- Email: [email protected]
A comparison of interactions between stuttering children, nonstuttering children, and their mothers
J. FLUENCY
DISORD.
I I (19861, 263-273
A COMPARISON OF INTERACTIONS BETWEEN STUTTERING CHILDREN, NONSTUTTERING CHILDREN, AND THEIR MOTHERS AIMkE LANGLOIS, LINDA L. HANRAHAN, INOUYE Humboldt
State
University,
At-rata,
and LYNN
L.
California
Conversations between eight stuttering children, eight nonstuttering children, and their respective mothers were observed, recorded, and analyzed. Results indicate that mothers of stutterers made significantly more demands, commands, and requests when talking with their children; on the other hand, mothers of nonstutterers uttered more statements. Additional findings reveal that the stuttering children were more verbal, while tering peers communicated more frequently with gestures and other means The data are discussed in light of theories that parent-child interactions are onset and development of stuttering. Implications for clinical management terers are presented.
their nonstutof expression. critical to the of young stut-
Many theories propose that children acquire stuttering behaviors as a result of conflicts that they experience. The literature reflects the fact that “more than any other etiologic factor, emotional conflict has been blamed as the source of stuttering” (Van Riper, 1982, p. 76). Some investigators originally identified components of this conflict by reporting and documenting what attitudes, child-training practices, and personality traits of the stutterer’s parents are detrimental to acquiring and maintaining fluent speech (Moncur, 1952; Kinstler, 1961; Goldman and Shames, 1964a, 1964b; Quarrington et al. 1969). Other authors provided data on how adults react to children’s stuttering (Johnson, 1942, 1959; Bloodstein et al. 1952; Glasner and Rosenthal, 1957) and on how the communicative stresses experienced by these children are related to increases in disfluency (Schindler, 1955; Bloodstein, 1975; Hood, 1978; Van Riper, 1982). The role of the verbal behavior of the parents was specifically identified as one of these stresses (Kasprisin-Burrelli et al. 1972; Allan and Williams, 1974). Results of these studies have shown that parents of stutterers comAddress correspondence to Dr. AimCe Langlois, Department ences, Humboldt State University, Arcata, CA 95521.
8 1986 by Elsevier 52 Vanderbilt
Ave..
Science Publishing Co.. Inc. New York. NY 10017
of Speech
and Hearing
Sci-
263 0094-730x/861$03.50
264
A. LANGLOIS
et al.
municate differently with their children than do parents of nonstutterers. In addition, Egolf et al. (1972) demonstrated that how parents talk to their child affects the severity and frequency of that child’s stuttering. The literature on conflict as an etiologic factor in stuttering suggests that some parents may unwittingly create a number of conflicts and stresses that result in stuttering in their children. However, lacking from this literature are specific descriptions of the verbal interchanges between parents and their stuttering children. There is also no information on the overall communication strategies used both by the stuttering child and his or her parents. Knowledge about specific interactional patterns between stuttering children and their parents is important in understanding possible factors that precipitate and maintain stuttering. The documentation of such knowledge is paramount to the development of effective intervention programs for children who stutter. This study was, therefore, designed to identify patterns of interaction between stuttering and nonstuttering children and their respective mothers, and to determine if and how the mothers’ verbal communication affects their children’s responses, regardless of stuttering. METHODS Subjects The experimental subjects in this study were eight elementary school children who had been diagnosed by their school’s speech-language pathologist as presenting a mild stuttering problem. The matched control group consisted of eight normal-speaking children with no history of stuttering. Matching was performed on the basis of sex, chronologic age, and school grade placement. In both groups, four of the children were male and four were female. The mean age of the two groups was 7 years, with a range of 5 to 9 years. Table 1 shows the distribution of subjects according to matching criteria. The mothers of these children also served as subjects; however, no specific selection criteria besides availability were identified for them. Materials The Adult-Child Interaction Assessment procedure (Lowe, 1980) was chosen to observe, record, and categorize the interchanges between the mothers and their children. This instrument was selected because, in a minimal amount of time, it quantifies interactions and categorizes specific communication events between child and adult as they occur. The tool identities four communication behaviors demonstrated by an adult (declarative, imperative, interrogative, social filler) and four modes of re-
A COMPARISON
OF INTERACTIONS
265
Table 1. Characteristics of Matched Subject Pairs at Time of Observations Subjects pair number
Sex
Age (yr)
Grade
sponse used by a child (verbal, vocal, nonverbal, no response), while the two are interacting. These categories are briefly defined in Appendix A. Procedures The children and their mothers were observed in their homes in a quiet room free from distractions. The mothers were encouraged to interact with their child as they normally did and to use toys, games, puzzles, and any objects common to their daily routine. They were told to avoid reading, singing, or reciting learned material because these activities would bias the samples. The investigator sat unobtrusively approximately 5 to 10 feet away from the mother and child and audiotaped the entire play session. The first 5 minutes were used as a warm-up period and interactions were not charted because this time allowed the mother and child to become involved in the activities. After this period and for the next 5 minutes, the investigator charted her observations on a score sheet according to “directions for administering and scoring,” as delineated by Lowe (1980). A sample of interaction and how it is scored can be found in Appendix B. To ensure reliability, the audio recordings were reviewed on an utterance by utterance basis and corrections were made as needed. The number of responses in each of the communication categories was then totaled on the score sheet and transferred to the Scoring Analysis Form (Appendix C), following Lowe’s instructions (1980). The data provided on this form for each mother-child pair were then used for statistical analysis. RESULTS Mothers’ Communicative
Behaviors
The data computed for each communication strategy used by the mothers were converted to percentages. Their means, standard deviations, and results of a one-way analysis of variance are presented in Table 2. These
A. LANGLOIS
266
Table 2. Percentage Adult communication strategy
of Communication Mothers
Declarative Imperative Interrogative Social filler
Strateav
Use bv the Mothers Mothers of nonstutterer
of stutterers
Mean
SD
Mean
SD
43.13
4.55
64.75
I I .25
5.06
7.78 5.37 4.14 6.00
7.07 I I .48
24.63 21.00
et al.
