficulty developing positive identities around their stuttering. Many students experience both physical and social consequences from stuttering. The great lengths that speakers go to try to hide their stuttering and to speak fluently increase their difficulty. As long as school-age children who stutter try to identify as fluent speakers, they will have difficulty lessening the negative impact of stuttering on their lives. Fortunately, many people who stutter also report positive stuttering experiences. Speech-language pathologists can use these positive experiences to help school-age children grow more comfortable with stuttering. They can also help school-age children reduce some of the speaking effort and social stigma that leads them to try to conceal their stuttering in the first place. To accomplish both these goals, I propose a stutter-affirming therapy.

METHOD

This clinical focus article summarizes previous research about identity development in stuttering. I discuss a therapy approach I call stutter-affirming therapy. In elucidating this approach, I discuss practical ways that speech-language pathologists can use to help school-age children develop positive stuttering identities through easier speaking and stuttering. I ground these examples in a case study of a 12-year-old boy who stutters.

DISCUSSION

stutter-affirming therapy focuses on conditioning the speaker's reaction to stuttering in ways that move toward and embrace stuttering (stutterphilic reactions) rather than in ways that move away from and reject stuttering (stutterphobic reactions). Speech-language pathologists can help school-age children who stutter foster positive stuttering identities using the three priorities of stutter-affirming therapy. First, reject fluency by reducing stutterphobic and increasing stutterphilic reactions to stuttering. Second, value stuttering by discovering what speakers gain from it. Third, create an environment in which it is easier to stutter through education, advocacy, disclosure, and voluntary stuttering.

Stuttering, Intersectionality, and Identity: A Qualitative Analysis of the Experiences of Lesbian, Gay, and Bisexual Individuals Who Stutter

PURPOSE

Speech-language pathologists are influential in shaping identity development for individuals who stutter, particularly as it relates to communication. This study investigated the experiences of lesbian, gay, and bisexual individuals who stutter to learn more about how multiple marginalized identities affect their psychosocial experiences.

METHOD

Semi-structured interviews were conducted with seven individuals who stutter with lesbian, gay, and bisexual identities. Participants ranged in age from 22 to 60 years. Data were analyzed for themes and categories by using interpretive phenomenological analysis.

RESULTS

Four primary themes were identified: (a) the importance of visibility and shared social identity connections for affirmation; (b) effects of oppressive social expectations on identity; (c) intersectionality of stuttering, gay, lesbian, and bisexual identities; and (d) effects of not being affirmed for identity.

DISCUSSION

Results are discussed in the context of identity affirmation and intersectionality. Through an understanding of identity formation and psychosocial experiences of lesbian, gay, and bisexual individuals who stutter, speech-language pathologists can use identity-affirmative practices to support individuals who stutter and mitigate stigmatizing experiences. Implications focus on suggestions for the provision of identity-affirming speech-language pathology practices for students who stutter.

Self-Disclosure Experiences of Adults Who Stutter: An Interpretative Phenomenological Analysis

PURPOSE

Self-disclosure describes the act of revealing personal information to another person. To date, researchers in the area of stuttering have primarily demonstrated the utility of self-disclosure through analysis of listener perceptions. This study explores the utility of informative self-disclosure use from the perspectives of adults who stutter with experience using this strategy over time and across contexts.

METHOD

Twelve adults who stutter discussed their self-disclosure experiences in semistructured interviews. Interview transcripts were analyzed using interpretative phenomenological analysis to produce themes reflecting the most salient aspects of self-disclosure experiences. Credibility was achieved through bracketing, investigator triangulation, and member checking.

RESULTS

Four superordinate themes reflecting experiences shared by all 12 participants were generated. Each superordinate theme contained two to three corresponding subthemes. The superordinate themes included cognitive relief, self-empowerment, social connection, and personalization. These findings reflect the positive impact of informative self-disclosure use on communication and quality of life.

CONCLUSIONS

Adults who stutter perceive informative self-disclosure to be an effective strategy that provides various benefits to the speaker, in addition to facilitating positive listener perceptions. Clinicians should encourage clients to self-disclose in an informative and personalized manner, provide opportunities for practice, and support clients in determining when and where it is most beneficial for them to implement this strategy.

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.

Stuttering and the social model

Stuttering has traditionally been thought of as a defect located within an individual. As such, stuttering is caused by pathology, leading to impaired communication and reduced quality of life. Research from this medical tradition has looked to understand the etiology of stuttering to develop curative therapeutic approaches. From this frame, professionals and academics are experts and holders of knowledge; people who stutter the recipients of this expertise. The social model emerged from within the disability rights movement and offers a counter narrative. It sees the way society is structured as disabling rather than physical impairment itself. Disability is experienced when a person is unable to participate fully in society through a mismatch between their body and the environment around them; thus, disability becomes a dynamic process, not an inherent characteristic. The social model highlights society's norms and values, and, in the case of stuttering, demonstrates how society is designed for, and expects, fluent speakers. From this frame, people who stutter are the experts of their experience and holders of knowledge; professionals and academics are their allies, collaborators, and advocates for social change. This theoretical framework poses challenging questions of the foundational theories upon which stuttering therapy is historically rooted. They call into question the hierarchical structures, power dynamics and even purpose of stuttering therapy and research. In this discussion paper, we will explore the social model of disability and its implications for stuttering therapy and research. We discuss the benefits of a social model approach as well as its limitations.

