Perceptions of and beliefs about stuttering in the Hispanic/Latino community.

PURPOSE: The aim of this exploratory study was to investigate perceptions of people who stutter and beliefs about the causes and cures of stuttering within the Hispanic/Latino community. METHODS: Respondents who were 18 or older and of Hispanic/Latino origin were invited to respond to a 24-question online survey. Questions involved exploring familiarity with and beliefs regarding etiologies, treatment approaches, treatment providers, stereotypes, and perceptions of people who stutter. Data from 151 respondents were analyzed using descriptive statistics. RESULTS: Results revealed that the most commonly held beliefs regarding the causes of stuttering were being "born with it", an "emotional disturbance or trauma", a "brain disorder", and/ or a "sensory impairment". The most frequently cited beliefs regarding treating stuttering were "therapy", "rehabilitation", and "tell them to slow down". Over 75 % of respondents believed that "speech therapists" can cure or treat stuttering. Respondents' perceptions of people who stutter are that they are generally "nervous" and "shy". CONCLUSIONS: Common beliefs and perceptions relative to stuttering were identified in the Hispanic/Latino community. The beliefs one holds about the cause of stuttering as well as their negative perceptions of stutterers may contribute to the continued stigmatization of people who stutter. Implications are discussed regarding the need for culturally appropriate education for individuals who stutter, their families, and the general public.

Phenome risk classification enables phenotypic imputation and gene discovery in developmental stuttering.

Developmental stuttering is a speech disorder characterized by disruption in the forward movement of speech. This disruption includes part-word and single-syllable repetitions, prolongations, and involuntary tension that blocks syllables and words, and the disorder has a life-time prevalence of 6-12%. Within Vanderbilt's electronic health record (EHR)-linked biorepository (BioVU), only 142 individuals out of 92,762 participants (0.15%) are identified with diagnostic ICD9/10 codes, suggesting a large portion of people who stutter do not have a record of diagnosis within the EHR. To identify individuals affected by stuttering within our EHR, we built a PheCode-driven Gini impurity-based classification and regression tree model, PheML, by using comorbidities enriched in individuals affected by stuttering as predicting features and imputing stuttering status as the outcome variable. Applying PheML in BioVU identified 9,239 genotyped affected individuals (a clinical prevalence of ∼10%) for downstream genetic analysis. Ancestry-stratified GWAS of PheML-imputed affected individuals and matched control individuals identified rs12613255, a variant near CYRIA on chromosome 2 (B = 0.323; p value = 1.31 × 10-8) in European-ancestry analysis and rs7837758 (B = 0.518; p value = 5.07 × 10-8), an intronic variant found within the ZMAT4 gene on chromosome 8, in African-ancestry analysis. Polygenic-risk prediction and concordance analysis in an independent clinically ascertained sample of developmental stuttering cases validate our GWAS findings in PheML-imputed affected and control individuals and demonstrate the clinical relevance of our population-based analysis for stuttering risk.

Rates of Typical Disfluency in the Conversational Speech of 30-Month-Old Spanish-English Simultaneous Bilinguals.

Purpose: The aim of this study was to investigate the typical disfluency rates at 30 months old in a large group of simultaneous bilingual children and also investigate the relationships between disfluency rates and linguistic complexity (mean length of utterance in words [MLU-W]), vocabulary diversity (VocD), and speaking rate (utterances per unit time). Method: Fifty-three typically developing children who had been exposed to Spanish and English from birth participated in this descriptive study. The average percent input at home was 46% in English and 54% in Spanish. Outside the home, the children averaged 9 hr of exposure per week in each language. Spontaneous speech samples in both languages were obtained during play sessions between the children and a parent. Results: Nonparametric tests revealed a significant difference in typical disfluency rates across languages, with more children being disfluent in English and with a larger range of disfluency rates in English. The effect size for this difference was small. The children had significantly higher MLU-W in English; there were no differences in VocD or speaking rate between the 2 languages. Typical disfluency rate in Spanish was not significantly correlated with MLU-W, VocD, or speaking rate. Typical disfluency rates in English were correlated with MLU-W and VocD, but not with speaking rate. Conclusion: This article described the typical disfluency rates of a large group of simultaneous Spanish-English bilingual children at 30 months of age. The typical disfluency rates reported here are lower than those reported in the literature for monolingual children of similar ages. Clinical implications of these findings are addressed.