‘i ._. 75 IO.50 19.63
F ratio of difference ‘wJ.075t 5.191” 23.778’
0,090
* ,’ c 0.05:f p i 0.01,
data indicate that the mothers of nonstuttering children made significantly more statements (declaratives) than did the mothers of stuttering children. On the other hand, mothers of stutterers asked more questions (interrogatives) and made more demands (imperatives) of their children. These data support earlier findings (Kasprisin-Burrelli et al., 1972), which showed that there are differences in the ways parents of stutterers interact with their child when compared with parents of nonstutterers.
Children’s Communicative
Behaviors
The means and standard deviations that represent the children’s usage of their four modes of response are presented in Table 3. Our statistical analysis did not yield any significant differences between the two groups. However, the stuttering children did show a tendency to be more verbal than the nonstuttering children, while this latter group engaged more frequently in nonverbal communication, such as gestures and spoken noises (vocal and nonverbal categories). The data in Table 3 also indicate that stuttering children ignored their mothers 2 to 7% of the time (no response category), and that the nonstuttering children, on the other hand, never demonstrated such behavior.
Table 3. Percentage of Mode of Response Nonstuttering Children Stuttering
children
Use by Stuttering Nonstuttering
and
children
Mode of response
Mean
SD
Mean
Verbal Vocal Nonverbal No response
x3.00 7.63 7.3x 2.00
9.x 7.73 9.07 4.90
79.50
I I .8?
IO.00
10.3 I 9.24
IO.50 0.00
SD
0.00
F ratio of difference 0.435 0.x5 0.46h 1.333
A COMPARISON
OF INTERACTIONS
Table 4. Frequency Adult
category/child’s response
Declarative/verbal Imperative/verbal Interrogative/verbal Social filler/verbal Declarative/vocal Imperative/vocal Interrogative/vocal Social filler/vocal Declarative/nonverbal Imperative/nonverbal Interrogative/ nonverbal Social filler/nonverbal
*p <
of Occurrence
267
of Adult to Child Sequences
Stuttering group
Nonstuttering
group
Mean
SD
Mean
SD
F ratio of difference
9.00 2.38 9.88 3.88 1.25 1.00 0.13 0.63 0.13 0.88 1.25
3.02 1.85 3.68 3.02 I .28 1.60 0.35 0.74 0.35 1.67
16.25 1.25 5.25 2.88 3.13 0.13 0.25 0.13 2.63 2.13 0.88
5.20 I .39 2.60 2.03 4.22 0.35 0.46 0.35 2.61 2.95 0.64
11.61lt 1.896 8.414* 0.151 I .444 2.272 0.368 2.947 6.897* I.155 0.352
0.50
1.41
0.00
0.00
1.00
1.46
0.05: t p < 0.01
Adult to Child Communication
Sequences
of occurrences of each adult to child interactional sequence was computed. Means and standard deviations for all possible sequences were calculated for each group, and are presented in Table 4. These results indicate that the two groups differed significantly in three sequences. On one hand, the nonstuttering children displayed a substantially greater number of both verbal and nonverbal responses after their mothers’ statements. On the other hand, the stuttering children answered their mothers’ questions far more frequently with verbal responses. The number
DISCUSSION Results of this study indicate that interactions between stuttering children, nonstuttering children, and their respective mothers differ. Our data support the findings of previous researchers (Egolf et al., 1972; KasprisinBurrelli et al., 1972; Allan and Williams, 1974) who proposed that parents of stutterers communicate differently with their children. It is possible that stuttering children experience communicative pressure when most of the utterances addressed to them are questions, commands, and requests. As evidenced by the high frequency of their verbal answers to questions, stuttering children may also feel the additional pressure to reply verbally to interrogatives. The communication strategies described in this report have been hypothesized by many researchers to influence the onset and development of stuttering. Our findings, therefore, support theories which propose that stuttering is related to environmental stress.
268
A. LANGLOIS
et al.