A Point of View About Fluency

PURPOSE

This article presents several potential concerns with the common usage of the term fluency in the study of stuttering and people who stutter (or, as many speakers now prefer, stutterers). Our goal is to bridge gaps between clinicians, researchers, and stutterers to foster a greater sense of collaboration and understanding regarding the words that are used and meanings that are intended.

METHOD

We begin by reviewing the history of the term fluency. We then explore its usage and current connotations to examine whether the term meaningfully describes constructs that are relevant to the study of the stuttering condition.

RESULTS

By highlighting current research and perspectives of stutterers, we conclude that the term fluency (a) is not fully inclusive, (b) encourages the use of misleading measurement procedures, (c) constrains the subjective experience of stuttering within a false binary categorization, and (d) perpetuates a cycle of stigma that is detrimental to stutterers and to the stuttering community as a whole.

CONCLUSIONS

We recommend that researchers and clinicians cease referring to stuttering as a fluency disorder and simply refer to it as stuttering. Furthermore, we recommend that researchers and clinicians distinguish between moments of stuttering (i.e., what stutterers experience when they lose control of their speech or feel stuck) and the overall lived experience of the stuttering condition.

Understanding the Speaker's Experience of Stuttering Can Improve Stuttering Therapy

The purpose of this paper is to highlight the value for speech-language pathologists of considering the overall stuttering condition-including speakers' experiences during and around moments of stuttering-in treatment with individuals who stutter. We first highlight a framework for conceptualizing the entirety of the stuttering condition. We then present recent research and clinical perspectives about stuttering to support the claim that speech-language pathologists who account for individual differences in how their clients experience stuttering are better positioned to treat stuttering more effectively. Ultimately, this will yield better treatment outcomes and help clinicians achieve greater gains in quality of life for their clients who stutter.

Comparing evaluations of social situations for adults who do and do not stutter

PURPOSE

Numerous research studies indicate that stuttering is associated with increased risk for social anxiety disorder (SAD). Interpretation bias is one of four cognitive biases thought to maintain symptoms associated with SAD. Interpretation bias occurs when one evaluates social situations as more negative than they actually are. The purpose of this study was to investigate if adults who do and do not stutter interpret positive, ambiguous, mildly negative, and profoundly negative social situations similarly, or-if like individuals with SAD-adults who stutter exhibit negative interpretation biases.

METHOD

Forty-eight adults who stutter and 42 age-and gender-matched adults who do not stutter participated. Participants completed the Fear of Negative Evaluation (FNE) and were assigned to one of four groups: adults who stutter with high FNE (AWS-High), adults who stutter with low FNE (AWS-Low), adults who do not stutter with high FNE (AWNS-High), and adults who do not stutter with low FNE (AWNS-Low). All participants completed the trait scale of the State Trait Anxiety Inventory (STAI) and the Interpretation and Judgmental Questionnaire (IJQ). The IJQ contains descriptions of four types of social situations: positive, mildly negative, profoundly negative, and ambiguous. Within each situation type there are five different scenarios, for a total of 20 scenarios across the four situation types. Participants provided written responses to these 20 social scenarios. Qualitative analyses were used to understand how members of each group interpreted the different social scenarios.

RESULTS

Thematic analysis revealed that each group responded in similar ways to each of the social scenarios, regardless of the type of situation. Adults who do and do not stutter with low and high FNE agreed on many themes related to the 20 social scenarios, and they agreed across all four types of social situations. Somewhat surprisingly, the theme "stuttering" was mentioned infrequently by the adults who stutter.

CONCLUSIONS

Results suggested that adults who do and do not stutter with low and high FNE interpret social situations similarly, and that no group demonstrated a negative interpretation bias consistent with what is observed in adults with SAD. The interpretations provided by each group were appropriate to the specific scenarios being evaluated.

Preliminary study of self-perceived communication competence amongst adults who do and do not stutter

PURPOSE

Adults who stutter report a significant impact of stuttering on their quality of life, including negative thoughts and attitudes toward communication. In addition to this impact, adolescents who stutter also report lower levels of self-perceived communication competence (SPCC) compared to fluent peers. The purpose of this study was to extend the investigation of SPCC to adults who do and do not stutter. Additional aims investigated included if 1) SPCC predicted overall impact of stuttering, and, 2) stuttering frequency predicted SPCC among adults who stutter.

METHODS

Twenty-four adults who stutter and twenty-seven adults who do not stutter matched for age, gender, and education completed the Self-Perceived Communication Competence Scale (Richmond & McCroskey, 1997). All participants who stutter completed the Overall Assessment of the Speaker's Experience of Stuttering (OASES [ages 18+]; Yaruss & Quesal, 2006) and speaking samples to measure stuttering frequency.

RESULTS

Adults who stutter reported significantly lower SPCC scale total scores than adults who do not stutter. For adults who stutter, lower SPCC scale scores significantly predicted more severe overall impact of stuttering as measured by the OASES. Stuttering frequency did not predict SPCC scale scores.

DISCUSSION

This is the first study to report differences in self-perceived communication competence between adults who do and do not stutter. Results suggest adults who stutter report lower self-perceived communication competence compared to adults who do not stutter. Adults who perceive themselves to have greater communication competence reported less severe overall impact of stuttering, and stuttering frequency did not influence SPCC. Clinical implications for intervention are discussed.

