Beliefs of teachers versus non-teachers about people who stutter

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Journal of Fluency Disorders

Beliefs of teachers versus non-teachers about people who stutter Hayley S. Arnold a,∗ , Jian Li b , Kathryn Goltl a a b

Speech Pathology and Audiology, Kent State University, United States Evaluation and Measurement, Kent State University, United States

a r t i c l e

i n f o

Article history: Received 29 August 2014 Received in revised form 8 December 2014 Accepted 14 December 2014 Available online xxx Keywords: Stuttering Beliefs Attitudes Perceptions Teachers

a b s t r a c t Purpose: Although prior research has investigated teachers’ beliefs about people who stutter (PWS), this work has not indicated how these beliefs compare with those of the general public or taken into account key demographic variables that may be related to these beliefs. The main purpose of this study was to evaluate whether beliefs about PWS in teachers are different from those in the general public. The second purpose of this study was to examine whether gender is related to beliefs about PWS for teachers, who are more frequently women. Methods: Analyses were based on questionnaire responses regarding beliefs about PWS from 269 teachers and 1388 non-teachers in the United States. Due to their potential link to beliefs about PWS, familiarity with PWS and sociodemographic variables were included in the statistical model for this study. Results: Teachers’ beliefs about PWS are no different than those of people in non-teaching professions. Findings also indicated that, regardless of whether respondents were teachers, women had more accurate beliefs about PWS than men. The statistical model tested indicated that beliefs about PWS were more accurate when the respondents were older, had more education, and had familiarity with a PWS. Conclusion: In the first study to compare teachers’ beliefs about PWS to the general public, findings indicated that teachers are no more accurate than the public in their beliefs about PWS. Associations found between these beliefs and several variables may indicate some promising mechanisms for improving beliefs, such as increased familiarity with individuals who stutter. Educational Objectives: Readers should be able to: (a) describe stuttering’s potential effects on children’s participation in the school setting; (b) identify actions teachers can take to improve the school experience of their students who stutter; (c) summarize findings regarding teachers’ beliefs about people who stutter (PWS); (d) identify key variables that are associated with beliefs about PWS. © 2015 Elsevier Inc. All rights reserved.

∗ Corresponding author at: Speech Pathology and Audiology, 1325 Theatre Drive, Music and Speech Building, Kent State University, Kent, OH 44242-0001, United States. Tel.: +1 330 672 0259. E-mail address: [email protected] (H.S. Arnold). http://dx.doi.org/10.1016/j.jfludis.2014.12.001 0094-730X/© 2015 Elsevier Inc. All rights reserved.

Please cite this article in press as: Arnold, H. S., et al. Beliefs of teachers versus non-teachers about people who stutter. Journal of Fluency Disorders (2015), http://dx.doi.org/10.1016/j.jfludis.2014.12.001