According to Johnson’s (1959) diagnosogenic theory of stuttering, a child is likely to begin to stutter in response to parental anxieties, pressures, help, criticisms, and corrections; these usually occur when the parents become concerned about their child’s normally disfluent speech that they have labeled as stuttering. It has been proposed (Marshall et al. 1973; Seitz, 1975) that these types of parental interactions restrict talking and may even hinder the development of communicative skills. Hubbell (1977) stated that such adult verbal behaviors are constraints on a child’s expression. Our findings further support this hypothesis; the stuttering children’s tendency to ignore their mothers 2 to 7% of the time suggests that they may have felt constrained in fully expressing themselves. On the other hand, one may speculate from the nonstuttering children’s greater use of gestures and other means of expression that they demonstrate more facility than their nonstuttering peers not only in expressing themselves verbally, but in using nonverbal communication skills as well. In light of these findings, we suggest that interactional patterns between stuttering children and their parents be routinely assessed by clinicians who are planning the treatment of a child who stutters. Information gained from this type of assessment could then be incorporated into an individualized treatment plan. It has been proposed by several authorities (Luper and Mulder, 1964; Van Riper, 1974; Bloodstein, 1975; Shames and Egolf, 1976; Zwitman, 1978) that speech therapy for the child who stutters should focus on the interpersonal relationships between the child and those in the environment. Sheehan (1979) stated that family members must be involved in the therapy for the stuttering child because “members of the family are members of the problem” (p. 204). Therapy of this nature has traditionally taken the form of counseling, whereby parents receive information on early speech and language development, on stuttering, and on means to facilitate fluency (Brown, 1949; Sander, 1959). In contrast, we propose that parents become active participants in the therapeutic process; we suggest that in addition to receiving information, they attend regular therapy sessions and learn to identify and modify those interactions that are contributing to their child’s stuttering. In this vein, we concur with Johnson (1980), Culp (1984), Riley and Riley (1984), and Shine (1984), who emphasize the importance of parent training as an essential component of a child’s stuttering therapy program and who describe approaches to achieve such a goal. The subject population of this study was rather limited in size and only consisted of mild stutterers. It is, therefore, suggested that this research be replicated with larger groups of stutterers, with different age groups, and with fathers and siblings. Furthermore, information is needed to determine if the severity of stuttering in a child is related to the patterns of interaction his or her parents use. The documentation on the environ-
A COMPARISON
OF INTERACTIONS
269
mental pressures that are related to the etiology of stuttering is by no means complete. Continued research is, therefore, needed to provide additional and valuable insights about the factors that contribute to the development and maintenance of stuttering.
REFERENCES Allan, F., and Williams, C.L. Interaction patterns of families containing a stuttering sibling. Australian Journal of Human Communication Disorders, 1974, 2, 32-40.
Bloodstein, O., Jaeger, W., and Tureen, J. A study of the diagnosis of stuttering by parents of stutterers. Journal of Speech and Hearing Disorders, 1952, 17, 308-315.
Bloodstein, 0. A Handbook on Stuttering. Chicago, Illinois: National Easter Seal Society for Crippled Children and Adults, 1975. Brown, S.F. Advising parents of early stutterers.
Pediatrics,
1949, 3, 170-175.
Culp, D.M. The preschool fluency development program: Assessment and treatment. In: M. Peins (ed.). Contemporary Approaches in Stuttering Therapy. Boston, Massachusetts: Little, Brown and Company, 1984. Egolf, D.G., Shames, G.H., Johnson, P. R., and Kasprisin-Burrelli, A. The use of parent-child interaction patterns in therapy for young stutterers. Journal of Speech
and Hearing Disorders,
1972, 37, 222-232.
Glasner, R.J., and Rosenthal, D. Parental diagnosis of stuttering in young children. Journal of Speech and Hearing Disorders, 1957, 22, 288-295. Goldman, R., and Shames, G.H. A study of goal-setting behavior of parents of stutterers and parents of nonstutterers. Journal of Speech and Hearing Disorders, 1964a, 29, 192-194. Goldman, R. and Shames, G.H. Comparisons of the goals that parents of stutterers and parents of nonstutterers set for their children. Journal of Speech and Hearing Disorders, 1964b, 29, 381-389. Hood, S.B. The assessment Diagnostic
land: University Hubbell, Speech
Johnson,
Speech
in Hearing,
R.D. On facilitating
spontaneous
and Hearing Disorders,
L. J. Facilitating
Seminars
Johnson,
of fluency disorders. In: S. Singh and J. Lynch (eds.). Speech, and Language. Baltimore, MaryPark Press, 1978.
Procedures
in Speech,
talking in young children.
parental involvement
Language
and Hearing,
of
in therapy of the disfluent child. 1980, 1, 301-310.
W. A study of the onset and development Disorders,
Journal
1977, 42, 216-231.
of stuttering.
Journal
of
1942, 7, 251-255.
Johnson, W., et al. The Onset of Stuttering: Research Findings and Implications. Minneapolis, Minnesota: University of Minnesota Press, 1959.
270
A. LANGLOIS
et al.
Kasprisin-Burrelli, A., Egolf, D.B., and Shames, G.H. A comparison of parental verbal behaviors with stuttering and non-stuttering children. Journu/ of Communication Disorders, 1972, 5. 335-346. Kinstler, Speech
D.B. Covert and Hearing
Lowe, M. Adult-Child of Montana, 1980.
and overt Disorders,
maternal rejection 1961, 26, 145-155.
Interaction
Assessment.
Luper, H., and Mulder, H. Stuttering New Jersey: Prentice Hall, 1964.
in stuttering.
Missoula,
Montana:
Therapy for Children.