Relationships between stigma-identity constructs and psychological health outcomes among adults who stutter

PURPOSE

In the current study, stuttering was conceptualized as a concealable stigmatized identity (CSI). The purpose of this investigation was to determine if four specific stigma-identity constructs that contribute to variability in psychological distress among people in other CSI groups also contribute among adult who stutter (AWS).

METHOD

505 AWS completed an online survey that included measures of four stigma-identity constructs in addition to general demographics and measures of self-rated stuttering severity, distress, and adverse impact of stuttering on quality of life. Hierarchical regression was performed to determine the extent that stigma-identity constructs explained variability in psychological health outcomes among AWS. Self-rated stuttering severity was investigated as a moderator in these relationships.

RESULTS

The stigma-identity constructs accounted for a significant proportion of the variability in distress (∼25 %) and adverse impact of stuttering on quality of life (∼30 %) among AWS. Further, the constructs of salience, centrality, and concealment were positively predictive of distress and adverse impact of stuttering after controlling for demographics and neuroticism. Compared to the other predictor variables (self-rated stuttering severity, demographic characteristics, neuroticism, and the three other stigma-identity constructs), concealment was the strongest predictor of adverse impact of stuttering on quality of life. Finally, self-rated stuttering severity was a moderating variable.

CONCLUSIONS

The results from this study suggest that there are useful applications in conceptualizing stuttering as a type of CSI. Speech-language pathologists should be aware of the relationships that stigma has with psychological health outcomes among AWS and should consider the implications for intervention.

Burn self-stigma: A hybrid concept analysis

AIM

As burn self-stigma has not been addressed fully, the purpose of current study is to analyze dimensions of the concept using literature and lived experiences in burn survivors.

METHODS

Using hybrid concept analysis method, we investigated self-stigma in three phases (i.e. theoretical, fieldwork, and final analytical phase). In the first phase we reviewed the literature using PubMed, SCOPUS, Web of Science, Cochrane Library, OVID, SID and Google Scholar. Thirteen semi-structured interviews with burn survivors were conducted during the fieldwork phase. Two extra interviews with health care providers were undertaken for the aim of data triangulation. Textual content analysis and inductive content analysis were used to analyze the data of the first and second phases of this study, respectively. The findings of both phases were combined in the final analytical phase and a comprehensive definition was emerged.

RESULTS

We assigned all our findings into three content areas (i.e. antecedents, properties and consequences), which are dimensions of self-stigma. In final analytical phase antecedent, properties and consequences of the concept were formed in one (society's misconception about burns), three (negative definition of self, emotional responses, and behavioral responses), and three (negative individual effects, negative social effects, and negative familial effects) categories, respectively. Based on these categories and their corresponding subcategories, a comprehensive definition of the concept was presented.

CONCLUSION

Burn self-stigma is a state in which burn survivors experience unfavorable thoughts and feelings about themselves as a result of society's misconceptions about them. They give emotional and behavioral responses that define them in a negative way. In the end, the burn survivor's individual, familial, and social dimensions are significantly impacted.

Consensus Guidelines for the Assessments of Individuals Who Stutter Across the Lifespan

Purpose This project sought to develop consensus guidelines for clinically meaningful, comprehensive assessment procedures for people who stutter across the lifespan. Method Twelve expert clinicians and researchers who have written extensively about stuttering provided detailed descriptions of the type of data that they routinely collect during diagnostic evaluations of preschool children, school-age children, adolescents, and adults who stutter. Iterative content analysis, with repeated input from the respondents, was used to identify core areas that reflect common domains that these experts judge to be important for evaluating stuttering for varying age groups. Results Six core areas were identified as common components of a comprehensive evaluation of stuttering and people who stutter. These areas should be included to varying degrees depending upon the age and needs of the client or family. The core areas include the following: (a) stuttering-related background information; (b) speech, language, and temperament development (especially for younger clients); (c) speech fluency and stuttering behaviors; (d) reactions to stuttering by the speaker; (e) reactions to stuttering by people in the speaker's environment; and (f) adverse impact caused by stuttering. Discussion These consensus recommendations can help speech-language pathologists who are uncertain about appropriate stuttering assessment procedures to design and conduct more thorough evaluations, so that they will be better prepared to provide individualized and comprehensive treatment for people who stutter across the lifespan.

Evaluation of an integrated fluency and Acceptance and Commitment Therapy intervention for adolescents and adults who stutter: Participant perspectives

PURPOSE

Childhood-onset stuttering is a neurodevelopmental disorder that may cause pervasive negative consequences for adults who stutter. In addition to significant challenges in personal, social, and emotional domains, stuttering has been shown to impose an economic burden on adults who stutter. Intervention for adults who stutter has historically addressed speech fluency more so than the covert psychosocial aspects of the disorder. There is an identified clinical need for holistic, efficacious, and cost-effective stuttering interventions that meet consumer needs. The purpose of the present study is to evaluate a novel, integrated intervention that combined traditional fluency techniques with Acceptance and Commitment Therapy, from the perspective of the adults who stutter who participated in the intervention.

METHOD

Twenty-eight adults who stutter completed the intervention program. Participants were invited to complete an online post-program written survey (including qualitative comments) and a semi-structured interview to explore their evaluations of the program with respect to its authenticity, acceptability, and social validity.

RESULTS

Participants perceived positive psychosocial changes as a result of the program, and were satisfied with the program overall. Qualitative thematic analyses of the written survey comments and the semi-structured interviews identified two major themes: factors specific to the intervention and factors specific to the therapeutic process. Several important sub-themes were also identified.