A Hispanic mother's beliefs about stuttering aetiology: A systemic functional linguistic analysis.

The aim of this study was to identify the linguistic resources a Hispanic mother used to convey her beliefs about the aetiology of her adult son's stuttering. A qualitative research paradigm was adopted for data collection and analysis. An Ecuadorian mother and her adult son who stutters recorded a conversation in Spanish about the son's stuttering. Tools derived from systemic functional linguistic (SFL) theory were used to analyse conversation transcripts and to describe the word choices and sentence structures the mother used to talk about her son's stuttering. The mother deflected community-assigned blame for causing her son's stuttering by configuring her 'strong' temperament as a separate, uncontrollable entity. She structured the pervasiveness of stigma, lack of resources and misinformation within the community as causes for her inability to identify and seek help for her son's stuttering, which also served as a means for deflecting blame. SFL-based analyses were appropriate tools for the investigation of how a Hispanic mother construes her views, attitudes and experiences relative to her son's stuttering. Clinical implications of findings regarding parent education and the utility of SFL-based tools in the speech-language therapy setting are discussed.

A Persian-version of the stuttering severity instrument-version four (SSI-4): How the new additions to SSI-4 complement its stuttering severity score?

PURPOSE: The fourth version of the Stuttering Severity Instrument (SSI-4) has been available since 2009. It has some modifications and new features which make it more appropriate at least for clinical practice, although further documentation is needed. The objective of the current research was to translate SSI-4 into Persian language and to discuss its relative and absolute reliability as well as its criterion validity for Persian adults who stutter (PWS). We also aimed to study how the new subjective self-reports of the SSI-4 complement the stuttering severity score obtained from the SSI-3 or the SSI-4. METHOD: The cross-cultural guideline recommended by the International Quality of Life Assessment project was used to translate the SSI-4 into Persian language. Thirty five PWS from ages 17 to 42 were recruited and 10 speech and language pathologists assessed their stuttering severity using either the SSI-4 or stuttering severity ratings (SR) to test validity and reliability of the Persian translated version. RESULTS: A very high inter-judge relative reliability along with a poor absolute inter-judge reliability was found for the SSI-4 scores. The results were more promising for the intra-judge absolute reliability. Test-retest reliability of the complementary questions to the SSI-4 was also found acceptable. However, no strong relationship was found between the SSI-4 scores and its complementary questions. CONCLUSION: The Persian version of the SSI-4 can be used reliably by trained SLPs for research and clinical purposes, but not to document small changes in stuttering severity. We argue that the response of participants to the complementary self-report questions should also be considered in calculating their stuttering severity score.

The experience of stuttering among Ultra-Orthodox and Secular/Traditional Jews.

PURPOSE: This groundbreaking research compares the experience of stuttering among adult male People Who Stutter (PWS) from the ultra-Orthodox (UO) Jewish community in Israel to those from Secular/Traditional (ST) backgrounds. METHODS: Participants were 32 UO and 31 ST PWS, aged 18-67 years. Self-report questionnaires utilized: Perceived Stuttering Severity (PSS); Overall Assessment of the Speaker's Experience of Stuttering (OASES-A); Students' Life Satisfaction Scale (SLSS); Situation Avoidance Behavior Checklist (SABC). Demographic, religious, and stuttering information was collected. Groups were compared on scales, and correlations between scales and the PSS. RESULTS: Subjective stuttering severity ratings were significantly higher among the UO. A significant group effect was found for the OASES-A quality of life subscale, but not other subscales. Significant positive correlations were found between: 1) PSS and OASES-A Total Impact; 2) PSS and 3 OASES subscales; and 3) PSS and SABC (indicating increased avoidance with increased stuttering severity rating). A significant negative correlation was found between the PSS and SLSS, indicating lower life satisfaction with higher rates of stuttering severity among the ST. Interestingly, when tested by group, significant correlations between the PSS and all other study measures were observed only among the ST. CONCLUSION: UO participants showed higher subjective stuttering severity ratings, yet less impact on quality of life, and no correlation between subjective stuttering and other measures of stuttering experience. These novel findings may result from the combined protective effect of religiosity and socio-cultural characteristics on UO PWS' well-being, despite heightened concern about social consequences of stuttering within UO society.