Journal
of
University
Englewood
Cliffs,
Marshall, N.R., Hegrenes, J.R., and Goldstein, S. Mothers and their retarded children vs. mothers and their non-retarded children. American Journal of Mental Deficiency, 1973, 77, 415-419. Moncur, J.P. Parental domination Disorders, 1952, 17, 155-165.
in stuttering.
Journal
of Speech
and Hearing
Quarrington, B., Seligman, J., and Kosover, E. Goal setting behavior of parents of beginning stutterers and parents of nonstuttering children. Journal of Speech and Hearing Research, 1969, 12, 435-442. Riley, G.D. and Riley, J. A component model for treating stuttering in children. In: M. Peins (ed.). Contemporary Approaches in Stuttering Therapy. Boston, Massachusetts: Little, Brown and Company, 1984. Sander, E.K. Counseling parents of stuttering Hearing Disorders, 1959, 24, 262-271. Schindler, versity
M.D. Stuttering in Children of Minnesota Press, 1955.
children.
und Adults.
Journal
Minneapolis,
of Speech
and
Minnesota:
Uni-
Seitz, S. Language intervention: Changing the language environment of the retarded child. In: R. Koch, F. de la Cruz and F. Menolascino (eds.). Downs Syndrome: Research, Prevention and Management. New York: BrunesiMazel, 1975. Shames, G.H., and Egolf, D.B. Operant Conditioning and the Munagement Stuttering. Englewood Cliffs, New Jersey: Prentice-Hall, 1976. Sheehan, J.G. Current Controversies About Press, 1979.
issues on stuttering and recovery. In: H. Gregory Stuttering Therapy. Baltimore, Maryland: University
of (ed.). Park
Shine, R.E. Assessment and fluency training with the young stutterer. In: M. Peins (ed.). Contemporary Approaches in Stuttering Therapy. Boston, Massachusetts: Little, Brown and Company, 1984. Van Riper, tice-Hall,
C. The Treatment 1974.
Van Riper, C. The Nature Prentice-Hall, 1982.
of Stuttering.
of Stuttering,
Englewood
Cliffs, New Jersey:
2nd ed. Englewood
Zwitman, N.H. The Disfluent Child, A Management land: University Park Press, 1978.
Program.
Cliffs,
Pren-
New Jersey:
Baltimore,
Mary-
A COMPARISON
OF INTERACTIONS
271
APPENDIX A: DEFINITION OF COMMUNICATION CATEGORIES FOR ADULT AND CHILD Adult Categories 1. Declaratives: adult statements; any verbal utterances that are not imperative remarks or questions. 2. Imperatives: adult commands, demands, requests that clearly indicate the behaviors (verbal or not) that are expected of the child. 3. Interrogatives: direct questions to which the child is expected to respond either verbally or nonverbally. 4. Social fillers: short remarks that serve to keep the conversation going. Child Categories 1. Verbal: a single word, phrase, or sentence that is meaningful. 2. Vocal: audible sounds such as vowel-consonant sounds, spoken noises, yells, laughter, crying, animal noises, or meaningless, unintelligible utterances (jargon). 3. Nonverbal: gestures, body postures, and facial expressions that are attempts to communicate. 4. No response: child ignores the adult with behaviors such as lack of eye contact, leaving the area, or pretending not to hear.
A COMPARISON
272
OF INTERACTIONS
APPENDIX B: SAMPLE SCORING PROCEDURE The Adult-Child dialogue that follows is scored at the bottom of this page. The dialogue is scored from left to right. Category headings are listed on both sides of the page to increase the ease of accurate scoring. Each loop in the line is counted as an individual communication event. The “total” for each category is determined by counting the total number of loops in that category. The number is then recorded in the “Totals” column. Category 2 7 I 6 3 2 8 I 5 5 5
#
Sample Communicative Interaction Dialogue Speaker Let’s go over here. Tommy. Adult (Tommy walks to where adult points.) Child I’m going to play with this puzzle. Adult Child Mmmmmm. Adult What are you doing’? You can’t color on that puzzle. Adult (Tommy ignores adult and continues to color.) Child I’m going to put the puzzle away now. Adult Child No, no! Child 1 be good. I won’t color no more. Child
Total number of Adult-to-Child Utterances: _5 Total number of Child Utterances (Vocal + Verbal): _4 Adult MLU 7.3 Child MLU 3.7
Adult: Child: Scorer: Date:
Mrs. Smith Tommy Langlois 9/12/80
A COMPARISON
APPENDIX
273
OF INTERACTIONS
C: SCORING
ANALYSIS
FORM
Scorer Date
Child Adult Adult Category Counts Cateaorv 1. Declarative 2. Imperative 3. Interrogative 4. Social Filler Adult Total ”
d
Child Category Counts Category 5. Verbal 6. Vocal 7. Nonverbal 8. No Response Child Total
# of Events
Percentage
of Adult Total
# of Events
Percentage
of Child Total
Adult-Child Sequence Counts (Example: An adult “Declarative” statement that was followed immediately by a child “Verbal” statement five different times during the 5 minute sample would be recorded as follows: Declarative/Verbal 5.) _’
Sequences Declarative/Verbal Imperative/Verbal Interrogative/Verbal Social Filler/Verbal Declarative/Vocal Imperative/Vocal
Number of Occurrences
Sequences Interrogative/Vocal Social Filler/Vocal Declarative/Nonverbal Imperative/Nonverbal Interrogative/Nonverbal Social Filler/Nonverbal
Number of Occurrences
DISORD.