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1. Introduction Although often described according to its observable speech characteristics, the experience of stuttering may be more fully understood, as suggested by Yaruss and Quesal (2004), within the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF) framework (World Health Organization, 2001). This framework helps, among other things, to characterize how stuttering impacts participation in society. Considering this ICF framework for a child who stutters, the experience of stuttering at school and in other settings may result in negative affective, behavioral, and cognitive reactions (Boyle, 2013; Corcoran & Stewart, 1998; Crichton-Smith, 2002; Daniels, Gabel, & Hughes, 2012; Hayhow, Cray, & Enderby, 2002; Klompas & Ross, 2004). Some of these reactions come internally, from the child who stutters. On the other hand, some of the negative reactions are external to the child, coming from teachers or peers in the classroom. Although both reactions, internal and external to the child, may reduce quality of life (Yaruss, 2010; Yaruss & Quesal, 2004), the focus of this study is on an external component, beliefs held by others about people who stutter (PWS). Inaccurate beliefs about PWS are important because they may result in experiences of discrimination and role entrapment (Gabel, Hughes, & Daniels, 2008; Klein & Hood, 2004). For the disorder of stuttering and PWS, inaccurate beliefs by the public abound (Craig, Tran, & Craig, 2003; Doody, Kalinowski, Armson, & Stuart, 1993; Hughes, Gabel, Irani, & Schlagheck, 2010). For example, Craig and his colleagues (2003) indicated that the public believes PWS are shy,1 self-conscious, anxious, and lacking in confidence. Similarly, in an interview study of United States (US) college students, prominent themes indicated that they believe PWS are frustrated, impatient, angry, annoying, shy, or disabled in learning (Hughes et al., 2010). The public’s inaccurate beliefs are likely to be particularly influential for the youngest PWS, children who stutter. In research on racial identity, children’s beliefs about their own differences are highly susceptible to their social context (Spencer, 1984; Spencer & Markstrom-Adams, 1990). For children, part of that social context is their school setting, in which teachers are central figures. Teachers’ beliefs, even when expressed in implicit, non-verbal ways, can influence the beliefs of their students (Vezzali, Giovannini, & Capozza, 2012). Ideally, teachers can counteract the potentially negative effects that inaccurate public beliefs about stuttering may have on their students who stutter. This calls for an investigation of whether teachers’ beliefs about stuttering are more accurate than those of the general public. Since at least the early 1980s, researchers have found the question of teachers’ beliefs (i.e., attitudes, perceptions, etc.) about stuttering to be important (Crowe & Walton, 1981; Dorsey & Guenther, 2000; Irani & Gabel, 2008; Lass et al., 1994, 1992; Ruscello, Lass, Schmitt, & Pannbacker, 1994; Yeakle & Cooper, 1986). This has likely been a topic of interest because teachers are the primary figures within the school setting, which is a place where children spend a lot of time per week (Juster, Ono, & Stafford, 2004). The years children spend in school constitute a period of many changes. For example, during adolescence there are many changes in brain structure that impact physiological and emotional functioning. The trajectory of this development can be affected by stressors along the way, which can have enduring effects on the brain (see Eiland & Romeo, 2013, for review). Thus, given their developmental sensitivity during this wide time range of school attendance, children’s school experiences, including interactions with teachers, are likely to be influential. The importance of school experiences is consistent with themes that have emerged from the self-reports of PWS (Corcoran & Stewart, 1998; Crichton-Smith, 2002; Daniels et al., 2012; Hayhow et al., 2002; Klompas & Ross, 2004). Daniels et al. (2012), who gathered qualitative data from semi-structured interviews with PWS, reported that for 90% of their 21 respondents, stuttering impacted their classroom participation, academics, and learning, from kindergarten through twelfth grade (K-12). For example, some PWS reported that anxiety about reading aloud or speaking in class diverted their attention from learning (Daniels et al., 2012). In a mail-based questionnaire study by Hayhow and colleagues (2002), PWS belonging to the British Stammering Association indicated the degree to which stuttering affected their lives in school and other areas. Respondents were also asked to provide examples for how stuttering had affected these life experiences. Of the 332 PWS who responded, 95% reported that stuttering affected them at school, with 56% of the total sample indicating the extent of the effect was “a lot” and 39% indicating “a bit” (Hayhow et al., 2002). These studies also highlight the teacher’s role in children’s school experiences. Most of the Daniels et al. (2012) respondents, who mentioned experiences with teachers in school, indicated they were either neutral or positive. However, there was at least one respondent who reported negative experiences with teachers. Hayhow and colleagues indicated that many of their respondents reported “feeling that their difficulties were not understood by teachers” (p. 5). One respondent in their study reported, “Teachers stopped asking me to read because my blocks were too long.” Negative or neutral school experiences may have long-term consequences for children who stutter. Research has shown that stuttering severity is significantly related to fewer years of educational attainment (O’Brian, Jones, Packman, Menzies, & Onslow, 2011). Although there is not enough evidence to establish a causal relationship between stuttering severity and years of educational attainment, the correlational relationship suggests the importance of examining the role the people in the educational environment play in the lives of students who stutter. Many of the negative school experiences reported by PWS related to reading aloud or other forms of speaking in front of groups (Daniels et al., 2012; Hayhow et al., 2002). Thus, it is important to note that public speaking requirements in the

1 The interpretation of the “shy” trait as negative in some of the previous work may be the result of western society’s preference for extroversion. The same trait might be interpreted as positive in other cultural contexts (see Cain, 2012, for in depth discussion of this issue).