CONCLUSION

Findings support the authenticity, acceptability, and social validity of an integrated fluency and psychosocial intervention for stuttering. Findings also highlight the need for consideration of the consumer voice in the management of stuttering disorders, in keeping with person-centred care.

Temperament is Linked to Avoidant Responses to Stuttering Anticipation

PURPOSE

The purpose of the present study was to examine the degree to which certain temperament constructs predict individual differences in three types of behavioral responses to anticipation among children and adults who stutter (CWS and AWS, respectively): avoidance, physical change, and approach.

METHODS

Participants included 64 CWS (9- to 17-years-old) and 54 AWS (18- to 50-years-old) who completed an online survey package including a temperament questionnaire (Early Adolescent Temperament Questionnaire-Revised for the CWS; Adult Temperament Questionnaire for the AWS) and the Stuttering Anticipation Scale. The data were analyzed separately for CWS and AWS using multivariate multiple regressions to assess how each temperament construct predicted avoidance, physical change, and approach responses to anticipation.

RESULTS

CWS who reported higher levels of shyness were more likely to engage in avoidant behavioral responses when they anticipate an upcoming moment of stuttering. AWS who reported higher levels of orienting sensitivity were more likely to engage in avoidant behavioral responses when they anticipate an upcoming moment of stuttering. No temperament constructs predicted physical change or approach responses to anticipation among either age group.

CONCLUSION

Specific aspects of temperament appear to be linked to the degree that CWS and AWS engage in avoidant behavioral responses to stuttering anticipation. These findings support the continued study of how individual differences impact the internal experience and outward manifestation of stuttering behaviors.

A Framework for a Sociological Description of the Communicative Interaction in Adults Who Stutter

Purpose The author presents a descriptive sociological framework for the communicative interaction between an adult who stutters (AWS) and other communication partners. The author shows that the communicative interaction between an AWS and another interactant is a sociological object that can be evaluated by both parties in real-time, and is impacted by settings, participants, identity, stigmatization, and the type of talk. These elements are consistent with Hymes' SPEAKING model, which was developed to describe speech communication in a social context and can lay the foundation for the development of an ethnography of stuttering. The clinical applications and implications of a sociological framework are discussed and future directions for research are suggested. Method This work is a refinement and enhancement of Mancinelli (2018) and Mancinelli (2019) and the research associated with that work. This is a tutorial with a clinical focus designed to introduce the readership to a sociological perspective on communicative interactions in AWS. Conclusions Stuttering is an emergent phenomenon embedded within a social interaction, necessitating a deeper understanding of the processes at work during those interactions. A sociological framework can provide a more comprehensive description of the communicative interactions as well as the sociocommunicative lives of people who stutter. The information obtained can inform the formulation of realistic, functional goals based on the daily life of the client. Implications for the development of an ethnography of stuttering are discussed.

Larger reported impact of stuttering in teenage females, compared to males - A comparison of teenagers' result on Overall Assessment of the Speaker's Experience of Stuttering (OASES)

PURPOSE

The aim of this cross-sectional study was to explore the impact and experience of stuttering, and attitude to communication for female and male teenagers who stutter (TWS) in comparison with teenagers with no stutter (TWNS).

METHODS

The Swedish version of the Overall Assessment of the Speaker's Experience of Stuttering (OASES-T-S), was administered to 56 TWS, 13-17 years old (26 females, 30 males). An adapted version of OASES, Attitude to Speech and Communication (ASC), was administered to 233 TWNS. The impact scores were analyzed in relation to sex in TWS and TWNS.

RESULTS

Female TWS reported that stuttering had a greater impact on their life than it did on male TWS (on average 0.5 higher impact scores; Hedges' g = 0.87). The differences did not seem to be caused by differences in severity of overt stuttering symptoms. Female and male TWS particularly differed on items related to difficulties in day-to-day communication and affective/behavioral reactions to stuttering. Such sex differences were not as pronounced among TWNS, suggesting that teenage women may be more vulnerable to the negative impact of stuttering than men the same age.

CONCLUSION

Female teenagers report more negative experiences and a greater tendency to use avoidance strategies than male teenagers.

Quality and readability of internet information about stuttering

PURPOSE

We examined the quality and readability of English-language Internet information about stuttering and evaluated the results considering recommendations by experts in health literacy.

METHOD

A search of Internet websites containing information about stuttering was conducted. Three key words (i.e., stuttering, stammering, speech disfluency) were entered into five country-specific versions of the most commonly used Internet search engine. A total of 79 websites were assessed. Their origin (commercial, non-profit, government, personal or university), quality [Health On the Net (HON) certification and DISCERN scores], and readability [Flesch Reading Ease (FRE) score, Flesch-Kincaid Grade Level Formula (F-KGL), and Simple Measure of Gobbledygook (SMOG)] were assessed.

RESULTS

Of the 79 websites, 38 % were of commercial, 42 % were of nonprofit organization, 15 % were of government and 5% were of university origins, respectively. Only 13 % had obtained HON certification and the mean DISCERN scores was 3.10 in a 5-point scale. The mean reading grade levels were at 13th and 14th grade and 100 % of the websites exceeded the recommended 5th to 6th reading grade level for health information.

CONCLUSIONS

The quality of Internet-based health information about the treatment of stuttering is generally adequate, but actual usability of the sites examined in this study may be limited due to poor readability levels. This is problematic in persons with poor literacy skills. Since the Internet can be readily accessed as a valuable consumer information resource, speech-language pathologists and other healthcare professionals have an opportunity to direct consumers to websites that provide readable information of good quality.