I I (19861, 263-273
A COMPARISON OF INTERACTIONS BETWEEN STUTTERING CHILDREN, NONSTUTTERING CHILDREN, AND THEIR MOTHERS AIMkE LANGLOIS, LINDA L. HANRAHAN, INOUYE Humboldt
State
University,
At-rata,
and LYNN
L.
California
Conversations between eight stuttering children, eight nonstuttering children, and their respective mothers were observed, recorded, and analyzed. Results indicate that mothers of stutterers made significantly more demands, commands, and requests when talking with their children; on the other hand, mothers of nonstutterers uttered more statements. Additional findings reveal that the stuttering children were more verbal, while tering peers communicated more frequently with gestures and other means The data are discussed in light of theories that parent-child interactions are onset and development of stuttering. Implications for clinical management terers are presented.
their nonstutof expression. critical to the of young stut-
Many theories propose that children acquire stuttering behaviors as a result of conflicts that they experience. The literature reflects the fact that “more than any other etiologic factor, emotional conflict has been blamed as the source of stuttering” (Van Riper, 1982, p. 76). Some investigators originally identified components of this conflict by reporting and documenting what attitudes, child-training practices, and personality traits of the stutterer’s parents are detrimental to acquiring and maintaining fluent speech (Moncur, 1952; Kinstler, 1961; Goldman and Shames, 1964a, 1964b; Quarrington et al. 1969). Other authors provided data on how adults react to children’s stuttering (Johnson, 1942, 1959; Bloodstein et al. 1952; Glasner and Rosenthal, 1957) and on how the communicative stresses experienced by these children are related to increases in disfluency (Schindler, 1955; Bloodstein, 1975; Hood, 1978; Van Riper, 1982). The role of the verbal behavior of the parents was specifically identified as one of these stresses (Kasprisin-Burrelli et al. 1972; Allan and Williams, 1974). Results of these studies have shown that parents of stutterers comAddress correspondence to Dr. AimCe Langlois, Department ences, Humboldt State University, Arcata, CA 95521.
8 1986 by Elsevier 52 Vanderbilt
Ave..
Science Publishing Co.. Inc. New York. NY 10017
of Speech
and Hearing
Sci-
263 0094-730x/861$03.50
264
A. LANGLOIS
et al.
municate differently with their children than do parents of nonstutterers. In addition, Egolf et al. (1972) demonstrated that how parents talk to their child affects the severity and frequency of that child’s stuttering. The literature on conflict as an etiologic factor in stuttering suggests that some parents may unwittingly create a number of conflicts and stresses that result in stuttering in their children. However, lacking from this literature are specific descriptions of the verbal interchanges between parents and their stuttering children. There is also no information on the overall communication strategies used both by the stuttering child and his or her parents. Knowledge about specific interactional patterns between stuttering children and their parents is important in understanding possible factors that precipitate and maintain stuttering. The documentation of such knowledge is paramount to the development of effective intervention programs for children who stutter. This study was, therefore, designed to identify patterns of interaction between stuttering and nonstuttering children and their respective mothers, and to determine if and how the mothers’ verbal communication affects their children’s responses, regardless of stuttering. METHODS Subjects The experimental subjects in this study were eight elementary school children who had been diagnosed by their school’s speech-language pathologist as presenting a mild stuttering problem. The matched control group consisted of eight normal-speaking children with no history of stuttering. Matching was performed on the basis of sex, chronologic age, and school grade placement. In both groups, four of the children were male and four were female. The mean age of the two groups was 7 years, with a range of 5 to 9 years. Table 1 shows the distribution of subjects according to matching criteria. The mothers of these children also served as subjects; however, no specific selection criteria besides availability were identified for them. Materials The Adult-Child Interaction Assessment procedure (Lowe, 1980) was chosen to observe, record, and categorize the interchanges between the mothers and their children. This instrument was selected because, in a minimal amount of time, it quantifies interactions and categorizes specific communication events between child and adult as they occur. The tool identities four communication behaviors demonstrated by an adult (declarative, imperative, interrogative, social filler) and four modes of re-
A COMPARISON
OF INTERACTIONS
265
Table 1. Characteristics of Matched Subject Pairs at Time of Observations Subjects pair number
Sex
Age (yr)
Grade
sponse used by a child (verbal, vocal, nonverbal, no response), while the two are interacting. These categories are briefly defined in Appendix A. Procedures The children and their mothers were observed in their homes in a quiet room free from distractions. The mothers were encouraged to interact with their child as they normally did and to use toys, games, puzzles, and any objects common to their daily routine. They were told to avoid reading, singing, or reciting learned material because these activities would bias the samples. The investigator sat unobtrusively approximately 5 to 10 feet away from the mother and child and audiotaped the entire play session. The first 5 minutes were used as a warm-up period and interactions were not charted because this time allowed the mother and child to become involved in the activities. After this period and for the next 5 minutes, the investigator charted her observations on a score sheet according to “directions for administering and scoring,” as delineated by Lowe (1980). A sample of interaction and how it is scored can be found in Appendix B. To ensure reliability, the audio recordings were reviewed on an utterance by utterance basis and corrections were made as needed. The number of responses in each of the communication categories was then totaled on the score sheet and transferred to the Scoring Analysis Form (Appendix C), following Lowe’s instructions (1980). The data provided on this form for each mother-child pair were then used for statistical analysis. RESULTS Mothers’ Communicative
Behaviors
The data computed for each communication strategy used by the mothers were converted to percentages. Their means, standard deviations, and results of a one-way analysis of variance are presented in Table 2. These
A. LANGLOIS
266
Table 2. Percentage Adult communication strategy
of Communication Mothers
Declarative Imperative Interrogative Social filler
Strateav
Use bv the Mothers Mothers of nonstutterer
of stutterers
Mean
SD
Mean
SD
43.13
4.55
64.75
I I .25
5.06
7.78 5.37 4.14 6.00
7.07 I I .48
24.63 21.00
et al.