Public attitudes toward stuttering in Europe: Within-country and between-country comparisons.

INTRODUCTION: Epidemiological research methods have been shown to be useful in determining factors that might predict commonly reported negative public attitudes toward stuttering. Previous research has suggested that stuttering attitudes of respondents from North America and Europe (i.e., "The West"), though characterized by stereotypes and potential stigma, are more positive than those from several other regions of the world. This inference assumes that public attitudes within various regions characterized by "The West" are similar. PURPOSE: This study aimed to determine the extent to which public stuttering attitudes are similar or different both within regions of three different European countries and between or among five different European countries or similar geographic areas. It also aimed to compare these European attitudes to attitudes from 135 samples around the world using a standard measure. MATERIAL AND METHODS: Using convenience sampling, 1111 adult respondents from eight different investigations completed the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) in the dominant language of each country or area. In Study I, the authors compared attitudes within three different regions of Bosnia & Herzegovina, Italy, and Norway. In Study II, the authors compared attitudes between combined samples from Bosnia & Herzegovina, Italy, and Norway (with additional respondents from Sweden), and two other samples, one from Germany and the other from Ireland and England. RESULTS: Attitudes of adults from the three samples within Bosnia & Herzegovina, Italy, and Norway were remarkably similar. By contrast, attitudes between the five different countries or area were quite dramatically different. Demographic variables on the POSHA-S did not predict the rank order of these between-country/area differences. Compared to the POSHA-S worldwide database, European attitudes ranged from less positive than average (i.e., Italians) to more positive than average (i.e., Norwegians and Swedes). CONCLUSION: Factors related to national identity appear to play a significant role in differences in public attitudes in Europe and should be explored in future research.

Public attitudes toward-and identification of-cluttering and stuttering in Norway and Puerto Rico.

PURPOSE: The study sought to compare public attitudes toward cluttering versus stuttering in Norway and Puerto Rico and to compare respondents' identification of persons known with these fluency disorders. METHOD: After reading lay definitions of cluttering and stuttering, three samples of adults from Norway and three from Puerto Rico rated their attitudes toward cluttering and/or stuttering on modified versions of the POSHA-Cl (for cluttering) and POSHA-S (for stuttering). They also identified children and adults whom they knew who either or both manifested cluttering or stuttering. RESULTS: Attitudes toward cluttering were essentially unaffected by rating either cluttering only or combined cluttering and stuttering on the same questionnaire in both countries. The same was also true of stuttering. Attitudes were very similar toward both disorders although slightly less positive for cluttering. Norwegian attitudes toward both disorders were generally more positive than Puerto Rican attitudes. The average respondent identified slightly more than one fluency disorder, a higher percentage for stuttering than cluttering and higher for adults than children. Cluttering-stuttering was rarely identified. CONCLUSION: Given a lay definition, this study confirmed that adults from diverse cultures hold attitudes toward cluttering that are similar to-but somewhat less positive than-their attitudes toward stuttering. It also confirmed that adults can identify cluttering among people they know, although less commonly than stuttering. Design controls in this study assured that consideration of stuttering did not affect either the attitudes or identification results for cluttering. EDUCATIONAL OBJECTIVES: The reader will be able to: (a) describe the effects-or lack thereof-of considerations of stuttering on attitudes toward cluttering; (b) describe differences in public identification of children and adults who either clutter or stutter; (c) describe differences between attitudes toward cluttering and stuttering in Norway and Puerto Rico.