Speech and Anxiety Management With Persistent Stuttering: Current Status and Essential Research

Purpose The purpose of this review article is to provide an overview of the current evidence base for the behavioral management of stuttering and associated social anxiety. Method We overview recent research about stuttering and social anxiety in the context of contemporary cognitive models of social anxiety disorder. That emerging evidence for self-focused attention and safety behavior use with those who stutter is considered in relation to current treatment approaches for stuttering: speech restructuring and social anxiety management. Results The emerging information about social anxiety and stuttering suggests a conflict between the two clinical approaches. For those clients who wish to control their stuttering and where speech restructuring is deemed the most suitable approach, it is possible that speech restructuring may (a) induce or increase self-focused attention, (b) promote the use of safety behaviors, and (c) become a safety behavior itself. This conflict needs to be explored further within clinical and research contexts. Conclusions The issues raised in this review article are complex. It appears that evidence-based speech treatment procedures are in conflict with current best-practice treatment procedures that deal with social anxiety. In this review article, we propose directions for future research to inform the development of improved treatments for those who stutter and recommendations for interim clinical management of stuttering.

Societal knowledge of stuttering in Saudi population

Stuttering is a common disease that exists in all societies and ethnic groups of differing incidence rates. The aim of this study was therefore to investigate the social awareness of stuttering in the Saudi community on the basis of a questionnaire. We will try to examine the incidence, triggers and duration of stuttering in the Saudi community. This study is descriptive, a questionnaire-based analysis involving the active participation of the Saudi community. The questionnaire, exposure to Stuttering, was addressed and balanced in terms of ethnicity, age and schooling. A total of 1,000 Saudi people was invited to participate in this questionnaire-based survey, with only 878 participants between 18 and 65 years of age participating in the study; most of them were males. In this survey, 79.5% of the Saudi population studies, most of them male (60.5% vs. 25.0% female) claimed that more than 6% of the population had stutters. There was also a substantial correlation between the degree of schooling, sex, and person experience and attitudes towards stuttering. It was often assumed that younger ages were prone to higher instances of stuttering relative to older ages (≤18 years vs 18 years of age). In comparison, handiness and IQ scores did not indicate any correlation with the occurrence of stuttering among the Saudi community. In conclusion, this questionnaire-based analysis, participants of both sexes claimed that more than 6% of the Saudi population were impaired by stuttering, which increased dramatically in males relative to females. They also claimed that both handiness and IQ ratings had little impact on the rate of stuttering. However, scant research on the effects of stuttering has scarcely been reported. Future experiments of effective public education preparation and health actions for stuttering are also welcome.

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.

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.

The Utility of Cinematherapy for Stuttering Intervention: An Exploratory Study

This preliminary study explored the feasibility and benefits of using cinematherapy with adults who stutter to address affective and cognitive reactions to stuttering and their impact on the persons' life. A mixed methods research design was used to explore the impact of cinematherapy. Four clients completed a 4-week structured cinematherapy program. All clients completed two questionnaires: Unhelpful Thoughts and Beliefs about Stuttering and Overall Experience of the Speaker's Experience of Stuttering, before starting and after completing the program. At the end of the program, clients also completed a semistructured interview. The semistructured interviews provide insight on clients' perceptions of cinematherapy, and questionnaires provided quantitative insights on the clients' perceptions of change. Qualitative data analysis indicated that clients reported five themes related to perceptions of cinematherapy: Promoted Vulnerability; Nurtured Empowerment; Stimulated Self-Reflection; Incited Feelings of Belonging; and Diminished Self-Stigma. Overall, clients reported a clinically significant decrease in scores on both questionnaires after completion of the 4-week cinematherapy program. Results indicate that cinematherapy was well received and had a positive impact on cognitive and affective aspects of stuttering in the four adult clients. These results provide preliminary support for larger scale clinical trials of cinematherapy as an adjuvant to traditional stuttering therapy.

Disclosure of a communication disorder during a job interview: A theoretical model

With the passage of the Americans with Disabilities Act Amendments Act of 2008 (ADAAA), the definition of disability was expanded and the terms "speaking, hearing, and communicating" were given status as major life activities. Therefore, any communication disorder which substantially limits these major life activities in the workplace can qualify as a disability under the law. This legal protection means that no employer can ever ask about the presence of a communication disorder, and a job applicant is never required to disclose their communication disorder during the hiring process. However, this right to refrain from disclosure potentially places job applicants in a difficult situation. Applicants can choose to remain silent about their disorder and hopefully avoid hiring discrimination, yet the only way that workplace accommodations can be legally requested is if disclosure of the disability takes place. This disclosure decision-making process is likely complex and dependent upon multiple factors. Aspects such as workplace culture, job duties, severity of symptoms, individual motivations, and characteristics of the communication disorder likely all play a role when weighing the decision to disclose. This article proposes a theoretical model which outlines the factors that might influence the disclosure decision-making process for those with communication disorders before a job interview. Each major component of this decision-making process is highlighted, focusing on which factors might inhibit or foster disclosure within a hiring context. Clinical implications are discussed which can allow speech-language pathologists to assist those who are struggling with this important decision. The article also identifies areas in need of future research.