‘i ._. 75 IO.50 19.63
F ratio of difference ‘wJ.075t 5.191” 23.778’
0,090
* ,’ c 0.05:f p i 0.01,
data indicate that the mothers of nonstuttering children made significantly more statements (declaratives) than did the mothers of stuttering children. On the other hand, mothers of stutterers asked more questions (interrogatives) and made more demands (imperatives) of their children. These data support earlier findings (Kasprisin-Burrelli et al., 1972), which showed that there are differences in the ways parents of stutterers interact with their child when compared with parents of nonstutterers.
Children’s Communicative
Behaviors
The means and standard deviations that represent the children’s usage of their four modes of response are presented in Table 3. Our statistical analysis did not yield any significant differences between the two groups. However, the stuttering children did show a tendency to be more verbal than the nonstuttering children, while this latter group engaged more frequently in nonverbal communication, such as gestures and spoken noises (vocal and nonverbal categories). The data in Table 3 also indicate that stuttering children ignored their mothers 2 to 7% of the time (no response category), and that the nonstuttering children, on the other hand, never demonstrated such behavior.
Table 3. Percentage of Mode of Response Nonstuttering Children Stuttering
children
Use by Stuttering Nonstuttering
and
children
Mode of response
Mean
SD
Mean
Verbal Vocal Nonverbal No response
x3.00 7.63 7.3x 2.00
9.x 7.73 9.07 4.90
79.50
I I .8?
IO.00
10.3 I 9.24
IO.50 0.00
SD
0.00
F ratio of difference 0.435 0.x5 0.46h 1.333
A COMPARISON
OF INTERACTIONS
Table 4. Frequency Adult
category/child’s response
Declarative/verbal Imperative/verbal Interrogative/verbal Social filler/verbal Declarative/vocal Imperative/vocal Interrogative/vocal Social filler/vocal Declarative/nonverbal Imperative/nonverbal Interrogative/ nonverbal Social filler/nonverbal
*p <
of Occurrence
267
of Adult to Child Sequences
Stuttering group
Nonstuttering
group
Mean
SD
Mean
SD
F ratio of difference
9.00 2.38 9.88 3.88 1.25 1.00 0.13 0.63 0.13 0.88 1.25
3.02 1.85 3.68 3.02 I .28 1.60 0.35 0.74 0.35 1.67
16.25 1.25 5.25 2.88 3.13 0.13 0.25 0.13 2.63 2.13 0.88
5.20 I .39 2.60 2.03 4.22 0.35 0.46 0.35 2.61 2.95 0.64
11.61lt 1.896 8.414* 0.151 I .444 2.272 0.368 2.947 6.897* I.155 0.352
0.50
1.41
0.00
0.00
1.00
1.46
0.05: t p < 0.01
Adult to Child Communication
Sequences
of occurrences of each adult to child interactional sequence was computed. Means and standard deviations for all possible sequences were calculated for each group, and are presented in Table 4. These results indicate that the two groups differed significantly in three sequences. On one hand, the nonstuttering children displayed a substantially greater number of both verbal and nonverbal responses after their mothers’ statements. On the other hand, the stuttering children answered their mothers’ questions far more frequently with verbal responses. The number
DISCUSSION Results of this study indicate that interactions between stuttering children, nonstuttering children, and their respective mothers differ. Our data support the findings of previous researchers (Egolf et al., 1972; KasprisinBurrelli et al., 1972; Allan and Williams, 1974) who proposed that parents of stutterers communicate differently with their children. It is possible that stuttering children experience communicative pressure when most of the utterances addressed to them are questions, commands, and requests. As evidenced by the high frequency of their verbal answers to questions, stuttering children may also feel the additional pressure to reply verbally to interrogatives. The communication strategies described in this report have been hypothesized by many researchers to influence the onset and development of stuttering. Our findings, therefore, support theories which propose that stuttering is related to environmental stress.
268
A. LANGLOIS
et al.