An overview of managing stuttering in Japan.

PURPOSE: The purpose of this article is to describe the rapid development of speech-language pathology in Japan since governmental licensing started in 1997 and to summarize the current trends in assessing and treating stuttering for preschoolers, school-age children, adolescents, and adults. METHOD: The authors review relevant information about the current assessment and treatment services for people who stutter in Japan and discuss the issues and challenges faced by speech-language pathologists in managing stuttering. CONCLUSION: It is predicted that as expertise in stuttering grows in Japan, the role of stuttering specialists in allied health, school districts, and research will increase.

Stuttering attitudes of students: Professional, intracultural, and international comparisons.

PURPOSE: The study sought to identify major-specific, training, and cultural factors affecting attitudes toward stuttering of speech-language pathology (SLP) students. METHOD: Eight convenience samples of 50 students each from universities in the USA and Poland filled out the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) in English or Polish, respectively. USA samples included undergraduate and graduate students in SLP majors or non-SLP majors as well as a sample of non-SLP students who were Native Americans. Polish samples included SLP (logopedics), psychology, and mixed majors. RESULTS: SLP students held more positive attitudes than non-SLP students in both countries. Graduate students held more positive attitudes than undergraduate students in the USA, and this effect was stronger for SLP than for non-SLP students. Native American students' stuttering attitudes were similar to other American non-SLP students' attitudes. Polish student attitudes were less positive overall than those of their American student counterparts. CONCLUSION: SLP students' attitudes toward stuttering are affected by a "halo effect" of being in that major, by specific training in fluency disorders, and by various cultural factors, yet to be clearly understood. EDUCATIONAL OBJECTIVES: The reader will be able to: (a) describe major factors affecting SLP students' attitudes toward stuttering; (b) describe similarities and differences in attitudes toward stuttering of students from the USA and Poland; (c) describe similarities and differences in attitudes toward stuttering of Native American students from the USA and non-Native American students.

Stuttering attitudes in Hong Kong and adjacent Mainland China.

The present study aims at studying the public attitudes towards stuttering in Hong Kong and Mainland China. Translated Chinese versions of the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) were distributed to convenience samples in Hong Kong and Mainland China, with a total number of 175 completed questionnaires returned in each sampling region (n 5 350). Mean ratings of respondents from Hong Kong and Mainland China were similar in most comparisons; yet, a few differences were noted. Larger but idiosyncratic differences characterized the Chinese respondents compared to more than 4000 respondents from numerous countries and languages around the world in the POSHA-S database archive. Overall, they documented aspects of stereotypes and potential stigma with respect to people who stutter. While premature to provide unambiguous conclusions, results suggest that Chinese respondents have unique stuttering attitudes.

Culture and listeners' gaze responses to stuttering.

BACKGROUND: It is frequently observed that listeners demonstrate gaze aversion to stuttering. This response may have profound social/communicative implications for both fluent and stuttering individuals. However, there is a lack of empirical examination of listeners' eye gaze responses to stuttering, and it is unclear whether cultural background plays a role in regulating listeners' eye gaze response to stuttering. AIM: To examine listeners' eye gaze responses to stuttering speech relative to fluent speech in three cultural groups. METHODS & PROCEDURES: Eighteen African-American, 18 European-American and 18 Chinese adults were audiovisually presented with three stuttering and three fluent speech samples, when an eye-tracking device simultaneously recorded their gaze behaviours. The targets of listeners' eye gaze included four regions of interest (ROIs) on the speaker's face: eyes, nose, mouth and outside (i.e., everything else). Listeners' per cent of gaze time, gaze fixation count and average duration of gaze fixation were analysed with repeated-measures ANOVAs regarding each ROI as functions of the speaker's fluency status and listeners' cultural background. OUTCOMES & RESULTS: When observing stuttering speech, listeners tended to reduce gaze fixation duration on the speaker's eyes and increase their gaze time on the mouth. However, different from the two American groups, the Chinese group reduced their gaze time on the speaker's mouth. In addition, the Chinese participants' gaze behaviours were more focused on the ROI of outside, whereas the two American groups showed a similar focus on the ROIs of eyes and mouth. CONCLUSIONS & IMPLICATIONS: All groups of listeners responded to stuttering with gaze aversions mainly contributed to by a reduction in gaze fixation duration rather than gaze fixation number. This pattern of gaze aversion suggests that stuttering oppresses listeners with an emotional and/or cognitive overload. Attention shift and compensation strategies for speech signal degradation may also account for listeners' gaze responses to stuttering. Cultural differences in eye gaze responses to stuttering were observed mainly between Chinese and American listeners.