Psychological correlates of biological and non-biological explanations for stuttering

Purpose: This study examined whether people who stutter would associate biological and non-biological explanations of stuttering with the endorsement of stereotypes about people who stutter, prognostic expectations for the reduction of stuttering, feelings of guilt, self-blame, and shame about stuttering, and agency for speech modification.Method: This was a cross-sectional study including 372 adults who stutter. Participants completed a web survey with scales that measured their agreement with biological and non-biological models of stuttering; their endorsement of common stereotypes for people who stutter; prognostic expectations for reduced stuttering; feelings of guilt, self-blame, and shame about stuttering; and feelings of agency in their ability to modify their speech.Result: Biological explanations for stuttering were significantly correlated with reduced stereotype endorsement about people who stutter, lower prognostic expectations for reducing stuttering, and reduced feelings of guilt and self-blame regarding stuttering. Non-biological explanations for stuttering were significantly correlated with increased endorsement of negative stereotypes about people who stutter, increased prognostic expectations for reducing stuttering, and increased feelings of guilt, self-blame, and shame about stuttering.Conclusion: It is concluded that the implications of biological framing of stuttering among people who stutter are complex and should be well thought out by professionals. Explaining stuttering as biological, but responsive to personal and environmental influences, may lead to reduced guilt and self-blame, while at the same time fostering feelings of agency for speech modification.

The Speaker's Experience of Stuttering: Measuring Spontaneity

Purpose This study measures the experience of spontaneous speech in everyday speaking situations. Spontaneity of speech is a novel concept developed to account for the subjective experience of speaking. Spontaneous speech is characterized by little premeditation and effortless production, and it is enjoyable and meaningful. Attention is not directed on the physical production of speech. Spontaneity is intended to be distinct from fluency so that it can be used to describe both stuttered and fluent speech. This is the first study to attempt to measure the concept of spontaneity of speech. Method The experience sampling method was used with 44 people who stutter. They were surveyed five times a day for 1 week through their cell phones. They reported on their perceived spontaneity, fluency, and speaking context. Results Results indicate that spontaneity and fluency are independent, though correlated, constructs that vary with context. Importantly, an increase in spontaneity significantly decreases the adverse impact of stuttering on people's lives. Fluency did not significantly affect adverse life impact of stuttering. Conclusion Findings support a theoretical construct of spontaneity that is distinct from speech fluency and that can inform our views of stuttering and approaches to stuttering treatment.

Repetitive Negative Thinking, Temperament, and Adverse Impact in Adults Who Stutter

Purpose Prior research has explored how repetitive negative thinking (RNT) contributes to both the increased persistence and severity of various disorders, such as depression, anxiety, and eating disorders. This study explored the potential role of RNT in the experience of stuttering, with a particular focus on the relationship between RNT, adverse impact, and certain temperament profiles. Method Three hundred thirteen adults who stutter completed a measurement of the frequency/severity of RNT (Perseverative Thinking Questionnaire; Ehring et al., 2011), 207 completed a temperament profile (Adult Temperament Questionnaire; Evans & Rothbart, 2007), and 205 completed a measurement of adverse stuttering impact (Overall Assessment of the Speaker's Experience of Stuttering; Yaruss & Quesal, 2016). Analyses were conducted within and across instruments to ascertain how RNT, temperament markers, and adverse impact interrelate within individuals. Results Results indicated that RNT significantly predicts Overall Assessment of the Speaker's Experience of Stuttering impact scores with great effect and that certain temperament markers (specifically, Effortful Control and Negative Affectivity) moderate this relationship for specific sections of the Overall Assessment of the Speaker's Experience of Stuttering. Conclusion By assessing RNT in people who stutter, clinicians can better understand individual differences in their clients, and this will allow them to make targeted diagnoses and develop more tailored intervention plans.

Group Experiences and Individual Differences in Stuttering

Purpose This study explored group experiences and individual differences in the behaviors, thoughts, and feelings perceived by adults who stutter. Respondents' goals when speaking and prior participation in self-help/support groups were used to predict individual differences in reported behaviors, thoughts, and feelings. Method In this study, 502 adults who stutter completed a survey examining their behaviors, thoughts, and feelings in and around moments of stuttering. Data were analyzed to determine distributions of group and individual experiences. Results Speakers reported experiencing a wide range of both overt behaviors (e.g., repetitions) and covert behaviors (e.g., remaining silent, choosing not to speak). Having the goal of not stuttering when speaking was significantly associated with more covert behaviors and more negative cognitive and affective states, whereas a history of self-help/support group participation was significantly associated with a decreased probability of these behaviors and states. Conclusion Data from this survey suggest that participating in self-help/support groups and having a goal of communicating freely (as opposed to trying not to stutter) are associated with less negative life outcomes due to stuttering. Results further indicate that the behaviors, thoughts, and experiences most commonly reported by speakers may not be those that are most readily observed by listeners.

