Assessing the Affective, Behavioral, and Cognitive Dimensions of Stuttering in Young Children Barbara Mathers-Schmidt, Ph.D., CCC-SLP Western Washington University Barbara.Mathers-Schmidt@wwu.edu It has long been recognized that an individual's reactions to stuttering likely influence the development and severity of the stuttering disorder. Several researchers have designed instruments that assess this aspect of stuttering. Instruments for the adult population include the widely used "Modified Erickson Scale," also known as the S24 Scale (Andrews and Cutler, 1974). The scale was devised by Erickson (1969) to assess stutterers' communication attitudes. Ingham (1979) warned that responses to the items on the S24 Scale might simply reflect the speaker's judgment of current situational speech performance. Watson (1987) was the first to interpret this shortcoming in terms of a failure to distinguish among the affective, behavioral, and cognitive dimensions of communication attitudes. More recently, Yaruss, Quesal, King, and Schaffner (1998) reported developing instruments for assessing adult speakers' reactions to stuttering (the affective, behavioral, cognitive, and attitudinal aspects of the experience) and the degree of disability and handicap that the speaker experiences in association with stuttering. The relationship between mal-attitude and stuttering in children has been studied fairly extensively using the Communication Attitude Test (e.g., Brutten & Dunham, 1989; DeNil & Brutten, 1991; Vanryckeghem & Brutten, 1992, 1996, 1997). This 35-item questionnaire has been administered to both grade school children who stutter and children with normal speech. Another questionnaire, the Speech Situation Checklist (SSC) (Brutten, 1965; Vanryckeghem et al., 2001) explores how negative emotion and dysfluency are related in specific situations. As a group, the CAT and SCC studies have demonstrated that children who stutter view speaking more negatively and experience more negative speech-related emotions than do their fluent peers. The findings support the need for addressing emotional aspects of communication, in addition to the stuttering behaviors, when providing assessment and intervention for children who stutter. As we expand our understanding of the scope of childhood stuttering, the contributions and limitations of these early studies should be considered. For example, Ingham (1997) questioned the validity of research that utilized the C.A.T., noting that the questions may elicit situational performance judgments rather than an indication of overall speech attitude. Furthermore, Watson s recommendations for a broader assessment of reactions to stuttering should be considered when assessing children s communication attitudes. Researchers also should demonstrate the content, criterion, and construct validity of such assessment tools. Other areas to address include response option format, item/response content, reliability estimates, and appropriate statistical analyses.
2 The present study involved the development of an assessment tool to measure the speech-related attitudes of elementary school children (K-5). The purpose of the study was to identify the affective, behavioral, and cognitive aspects of communication attitudes in elementary school-aged children who stutter, and to determine if their attitude profiles differ from those of children with normal communication skills. The reliability of the "Self-Ratings of Affective, Behavioral, and Cognitive Dimensions of Speaking Scale" assessment tool was determined as well. Participants 14 elementary school children who stutter 9 males and 5 females from grades K-5 (ages 6-11 years old) Currently being seen for stuttering intervention in the school setting Perform at age level in their classrooms (by teacher report) History of disfluency (determined by SLP screening; teacher report; parent report) 14 age and gender matched peers with normal communication skills (control group) Assessment Instrument Self-Ratings of Affective, Behavioral, and Cognitive Dimensions of Speaking Scale (ABC Scales) consists of 65 items. Child is instructed to "Point to the picture that best describes you" in response to each test question. Response format is based on a Likert-type scale with icons indicating the range of responses, and words plus icons anchoring the ends of the response scale. Affective Component Speaking Situation Subscale Speaking Comfort Level Subscale (Example: "How do you usually feel about how you talk when you ask a question in class?" Child points to one of the icons ranging from "really bad" to "really good.") Behavioral Component Frequency of Behaviors Subscale Overall Severity Subscale Cognitive Component Self-perception Subscale Listener Perception Subscale Both the similar response formats across subscales and the parallel structure of questions within subscales promote the efficiency of test administration. At several stages of development the test items have been reviewed for age appropriateness, clarity, and content validity.
3 Procedure Data Analysis SLP graduate students administered the ABC Scales individually to elementary school-aged participants. Two sample questions per subsection oriented the child to the response task. Each question was read aloud to the child. The child responded to the question by pointing to the response icon which best depicted the child's feelings, behaviors, or thoughts. Children in grades K-2 used a 3-point response scale, whereas children in grades 3-5 used a 5-point response scale. The order of subtest presentation was varied. Scale values, ranging from 0 to 4, were assigned to each response (0=positive response and 4=maximum negative response). Intra- and interjudge reliability were 100% for response scoring accuracy. Test-retest reliability correlation coefficients were r=.813 overall, and r=.740 and r=.951 for CWS and NS, respectively. Scores differed by more than 2 points on only 6 of 295 responses for CWS and on only 1 of 160 responses for NS. ABC totals were 474 and 448 for CWS, and 124 and 118 for NS on the original set of responses and the retest set, respectively. Results The group means and standard deviations for subtest scores and total ABC scores are presented in Table 1. A paired-samples t-test was used to determine the statistical significance of the group differences. Significant differences between children who stutter (CWS) and matched control subjects (NS) were found on the overall ABC score, each dimension (affective, behavioral, cognitive domains), and for each subtest (two per domain). These results are presented in Table 2. The individual ABC scores of age-matched pairs are presented in Figure 1. In all but one pair, the child who stuttered had a higher total score than the nonstuttering peer. Discussion Results suggest that the ABC Scales provide a reliable means of assessing the affective, behavioral, and cognitive dimensions of stuttering in young children. In the present study, children who stuttered had more negative emotions, negative behavioral experiences, and negative thoughts about communication than did their non-stuttering peers. These results are consistent with other studies that have shown that children who stutter may have developed a mal-attitude toward communication. The level of detail provided by administering the ABC Scales will guide clinicians in addressing these important aspects of the stuttering disorder. Additional research, involving a large number of children from a wide geographic region, is underway.
4 Table 1. Means and standard deviations of children who stutter (CWS) and matched control subjects (NS) on subtests of the Self-Ratings of Affective, Behavioral, Cognitive Dimensions of Speaking Scale. CWS Mean NS Mean CWS SD NS SD A1 15.79 9.79 6.52 3.87 A2 20.5 12.07 12.38 7.42 Total A 36.29 21.86 17.73 9.82 B1 31.29 18.79 9.48 9.11 B2 18.43 10.14 4.88 5.61 Total B 49.71 28.93 13.08 12.8 C1 9.64 3.71 5.11 2.7 C2 6.57 1.64 4.27 1.78 Total C 16.21 5.36 7.41 4.22 Total ABC 102.21 56.14 31.45 22.11 Table 2. Analysis of the differences between ABC scores of children who stutter and children who do not stutter using paired samples t-tests (twotailed significance). Mean paired diff. t df p A1 6.0000 2.980 13.011 A2 8.4286 2.184 13.048 Total A 14.4286 2.696 13.018 B1 12.5000 3.617 13.003 B2 8.2857 4.754 13.000 Total B 20.7857 4.622 13.000 C1 5.9286 3.818 13.002 C2 4.9286 4.433 13.001 Total C 10.8571 5.245 13.000 Total ABC 46.0714 4.768 13.000
5 Figure 1. Total ABC Scores 200 180 160 140 Score 120 100 80 60 40 20 0 5:11 F 6:4 M 7:11 M 8:3 F 8:5 M 8:6 M 8:7 M 8:8 M 9:5 M 9:7 F 10:5 F 11:3 F 11:3 M 11:6 M NS CWS Subjects