According to Johnson’s (1959) diagnosogenic theory of stuttering, a child is likely to begin to stutter in response to parental anxieties, pressures, help, criticisms, and corrections; these usually occur when the parents become concerned about their child’s normally disfluent speech that they have labeled as stuttering. It has been proposed (Marshall et al. 1973; Seitz, 1975) that these types of parental interactions restrict talking and may even hinder the development of communicative skills. Hubbell (1977) stated that such adult verbal behaviors are constraints on a child’s expression. Our findings further support this hypothesis; the stuttering children’s tendency to ignore their mothers 2 to 7% of the time suggests that they may have felt constrained in fully expressing themselves. On the other hand, one may speculate from the nonstuttering children’s greater use of gestures and other means of expression that they demonstrate more facility than their nonstuttering peers not only in expressing themselves verbally, but in using nonverbal communication skills as well. In light of these findings, we suggest that interactional patterns between stuttering children and their parents be routinely assessed by clinicians who are planning the treatment of a child who stutters. Information gained from this type of assessment could then be incorporated into an individualized treatment plan. It has been proposed by several authorities (Luper and Mulder, 1964; Van Riper, 1974; Bloodstein, 1975; Shames and Egolf, 1976; Zwitman, 1978) that speech therapy for the child who stutters should focus on the interpersonal relationships between the child and those in the environment. Sheehan (1979) stated that family members must be involved in the therapy for the stuttering child because “members of the family are members of the problem” (p. 204). Therapy of this nature has traditionally taken the form of counseling, whereby parents receive information on early speech and language development, on stuttering, and on means to facilitate fluency (Brown, 1949; Sander, 1959). In contrast, we propose that parents become active participants in the therapeutic process; we suggest that in addition to receiving information, they attend regular therapy sessions and learn to identify and modify those interactions that are contributing to their child’s stuttering. In this vein, we concur with Johnson (1980), Culp (1984), Riley and Riley (1984), and Shine (1984), who emphasize the importance of parent training as an essential component of a child’s stuttering therapy program and who describe approaches to achieve such a goal. The subject population of this study was rather limited in size and only consisted of mild stutterers. It is, therefore, suggested that this research be replicated with larger groups of stutterers, with different age groups, and with fathers and siblings. Furthermore, information is needed to determine if the severity of stuttering in a child is related to the patterns of interaction his or her parents use. The documentation on the environ-
A COMPARISON
OF INTERACTIONS
269
mental pressures that are related to the etiology of stuttering is by no means complete. Continued research is, therefore, needed to provide additional and valuable insights about the factors that contribute to the development and maintenance of stuttering.
REFERENCES Allan, F., and Williams, C.L. Interaction patterns of families containing a stuttering sibling. Australian Journal of Human Communication Disorders, 1974, 2, 32-40.
Bloodstein, O., Jaeger, W., and Tureen, J. A study of the diagnosis of stuttering by parents of stutterers. Journal of Speech and Hearing Disorders, 1952, 17, 308-315.
Bloodstein, 0. A Handbook on Stuttering. Chicago, Illinois: National Easter Seal Society for Crippled Children and Adults, 1975. Brown, S.F. Advising parents of early stutterers.
Pediatrics,
1949, 3, 170-175.
Culp, D.M. The preschool fluency development program: Assessment and treatment. In: M. Peins (ed.). Contemporary Approaches in Stuttering Therapy. Boston, Massachusetts: Little, Brown and Company, 1984. Egolf, D.G., Shames, G.H., Johnson, P. R., and Kasprisin-Burrelli, A. The use of parent-child interaction patterns in therapy for young stutterers. Journal of Speech
and Hearing Disorders,
1972, 37, 222-232.
Glasner, R.J., and Rosenthal, D. Parental diagnosis of stuttering in young children. Journal of Speech and Hearing Disorders, 1957, 22, 288-295. Goldman, R., and Shames, G.H. A study of goal-setting behavior of parents of stutterers and parents of nonstutterers. Journal of Speech and Hearing Disorders, 1964a, 29, 192-194. Goldman, R. and Shames, G.H. Comparisons of the goals that parents of stutterers and parents of nonstutterers set for their children. Journal of Speech and Hearing Disorders, 1964b, 29, 381-389. Hood, S.B. The assessment Diagnostic
land: University Hubbell, Speech
Johnson,
Speech
in Hearing,
R.D. On facilitating
spontaneous
and Hearing Disorders,
L. J. Facilitating
Seminars
Johnson,
of fluency disorders. In: S. Singh and J. Lynch (eds.). Speech, and Language. Baltimore, MaryPark Press, 1978.
Procedures
in Speech,
talking in young children.
parental involvement
Language
and Hearing,
of
in therapy of the disfluent child. 1980, 1, 301-310.
W. A study of the onset and development Disorders,
Journal
1977, 42, 216-231.
of stuttering.
Journal
of
1942, 7, 251-255.
Johnson, W., et al. The Onset of Stuttering: Research Findings and Implications. Minneapolis, Minnesota: University of Minnesota Press, 1959.
270
A. LANGLOIS
et al.
Kasprisin-Burrelli, A., Egolf, D.B., and Shames, G.H. A comparison of parental verbal behaviors with stuttering and non-stuttering children. Journu/ of Communication Disorders, 1972, 5. 335-346. Kinstler, Speech
D.B. Covert and Hearing
Lowe, M. Adult-Child of Montana, 1980.
and overt Disorders,
maternal rejection 1961, 26, 145-155.
Interaction
Assessment.
Luper, H., and Mulder, H. Stuttering New Jersey: Prentice Hall, 1964.
in stuttering.
Missoula,
Montana:
Therapy for Children.
Journal
of
University
Englewood
Cliffs,
Marshall, N.R., Hegrenes, J.R., and Goldstein, S. Mothers and their retarded children vs. mothers and their non-retarded children. American Journal of Mental Deficiency, 1973, 77, 415-419. Moncur, J.P. Parental domination Disorders, 1952, 17, 155-165.
in stuttering.