Stuttering as Defined by Adults Who Stutter

Purpose Numerous frameworks and definitions have sought to differentiate what behaviors and experiences should be considered as a part of stuttering. Nearly all of these efforts have been based on the perspectives and beliefs of conversational partners and listeners. This outside-in approach to defining stuttering lacks validation from people who live with the condition. Method In this study, 430 adults who stutter participated in a qualitative exploration of the term stuttering. Data were analyzed thematically to determine speakers' perspectives about moment of stuttering and the overall experience of stuttering in their lives. Results To adults who stutter, the term stuttering signifies a constellation of experiences beyond the observable speech disfluency behaviors that are typically defined as stuttering by listeners. Participants reported that the moment of stuttering often begins with a sensation of anticipation, feeling stuck, or losing control. This sensation may lead speakers to react in various ways, including affective, behavioral, and cognitive reactions that can become deeply ingrained as people deal with difficulties in saying what they want to say. These reactions can be associated with adverse impact on people's lives. This interrelated chain of events can be exacerbated by outside environmental factors, such as the reactions of listeners. Discussion Data from this survey provide novel evidence regarding what stuttering means to adults who stutter. These data are used to update the adaptation of the World Health Organization's International Classification of Functioning, Disability and Health as it applies to stuttering (Yaruss & Quesal, 2004) to better account for the complex and individualized phenotype of stuttering and to develop a definition of the experience of stuttering that is based not only on the observations of listeners but also on the impact of stuttering on the lives of adults who stutter.

Swedish outcomes of the Overall Assessment of the Speaker's Experience of Stuttering in an international perspective

Aim: The purpose of the present project was to translate the Overall Assessment of the Speaker's Experience of Stuttering (OASES) to Swedish, and to compare the results with available international data.Method: The Swedish versions of OASES-A, OASES-T and OASES-S were administered to 80 adults, 27 teenagers and 32 children who stutter, respectively. The overall impact scores and the impact scores for each of the four sections of the instrument were analyzed in relation to other studies involving the OASES.Results: The results revealed that all three Swedish versions of OASES had normally distributed outcomes and that they were reliable and valid. The overall impact scores for adults (2.33), teenagers (2.60) and children (2.28) all fell within Impact Rating Moderate. The mean overall impact score for OASES-A-S was significantly lower than corresponding data from USA, Australia and Japan (p < .01). There was no difference between Swedish and American teenagers, or between Swedish and American or Dutch schoolchildren.Conclusion: There seems to be cultural differences in the experience of negative consequences associated with stuttering. This suggests that cultural aspects should be carefully considered in assessment, treatment, and research involving individuals who stutter.

Self-efficacy beliefs: Experiences of adults who stutter

PURPOSE

Childhood-onset stuttering is a complex and multifaceted disorder. Intervention for adults who stutter has historically addressed speech fluency more so than psychosocial aspects of the disorder, including the nature of the individual's self-efficacy beliefs concerning their confidence in their capacity to enact change. Self-efficacy is an important construct related to quality of life, resilience, and maintenance of treatment gains for adults who stutter. The purpose of this qualitative study is to explore the nature of the self-efficacy beliefs expressed by adults who stutter in order to inform efficacious and holistic intervention for these individuals.

METHOD

Semi-structured interviews were conducted with 29 adults who stutter to describe their experiences as a person who stutters and elucidate the nature of their self-efficacy beliefs.

RESULTS

Thematic analysis identified several major themes that provided novel insight into the complex nature of the self-efficacy beliefs experienced by adults who stutter: speaker experiences shaped communicative confidence, there was a conflict between communication and fluency, stuttering was viewed as more than fluency, and individual perspectives shaped communicative confidence, as did the pervading influence of self. The notion that fluency and confidence are inextricably linked was evident within and across each major theme.

CONCLUSION

These preliminary findings provide further support for a multidimensional approach to the treatment of adults who stutter. Findings will be used to inform a novel integrated fluency and psychosocial intervention for adults who stutter that addresses fluency and self-efficacy concurrently, with a view of engendering durable improvements in speech fluency and communicative confidence.

The effects of self-disclosure on the communicative interaction between a person who stutters and a normally fluent speaker

PURPOSE

The purpose of this study was to investigate the effects of self-disclosure on the self-perception of stuttering severity, comfort, cognitive effort, and anxiety in a structured conversational interaction with a normally fluent speaker. The benefit of self-disclosure from the perspective of the person who stutters in a self-disclosed and in a non-disclosed condition was also studied. The total syllables produced and percent syllables stuttered were measured in both experimental conditions in order to evaluate the effects on the amount of speech produced and verbal fluency.

METHODS

Twenty-five adults who stutter were recruited in Philadelphia and New Jersey, through social media, university clinics, and National Stuttering Association (NSA) self-help groups. The participants engaged in a conversational task with a normally fluent speaker (NFS). The cognitive-affective variables (self-perception of stuttering severity, comfort, cognitive effort, anxiety and benefit) were measured using self-report questionnaires completed after each condition. The percent syllables stuttered and total syllables in each condition were also transcribed and analyzed.

RESULTS

Frequency distributions of Likert Scale ratings indicated a slight preference for self-disclosure over non-disclosure, but there was a non-significant difference on the benefit variable for the disclosed and non-disclosed conditions. There were correlations between total syllables produced and percent syllables stuttered and comfort, in the non-disclosed state only. Other findings included non-significant differences for the cognitive-affective variables across conditions.

CONCLUSION

From the perspective of the person who stutters, self-disclosure at the outset of the communicative interaction did not have a decisive impact on the cognitive-affective or speech variables.

Self-stigma among Korean patients with diabetes: A concept analysis

AIMS AND OBJECTIVES

To conduct a concept analysis of self-stigma among patients with diabetes and introduce an operational definition of self-stigma.

BACKGROUND

Due to fears of being monitored, patients with diabetes often conceal their disease and/or withdraw from social relationships. These behaviours negatively affect patients' self-care and socialisation.