A dialogue among various cultures and its manifestation in stuttering therapy.

UNLABELLED: This paper presents a historical retrospective of the evolution of the clinical aspects of stuttering, and refers to social, cultural, political, and economic variables that might have exerted an influence on this evolution, particularly in relation to the authors' experience in Israel. The retrospective commences in the early decades of the 20th century, when speech and language pathology did not exist as a profession, and presents the major approaches to therapy in children and adults employed by clinicians throughout the century. We focused on the impact of the change that occurred in religious society vis-à-vis stuttering on the various aspects of stuttering therapy and research. The Israeli Stuttering Organization - AMBI - is discussed in order to explore the possible influence of social, cultural, and political variables. In addition, we devoted special attention to the changes that occurred in the therapist-client relationship since they are indicative of the change in the nature of the treatment. We elaborated on the need for dialogue as a major component in the therapy and as an important contributor to a successful outcome. The dialogue is also discussed in terms of Eastern philosophy. Future developments in the understanding of stuttering and its implications for therapy are presented and discussed. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) summarize the history of the clinical development of stuttering and explore the possible influence of social, cultural, political, and economic variables particularly in relation to Israel; (2) provide a new definition of stuttering; and (3) contrast the model of a dialogue as opposed to a monologue and explain its use in the therapist-client relationship.

Multilingual children who stutter: clinical issues.

UNLABELLED: Stuttering occurs across all languages and cultures. However, the impact of speaking more than one language on assessment and treatment of young children who stutter is not well documented. This paper discusses some of the challenges related to clinical issues pertaining to this population including (a) identifying stuttering in an unfamiliar language, (b) the influence of language proficiency, and (c) treatment of multilingual young children who stutter. The paper is written from the perspective of the author's experience treating multilingual children who stutter within the context of the linguistic and cultural diversity of Canada, notably in the French speaking Province of Quebec where many children grow up speaking two or more languages in everyday life. Clinical examples will be taken from the evidence-based literature as well as the author's clinical experience. EDUCATIONAL OBJECTIVES: After reading this paper, the learner will be able to (1) summarize the literature regarding assessment and treatment of stuttering in young children speaking more than one language, (2) summarize some of the challenges related to this issue and (3) describe some of the findings associated with treatment of bilingual children who stutter and (4) be prepared to apply some of these suggestions in the treatment of bilingual children who stutter.

Investigation of the reliability of the SSI-3 for preschool Persian-speaking children who stutter.

UNLABELLED: There is a pressing need in Iran for the translation of widely used speech-language assessment tools into Persian. This study reports the interjudge and intrajudge reliability of a Persian translation of the Stuttering Severity Instrument-3 (SSI-3) (Riley, 1994). There was greater than 80% interjudge and intrajudge agreement on scale scores for Frequency and Duration, 54% interjudge and 62.2% intrajudge agreement for "Physical Concomitants" and greater than 80% interjudge and intrajudge agreement for the Overall score. In conclusion, although percentage agreement for Physical Concomitant Behaviors was low, the Persian translation of SSI-3 shows otherwise acceptable interjudge and intrajudge reliability when performed under ideal conditions. EDUCATIONAL OBJECTIVES: The reader of this article will be able to: (1) explain the process of test translation from the original language to another language; (2) summarize the process of determining interjudge and intrajudge reliability of the SSI-3 in preschoolers.