Please cite this article in press as: Arnold, H. S., et al. Beliefs of teachers versus non-teachers about people who stutter. Journal of Fluency Disorders (2015), http://dx.doi.org/10.1016/j.jfludis.2014.12.001

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classroom are on the rise in the US. The speaking tasks encouraged by the Common Core Standard Initiative include specific requirements for students to “use appropriate eye contact, adequate volume, and clear pronunciation” (2012). Therefore, communication demands in the school environment for children, including those who stutter, may be becoming more challenging. It is important to consider what can be done to support students who stutter in their attempts to meet these demands during this crucial stage in their development. Teachers have the potential to play a role in encouraging their students who stutter to attempt these speaking tasks (Glickman, 2010), making accommodations to grading criteria or task demands, or implementing a combination of these approaches (Scott, 2009). For example, Scott (2009) advises teachers of students who stutter to provide opportunities for the student to talk, praising the student for the ideas expressed. A proactive approach such as this facilitates inclusion of students who stutter within the educational setting, while increasing the chances that the student will experience communication success. However, when teachers have inaccurate beliefs about PWS, such as believing PWS are nervous or fearful, they may not take such a proactive approach to including their students in classroom speaking tasks. 1.1. Teachers’ beliefs about PWS Past findings of teachers’ beliefs about stuttering are mixed. Prior studies that asked teachers to indicate their beliefs about stuttering’s etiology, the traits of PWS, and the potential for PWS to succeed in school and work, reported that many teachers had beliefs about PWS that were inaccurate (Crowe & Walton, 1981; Lass et al., 1994, 1992; Ruscello et al., 1994; Yeakle & Cooper, 1986). A more recent questionnaire study by Irani and Gabel (2008), which assessed teachers’ beliefs about the traits of PWS, indicated that teachers rated a hypothetical PWS as more intelligent, more sincere, and more physically normal than a hypothetical person who does not stutter (PWNS). This departure from prior findings calls for further investigation of teachers’ beliefs about PWS, particularly because it would be important to know about a wider range of beliefs than those related to traits of PWS. That is, even if teachers believe that their students who stutter are more intelligent than their nonstuttering peers, teachers may still believe that stuttering will limit their students’ career options and potential to succeed in various areas of life. Thus, it is important to have a better understanding of a wider range of beliefs, including beliefs about the cause of stuttering, the people who can help PWS, and the potential for PWS to experience social and occupational success. One important methodological limitation of the prior research is that teachers’ beliefs about stuttering have not been compared to the beliefs of those in the general public. That is, previous findings of teachers’ beliefs about PWS and stuttering do not tell us about the societal context of their beliefs. Only with a comparison group of people who are not K-12 teachers is it possible to know whether teachers’ beliefs are more or less accurate than those of the general public. Ideally, teachers’ beliefs about PWS are more accurate than those of people in other occupations. Based on the preceding review, teachers must go beyond serving in a neutral role. In order to be a positive and supportive force in the school environment for their students who stutter, teachers must have the knowledge that enables them to take proactive measures to improve the ability of students who stutter to fully participate in academic and social aspects of education. In addition, although some of the prior work has taken into account respondent familiarity with PWS (Yeakle & Cooper, 1986) and demographic variables such as age and education (Crowe & Walton, 1981; Irani & Gabel, 2008), none have tested familiarity, age, education, and gender together within a single model. As reviewed below, there is evidence that these variables may all be linked to beliefs about PWS and need to be considered when comparing teachers to the general public. 