Journal
of Speech
and Hearing
Quarrington, B., Seligman, J., and Kosover, E. Goal setting behavior of parents of beginning stutterers and parents of nonstuttering children. Journal of Speech and Hearing Research, 1969, 12, 435-442. Riley, G.D. and Riley, J. A component model for treating stuttering in children. In: M. Peins (ed.). Contemporary Approaches in Stuttering Therapy. Boston, Massachusetts: Little, Brown and Company, 1984. Sander, E.K. Counseling parents of stuttering Hearing Disorders, 1959, 24, 262-271. Schindler, versity
M.D. Stuttering in Children of Minnesota Press, 1955.
children.
und Adults.
Journal
Minneapolis,
of Speech
and
Minnesota:
Uni-
Seitz, S. Language intervention: Changing the language environment of the retarded child. In: R. Koch, F. de la Cruz and F. Menolascino (eds.). Downs Syndrome: Research, Prevention and Management. New York: BrunesiMazel, 1975. Shames, G.H., and Egolf, D.B. Operant Conditioning and the Munagement Stuttering. Englewood Cliffs, New Jersey: Prentice-Hall, 1976. Sheehan, J.G. Current Controversies About Press, 1979.
issues on stuttering and recovery. In: H. Gregory Stuttering Therapy. Baltimore, Maryland: University
of (ed.). Park
Shine, R.E. Assessment and fluency training with the young stutterer. In: M. Peins (ed.). Contemporary Approaches in Stuttering Therapy. Boston, Massachusetts: Little, Brown and Company, 1984. Van Riper, tice-Hall,
C. The Treatment 1974.
Van Riper, C. The Nature Prentice-Hall, 1982.
of Stuttering.
of Stuttering,
Englewood
Cliffs, New Jersey:
2nd ed. Englewood
Zwitman, N.H. The Disfluent Child, A Management land: University Park Press, 1978.
Program.
Cliffs,
Pren-
New Jersey:
Baltimore,
Mary-
A COMPARISON
OF INTERACTIONS
271
APPENDIX A: DEFINITION OF COMMUNICATION CATEGORIES FOR ADULT AND CHILD Adult Categories 1. Declaratives: adult statements; any verbal utterances that are not imperative remarks or questions. 2. Imperatives: adult commands, demands, requests that clearly indicate the behaviors (verbal or not) that are expected of the child. 3. Interrogatives: direct questions to which the child is expected to respond either verbally or nonverbally. 4. Social fillers: short remarks that serve to keep the conversation going. Child Categories 1. Verbal: a single word, phrase, or sentence that is meaningful. 2. Vocal: audible sounds such as vowel-consonant sounds, spoken noises, yells, laughter, crying, animal noises, or meaningless, unintelligible utterances (jargon). 3. Nonverbal: gestures, body postures, and facial expressions that are attempts to communicate. 4. No response: child ignores the adult with behaviors such as lack of eye contact, leaving the area, or pretending not to hear.
A COMPARISON
272
OF INTERACTIONS
APPENDIX B: SAMPLE SCORING PROCEDURE The Adult-Child dialogue that follows is scored at the bottom of this page. The dialogue is scored from left to right. Category headings are listed on both sides of the page to increase the ease of accurate scoring. Each loop in the line is counted as an individual communication event. The “total” for each category is determined by counting the total number of loops in that category. The number is then recorded in the “Totals” column. Category 2 7 I 6 3 2 8 I 5 5 5
#
Sample Communicative Interaction Dialogue Speaker Let’s go over here. Tommy. Adult (Tommy walks to where adult points.) Child I’m going to play with this puzzle. Adult Child Mmmmmm. Adult What are you doing’? You can’t color on that puzzle. Adult (Tommy ignores adult and continues to color.) Child I’m going to put the puzzle away now. Adult Child No, no! Child 1 be good. I won’t color no more. Child
Total number of Adult-to-Child Utterances: _5 Total number of Child Utterances (Vocal + Verbal): _4 Adult MLU 7.3 Child MLU 3.7
Adult: Child: Scorer: Date:
Mrs. Smith Tommy Langlois 9/12/80
A COMPARISON
APPENDIX
273
OF INTERACTIONS
C: SCORING
ANALYSIS
FORM
Scorer Date
Child Adult Adult Category Counts Cateaorv 1. Declarative 2. Imperative 3. Interrogative 4. Social Filler Adult Total ”
d
Child Category Counts Category 5. Verbal 6. Vocal 7. Nonverbal 8. No Response Child Total
# of Events
Percentage
of Adult Total
# of Events
Percentage
of Child Total
Adult-Child Sequence Counts (Example: An adult “Declarative” statement that was followed immediately by a child “Verbal” statement five different times during the 5 minute sample would be recorded as follows: Declarative/Verbal 5.) _’
Sequences Declarative/Verbal Imperative/Verbal Interrogative/Verbal Social Filler/Verbal Declarative/Vocal Imperative/Vocal
Number of Occurrences
Sequences Interrogative/Vocal Social Filler/Vocal Declarative/Nonverbal Imperative/Nonverbal Interrogative/Nonverbal Social Filler/Nonverbal
Number of Occurrences