Prevalence of stuttering in African American preschoolers.

PURPOSE: In this study, the authors sought to determine the prevalence of stuttering in African American (AA) 2- to 5-year-olds as compared with same-age European Americans (EAs). METHOD: A total of 3,164 children participated: 2,223 AAs and 941 EAs. Data were collected using a 3-pronged approach that included investigators' individual interactions with each child, teacher identification, and parent identification of stuttering. RESULTS: No statistically significant difference for stuttering was found between AA and EA children. Using the investigator and teacher method of identification, the prevalence of stuttering was 2.52% for the entire sample. For both racial groups, boys exhibited a higher prevalence of stuttering than girls. Of the 3 predictors (age, race, sex) of stuttering, only sex was a significant predictor. CONCLUSIONS: AA 2- to 5-year-olds are not overrepresented in the stuttering population for this age group. When data are combined for both racial groups, the prevalence of stuttering is 2.52%. More boys than girls stuttered in this sample of preschoolers.

The Behavior Assessment Battery: a preliminary study of non-stuttering Pakistani grade-school children.

BACKGROUND: In recent years, the importance of a multimodal approach to the assessment of the person who stutters (PWS) has become increasingly recognized. The Behavior Assessment Battery (BAB), which is a normed test procedure developed by G. Brutten, makes it possible to assess the multidimensional facets of this disorder. The emotional and speech-disruptive components that differentiate one who stutters from one who does not (PWNS) are evaluated by means of the Speech Situation Checklist (SSC), their use of behaviours secondary to stuttering are assessed through the Behavior Checklist (BCL) and the person's speech-related attitude is determined via the Communication Attitude Test (CAT). Each of these BAB tests has been shown to be a reliable and valid measure whose obtained normative data are essentially equivalent in Western countries. AIMS: Because of the lack of normative data on children from non-Western cultures, the present preliminary study was aimed to investigate if the affective, behavioural and cognitive reports of non-stuttering Pakistani children on the BAB measures are like those of their Western peers. METHODS & PROCEDURES: Forty-five non-stuttering Pakistani children between the ages of 8 and 11 were administered the SSC, BCL and CAT. OUTCOMES & RESULTS: As in previous studies, the mean score of the normally fluent children on each of the BAB tests fell into the lower end of the possible distribution of scores. Intercorrelations between the different tests were statistically significant. CONCLUSIONS: Although the BCL and CAT results were similar to those found in Western-based investigations, the emotional reaction and speech disruption scores on the SSC reported by Pakistani children sampled were numerically higher to an extent that is noteworthy. The latter finding suggests that this particular BAB measure might be affected by cultural differences. It points to the possibility that the norms of test procedures, such as the BAB, might not be fully appropriate for use in other than Western cultures.

The epigenesis of stuttering.

UNLABELLED: This paper examines the data on which the Demands and Capacities Model (DCM) is based with the purpose of identifying areas where future research might determine consilience among genetic influences at the physiological, behavioral, and cultural levels. The determination of consilience across different levels would tend to validate the genetic influence on stuttering, but more importantly it would also sharpen the focus of researchers interested in the various possible expressions that genetic influences might have and the way in which they influence the development of the disorder. EDUCATIONAL OBJECTIVES: The reader will (1) learn about the distinction, as outlined in the DCM, between environmental/contextual influences on stuttering development and intrinsic/genetic influences on stuttering development; (2) learn about the concept of consilience and its usefulness in conferring validity on parallel constructs at the physiological, behavioral, and cultural levels of stuttering theory; and (3) be able to identify potential areas for research that might help in refining our understanding of the genetic influences on stuttering development.