1.2. Gender differences in teachers’ beliefs about PWS The population of teachers is comprised more of females than males (Sparks, 2012). This is particularly interesting because the population of PWS is comprised more of males than females (see Bloodstein & Bernstein Ratner, 2008, for review). For this reason, it is important to consider the possibility of gender differences in beliefs about PWS. The evidence for gender differences in beliefs about PWS in the general population is considerably mixed. Some studies have indicated that men are more apt to have negative beliefs about stuttering than women (Burley & Rinaldi, 1986; Schlagheck, Gabel, & Hughes, 2009; Weisel & Spektor, 1998). In one study by Burley and Rinaldi (1986), men rated recorded speech samples of PWS more negatively than women. Another study indicated that men, compared to women, made more negative and fewer positive comments about the characteristics of PWS (Schlagheck et al., 2009). In contrast, other studies indicate that gender is not associated with beliefs about PWS (Patterson & Pring, 1991; St. Louis, 2012a; Van Borsel, Brepoels, & Coene, 2011). For example, Patterson and Pring (1991) sought to replicate Burley and Rinaldi’s (1986) study in which men and women rated speech samples of PWS, but added the task of rating speech samples of typically fluent speakers. Patterson and Pring’s results indicated no gender differences in ratings of speech samples. This finding of no gender differences was supported by St. Louis’s (2012a) study of questionnaire responses from 50 men and 50 women. One reason for the variance in findings may be that gender differences in beliefs about PWS depend upon other characteristics of the men and women in the sample that were not examined. For example, men who become teachers may be subtly different from men who seek out other professions in ways that impact beliefs about PWS. However, the question of gender differences in beliefs about PWS has not been assessed among teachers. Outside the stuttering literature, there is some evidence that male teachers view male students’ behavior more positively than female teachers do (Dee, 2005; Mullola et al., 2012). Given that more children who stutter are male than female (Bloodstein & Bernstein Ratner, 2008), this Please cite this article in press as: Arnold, H. S., et al. Beliefs of teachers versus non-teachers about people who stutter. 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tendency among male teachers to judge male students more positively may mean that male teachers have more positive beliefs about PWS than female teachers, which is the opposite of the gender difference that would be expected based on some of the previous studies of the general population (Burley & Rinaldi, 1986; Schlagheck et al., 2009; Weisel & Spektor, 1998). 1.3. Sociodemographic covariates In order to test for differences based on teacher occupation (i.e., teacher status) and gender, it is important to take into account sociodemographic variables believed to be associated with beliefs about PWS. Because there is some evidence that respondent age (Al-Khaledi, Lincoln, McCabe, Packman, & Alshatti, 2009; de Britto Pereira, Rossi, & Van Borsel, 2008; Ming, Jing, Wen, & Van Borsel, 2001; Van Borsel, Verniers, & Bouvry, 1999) and education (de Britto Pereira et al., 2008; St. Louis et al., 2014) are related to beliefs about stuttering, we included these as covariates in this study. We also accounted for familiarity with PWS as there is some evidence, although at times conflicting, that familiarity is associated with respondents’ beliefs about PWS (Betz, Blood, & Blood, 2008; Boyle, Blood, & Blood, 2009; Crowe & Cooper, 1977; Crowe & Walton, 1981; Doody et al., 1993; Hurst & Cooper, 1983; Irani & Gabel, 2008; Schlagheck et al., 2009; Yairi & Williams, 1970; Yeakle & Cooper, 1986). Including these covariates in the model was particularly important given the observational nature of the study, which was not able to ensure equivalence between groups for these variables. 