DESIGN

A concept analysis was conducted using a three-phase (theoretical phase, fieldwork phase and final analysis phase) hybrid method by Schwartz-Barcott and Kim (Nursing research methodology: Issues and implementations, 1986, Rockville, MD: Aspen).

METHODS

During the theoretical phase, a literature search was conducted using PubMed and CINAHL. Using COREQ guidelines, in the fieldwork phase, in-depth interviews were conducted with nine participants with diabetes. The recorded data were analysed using a grounded theory approach. Results from both were included in the analytic phase.

RESULTS

In the fieldwork phase, nine patients with diabetes (four men and five women; mean age = 57.00 ± 21.93 years) participated in the interview. The mean duration of diabetes was 21.44 ± 12.39 years. The self-stigma concept included three categories with nine attributes: affective (negative feelings and feeling sorry for others who have concerns about me), cognitive (low self-esteem and self-efficacy, perceived weakness, low expectations for the future, worry for children and disease burden) and behavioural factors (social withdrawal and avoiding disease disclosure). The nine attributes included 23 indicators.

CONCLUSIONS

Self-stigma among patients with diabetes is defined as a state in which patients develop negative self-feelings as they deal with the disease. This can cause diminished self-esteem and self-efficacy, as well as a tendency to avoid disclosing the illness along with social withdrawal.

RELEVANCE TO CLINICAL PRACTICE

Based on this self-stigma concept analysis, we clarified the attributes of diabetes self-stigma and distinguished it from social stigma in nurse professionals during patient education and clinical assessment.

Disclosure of stuttering and quality of life in people who stutter

PURPOSE

This study investigated the disclosure practices of people who stutter, and the relationship between disclosure of stuttering and quality of life.

METHOD

Participants were 322 adults who stutter recruited from speech-language pathologists and support group leaders. Participants completed a survey that contained items measuring level of disclosure of stuttering, as well as a global measure of self-rated quality of life. Participants were grouped into low, average, and high quality of life subgroups. Analysis of variance tests compared disclosure levels among these subgroups.

RESULTS

The low quality of life subgroup reported significantly lower levels of disclosure compared to both the average and high quality of life subgroups. Participants with self-help/support group experience for stuttering demonstrated significantly higher levels of disclosure of stuttering compared to individuals without such experience. In addition, a substantial number of participants in the overall sample reported that they more than rarely feel the need to conceal stuttering from others (40%), and that no one knows that they stutter in many areas of life (37%).

CONCLUSIONS

Attempts to conceal stuttering in at least some life situations are not uncommon among adults who stutter. However, being involved in self-help support groups may be a helpful way of increasing disclosure of stuttering. Speech-language pathologists should become aware of the positive relationship between disclosure of stuttering and quality of life and its relevance in assessment and treatment when working with people who stutter.

Self-report of self-disclosure statements for stuttering

PURPOSE

To (1) analyze verbatim wording used by adults who stutter (AWS) to self-disclose stuttering, (2) determine contexts in which AWS may self-disclose, (3) examine the use of self-disclosure by AWS about other aspects of their identity, and (4) investigate the ways in which speech-language pathologists (SLPs) develop self-disclosure statements with AWS.

METHOD

Web-based questionnaires were administered to AWS (N = 42) and SLPs (N = 33) who work with AWS. The AWS questionnaire asked about the verbatim wording of self-disclosure statements used by AWS and the contexts in which they utilize them. For SLPs, the questionnaire probed how and why they work with AWS to formulate self-disclosure statements. Responses were openly coded and then funneled into concepts for analysis.

RESULTS

The majority of AWS provided verbatim self-disclosure statements which were educational in nature. However, when responding to fixed choices and when reporting on self-disclosing other aspects of their lives, the majority of participants selected a direct statement. The majority of AWS reported that they self-disclose when interviewing for a job. SLPs reportedly instruct their clients to use educational self-disclosure statements. SLPs also reported that they use an individualized approach to brainstorming self-disclosure statements. Finally, SLPs reported that they find self-disclosure beneficial because it facilitates self-empowerment for AWS.

CONCLUSION

AWS may benefit from learning about the type of self-disclosure statements and the contexts in which other AWS chose to disclose. Additionally, SLPs who work with AWS may benefit from the reported procedures for and types of self-disclosure statements formulated by AWS.

Changing Nonstuttering Preschool Children's Stuttering Attitudes

PURPOSE

Negative or uninformed stuttering attitudes proliferate among the general public, and bourgeoning research has shown that such attitudes might emerge as early as the preschool years. Much remains unknown about young children's stuttering attitudes, and conclusive recommendations to improve attitudes toward stuttering have yet to be advanced. This study sought to determine the effect of a new educational program on improving stuttering attitudes among preschool children using objective measures.

METHOD

Thirty-seven preschool children learned about stuttering and sensitive peer interactions by participating in the newly developed Attitude Change and Tolerance program. The program teaches children about human differences with an emphasis on stuttering and how to interact with people who stutter. Children's stuttering attitudes were measured using the Public Opinion Survey of Human Attributes-Stuttering/Child (Weidner & St. Louis, 2014) before and after the program.

RESULTS

Pre-post comparisons showed statistically significant improvements in children's overall stuttering attitudes. In particular, children demonstrated gains relative to their perceptions of and reactions toward people who stutter.

CONCLUSION

This study provides empirical evidence that young children's stuttering attitudes can be improved using the Attitude Change and Tolerance program. In addition, it supports previous research that negative stuttering attitudes emerge as early as preschool.