1.4. Purpose of the study In summary, previous literature indicates that school experiences are important for PWS. However, it remains unknown whether teachers, who are central figures in the school experience, have more accurate beliefs about PWS than the general public. Therefore, the first purpose of this study was to evaluate whether beliefs about stuttering and PWS in K-12 teachers, based on responses to the Public Opinion Survey of Human Attributes – Stuttering (St. Louis, 2012b), are significantly different from non-teachers. To allow for a more valid comparison, the present study is the first to assess differences based on teacher status while taking the following personal characteristics into account: age, years of education, and familiarity with PWS. Because of teacher training and greater exposure to disabilities in recent years, we would predict that teachers’ beliefs toward stuttering and PWS would be more accurate than those of their non-teacher counterparts. Also, because of the greater number of women than men in the profession of teaching (Sparks, 2012), and evidence from at least some studies that gender of respondents is related to beliefs about PWS (Burley & Rinaldi, 1986; de Britto Pereira et al., 2008; Weisel & Spektor, 1998), the second purpose of this study was to examine whether gender is related to beliefs about PWS for teachers. We believe that our findings provide new and important information that will help design interventions for improving the degree to which the external environment encourages individuals who stutter to fully participate in society. 2. Method 2.1. Data source The database for this study consists of responses to the Public Opinion Survey of Human Attributes – Stuttering (POSHA-S), developed and managed by the International Project on Attitudes Toward Human Attributes (IPATHA) under the leadership of Kenneth St. Louis. The POSHA-S is a survey instrument designed to provide a standard, interculturally appropriate measure of public attitudes of stuttering around the world (St. Louis, 2005, 2011a, 2011b, 2013; St. Louis, Reichel, Yaruss, & Lubker, 2009). The POSHA-S has been translated into 22 different languages (St. Louis, 2011a). As of March 2014, there were 9297 respondents gathered across 33 countries. Psychometric properties of the POSHA-S, such as item analysis and selection, reliability, construct and concurrent validity, and internal consistency, have been reported and documented extensively in past studies (St. Louis, 2005, 2011a, 2012a, 2012b; St. Louis & George, 2008; St. Louis, Lubker, Yaruss, & Aliveto, 2009; St. Louis, Reichel, et al., 2009; St. Louis & Roberts, 2010). We accessed the database with the permission of IPATHA. The authors’ Institutional Review Board also approved use of the data for our investigation. 2.2. Participants Selection filters included respondents who reported on their questionnaires that they were current residents of the United States of America. Respondents who identified themselves as speech–language pathologists were excluded from the study because these individuals, as a function of their training and work, would have a relatively high level of knowledge about stuttering. Likewise, people who stutter were not included in the study because evidence indicates they have better than average beliefs about stuttering and PWS (St. Louis & George, 2008). Additionally, all respondents less than 18 years of age were excluded from the sample, as these respondents would not be expected to be employed full-time and would likely still be students in the K-12 setting. Finally, respondents were excluded when occupation was not identified or under-identified (e.g., “administrator” may or may not refer to someone who is a school administrator). Next, respondents were grouped into the “teacher” group and the “non-teacher” group according to their answer to the question about the job that they were best trained to do or the job they worked at the longest. To be included in the Please cite this article in press as: Arnold, H. S., et al. Beliefs of teachers versus non-teachers about people who stutter. Journal of Fluency Disorders (2015), http://dx.doi.org/10.1016/j.jfludis.2014.12.001

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Table 1 Descriptive information (N = 1657). Continuous variables

Mean

SD

Min

Max

Beliefs about PWS Age Years of education

41.57 36.11 15.28

23.72 15.34 2.87

−33 18 0

100 89 22

Categorical variables

Percentage

Teacher Female Familiarity 1 (acquaintance or other) Familiarity 2 (close friend or relative)

16.2 71.9 46.1 27.1

Table 2 Descriptive statistics of age and years of education for teacher status. Group

N

Women (%)

Mean age (SD)

Mean years of education (SD)

Teachers Non-teachers

269 1388

77.70% 70.80%

43.02 (14.06) 34.77 (15.22)

17.15 (2.34) 14.91 (2.82)

teacher group, respondents had to identify their occupation as a teacher at the K-12 level, including those who specified teaching primary, grade-school, secondary, or working as a special education teacher or school administrator (e.g., principal, etc.). Due to the study’s focus on teachers interacting with individuals during the K-12 school years, we excluded preschool teachers and college-level instructors/professors from the study. Respondents were excluded from the study if they had educationally-based occupations, for which years of teacher training are unspecified and years of education completed are typically fewer than teachers (e.g., teacher’s aides, paraprofessionals, etc.). Also excluded from the study were respondents with instruction-related occupations that may not involve work within a school setting (coaches, band directors, dance teachers, piano teachers, etc.). That is, some of these individuals may have been teachers in the K-12 setting, but there was insufficient information given to make this determination. To be included in the comparison group, called the “nonteachers” for this study, respondents could have any occupation that did not involve classroom teaching, ranging from preschool through higher education. The sample selection procedure resulted in a total sample size of 1657, in which 269 (16.2%) were teachers and 1388 (83.8%) were non-teachers. There were 461 male (28.1%) and 1179 female (71.9%) respondents in this study. Among the respondents in this study, there was a variety of familiarity with PWS. Forty-six percent reported that they had an acquaintance who stuttered or they knew someone who stuttered; 27.1% reported that they had a close friend or a relative who stuttered; and the rest did not know anyone who stuttered. On average, the respondents were 36.1 years of age (SD = 15.34) and had a little bit more than 15 years of education (SD = 2.87) (see Table 1). These demographics are separated out by respondent group (i.e., teachers, non-teachers) in Table 2. The teacher group had a larger proportion of women, more years of education, and were older, on average, than the non-teacher group. 2.3. Measures The components of the POSHA-S used for this study assessed demographics (e.g., age, gender, birthplace, current residence, years of education, occupation, etc.) and beliefs about PWS. In order to assess the level of familiarity respondents had to PWS, the response to the following question was used: “Following are people I have known who have stuttering. . .” with the answer choices including “nobody,” “acquaintance,” “close friend, “relative,” “me,” and “other”. Recall that any respondents indicating “me” were excluded from the sample. Also, the answer choices of “close friend” and “relative” were combined as one category and the answer choices of “acquaintance” and “other” were combined as another category, which resulted in the answer choice of “nobody” serving as the third category for the variable of familiarity. The focus of this investigation was on the beliefs about PWS score. Items used for this scale require a 1–3 rating with 1 = “no”, 2 = “not sure”, and 3 = “yes” response. All scale ratings for beliefs about PWS were rescaled into a new metric ranging from −100 to +100 in the POSHA-S. This conversion from the nominal or ordinal scale to the interval scale have been tested and justified through empirical data and the results based on the different scales were not statistically different (St. Louis, 2012b). Several items on the beliefs about PWS scale were reverse scored (e.g., “People who stutter are shy and fearful”), so that lower scores represent less accurate attitudes and higher scores reflect more accurate attitudes (St. Louis, 2012b). The beliefs about PWS composite variable consists of four components about PWS, which, in turn, are comprised of 3–6 questionnaire items (St. Louis, 2012b). The four components include: (a) traits/personality (3 items, e.g., “People who stutter are nervous or excitable.”), (b) what/who should help stuttering (3 items, e.g., reverse score for “I believe stuttering should be helped by a speech–language pathologist.”), (c) what causes stuttering (6 items, e.g., reverse score for “I believe stuttering is caused by a very frightening event.”), and (d) potential for social and professional success (4 items, e.g., “People who stutter can lead normal lives.”). Past studies have shown that the constructs in the POSHA-S have good test–retest reliability, Please cite this article in press as: Arnold, H. S., et al. Beliefs of teachers versus non-teachers about people who stutter. Journal of Fluency Disorders (2015), http://dx.doi.org/10.1016/j.jfludis.2014.12.001

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ranging from 0.69 to 0.85 for the paper-and-pencil version and from 0.78 to 0.83 for the online version (St. Louis, 2012b). Also, the different components and composite variables in the POSHA-S database have exhibited good internal consistency as measured by Cronbach alpha coefficients, ranging from 0.79 to 0.90 (Al-Khaledi et al., 2009). 2.4. Data analysis Data were extracted and imported into Statistical Analysis System (SAS) version 9.3 for Windows (SAS institute, Cary, NC) for analysis using multiple linear regression. The beliefs about PWS score was the dependent variable; teacher status (i.e., teachers, non-teachers) and gender were the independent variables. Because we suspected that there would be an interaction effect between teacher status and gender on beliefs about PWS, the interaction term between these two independent variables was entered into the model and examined first (i.e., full model). If the interaction effect was not statistically significant, the interaction term would be dropped from the model and the main effects of teacher status and gender would be reported (i.e., reduced model). Beliefs about PWS was a continuous variable and both the teacher status (i.e., 0 = nonteacher; 1 = teacher) and gender (i.e., 0 = male; 1 = female) were dichotomous variables. In this study, the multiple linear regression was chosen over the analysis of covariance (ANCOVA) model because multiple regression relaxes the assumption of homogeneity of regression slopes in ANCOVA. Therefore, the interaction between the covariates and the main factors such as teacher status and gender could also be examined and estimated when necessary. Prior to analyses, we compared the number of years of education and age between the teacher and non-teacher groups using independent samples Welch’s t-tests as the variances of the two groups were not equal. Teachers reported, on average, 2.23 years (M = 17.15) more education than non-teachers (M = 14.92), which led to a statistically significant difference, t[434.80] = 13.78, p < 0.001. Also, on average, the teacher group (M = 43.02) was significantly older than the non-teacher group (M = 34.77), t[399.68] = 8.68, p < 0.05. Accordingly, the number of years of education and age were entered into the model as covariates. Descriptive statistics for years of education and age, broken down by teacher status, are displayed in Table 2. In addition, familiarity, a categorical variable with three levels, was entered into the model and estimated by two dummy variables with the respondents who did not know anyone with stuttering as the reference group. All continuous covariates were grand-mean centered to reduce the risk of collinearity. As missing data are inevitable in the vast majority of empirical studies, each variable used in this study also had varying degrees of missing values. The percentages of missing values on the variables ranged from 0.8% to 3.94%, resulting in a total missing data rate of 8.3% if listwise deletion, the default missing data treatment method in the computer package, had been used. Based on the assumption that the data were missing at random (MAR) in this study, we conducted multiple imputation (MI) through PROC MI in SAS to maximize the use of available information and minimize the estimation bias. Ten imputed data sets were generated and an identical complete-data analysis was conducted in each of the data sets. This process led to 10 sets of estimates and these estimates were then aggregated together through PROC MIANALYZE in SAS by using the rules provided by Rubin (1987) that adjust the standard error and degrees of freedom for between imputation variance. 3. Results The full model that contained teacher status (0, 1), gender (0, 1), the interaction term between teacher status and gender, and the three control variables was tested first. The missing data were imputed (i.e., assigned values based on information from the existing data) using the multiple imputation procedure and the identical analysis was conducted on each of the 10 imputed data sets. For each analysis, regression assumptions were first investigated through diagnostic techniques and the model was then fitted if none of the assumptions was violated. In summary, we examined the normality of errors, homogeneity of error variance, linearity between the covariates and the dependent variables and also screened for influential observations and collinearity issues. All the assumptions were upheld; therefore, the full model was fitted and the results were combined. The results of the full regression model indicated the six predictors on average explained 3.7% of the variance of beliefs about PWS (across the 10 analyses: Mean R2 = .037, with a minimum R2 = .036 and a maximum R2 = .039) with a significant level (F combined (7,2 352579) = 8.89, p combined < 0.0001). The coefficient of the teacher status and gender interaction was tested and was not statistically significant (B combined = 3.45, t combined = 0.93, p combined = 0.35), indicating the effect of teacher status on beliefs did not depend on the gender of the respondent. Thus, the interaction term was removed from the model. The same procedure as described for the full model in the above was utilized for the reduced model in which the interaction term was dropped. Across the 10 analyses, the combined results showed that the five predictors on average accounted for roughly the same amount of variance of beliefs about PWS (Mean R2 = .036, with a minimum R2 = .035 and a maximum R2 = .038) with a significant level (F combined (6, 217956) = 10.21, p combined < 0.0001). Both the unstandardized and the standardized regression coefficients and the results of the significance tests are displayed in Table 3 for this final model. Teacher status was positively associated with beliefs about PWS; however, this relationship was not statistically significant (B combined = 0.35, t combined = 0.21, p combined = 0.83). Regardless of teacher status, gender was significantly related to beliefs about PWS (B combined = 3.47, t combined = 2.68, p combined < 0.001), indicating that the beliefs about PWS score for female

2

The degrees of freedom are an approximation based on the multiple imputation procedure and independent of the original sample size.

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Table 3 Unstandardized and standardized regression coefficients and results of significance tests. Parameter

Unstandardized coefficient (Std. err.)

Standardized coefficient

df

t

p

Intercept Years of education Age Familiarity 1 (acquaintance or other) Familiarity 2 (close friend or relative) Sex Teacher status

34.501 (1.504) 0.634 (0.220) 0.115 (0.040) 5.373 (1.425)

0.000 0.076 0.075 0.113

187.46 187.75 192.90 180.19

22.95 2.89 2.92 3.77

<0.0001 0.0044 0.0039 0.0002

7.406 (1.599)

0.139

182.59

4.63

<0.0001

3.474 (1.294) 0.346 (1.644)

0.066 0.005

190.86 192.64

2.68 0.21

0.0079 0.8334

Note: Average R2 for the final model was 0.036.

respondents on average was 3.47 points higher than their male counterparts, holding all the other variables constant in the model. Although the other variables, such as age, years of education, and familiarity with PWS, were entered into the model as control/covariate variables, the results for these variables are interesting and worthy of closer examination. The number of years of education showed a positive relationship with beliefs about PWS (B combined = 0.63, t combined = 2.89, p combined < 0.01), indicating that as the number of years of education increased by one year, respondents’ beliefs about PWS score tended to increase by 0.63 points, holding all the other variables constant in the model. Similarly, there is a significant positive relationship between age and beliefs about PWS (B combined = 0.12, t combined = 2.92, p combined < 0.01). In other words, controlling all the other variables in the model, respondents’ beliefs about PWS score tended to increase by 0.12 points if their age increased by one year. Compared to respondents who did not know anyone who stuttered, people who had an acquaintance or knew someone who stuttered tended to have a significantly higher beliefs about PWS score by 5.37 points (t combined = 3.77, p combined < 0.0001); people who had a close friend or a relative who stuttered tended to have a higher beliefs about PWS score than people who knew no PWS by 7.41 points (t combined = 4.63, p combined < 0.001), if having the same values on all the other variables. In addition, the interactions between the covariates and the main factors were also investigated and no covariate was found to interact with the main factors of teacher status and gender. Therefore, the above model concluded the analysis. 4. Discussion The primary purpose of this study was to assess for the first time whether teachers’ beliefs about PWS are different from those of the general public. Given the amount of time students spend with their teachers in school and the influence teachers can have during students’ formative years, we certainly hoped K-12 teachers would have more accurate beliefs about PWS than their non-teacher counterparts. The secondary purpose of this study was to investigate whether gender is associated with beliefs about PWS. Due to mixed findings in the literature regarding the relationship between gender and beliefs about stuttering and PWS, we sought to clarify whether these differences between men and women exist. In order to test these two main effects, we first built and tested the interaction effects between gender and teacher status on beliefs about PWS, as main effects would be confounded if the interaction term was statistically significant. Findings did not indicate that the effects of teacher status on beliefs about PWS depended on gender. Therefore, we proceeded to the test of main effects. This indicated that, based on the POSHA-S beliefs about PWS scale, teachers have no more accurate beliefs about PWS than people not in the teaching profession. Gender in general predicted differences in beliefs about PWS, with men’s beliefs being less accurate than women’s. Results also indicated some potentially important variables related to beliefs about PWS, including age, education, and familiarity with PWS. 4.1. Gender differences in beliefs about PWS Findings indicated that, irrespective of whether the respondents were teachers, men had less accurate beliefs about PWS than women. This is consistent with some previous findings (Burley & Rinaldi, 1986; Schlagheck et al., 2009; Weisel & Spektor, 1998), but inconsistent with others (Patterson & Pring, 1991; St. Louis, 2012a; Van Borsel et al., 2011). The same inconsistency of gender difference findings can be found in studies assessing beliefs about intellectual disability, with any gender differences reported being consistent with males having less favorable beliefs than females (see for review, Scior, 2011). These inconsistencies may be due to the many variables influencing beliefs that were not accounted for in all studies. The present study did control for several relevant variables, including age, education, and familiarity with PWS. This fact, coupled with a much larger sample size than any previous studies of gender differences in beliefs about PWS, should lend more credence to the finding that women have more accurate beliefs about PWS than men. Perhaps gender differences in beliefs toward PWS and other groups are related to findings of greater empathy in females than males from infancy through Please cite this article in press as: Arnold, H. S., et al. Beliefs of teachers versus non-teachers about people who stutter. Journal of Fluency Disorders (2015), http://dx.doi.org/10.1016/j.jfludis.2014.12.001

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adulthood (Auyeung et al., 2009; Baron-Cohen & Wheelwright, 2004). Further research is needed to better understand the nature of these gender differences in beliefs about PWS so that efforts at changing these beliefs can be improved. 4.2. Teachers’ beliefs about PWS Present findings indicate that teachers’ beliefs about PWS are no more accurate than those of people who do not teach when age, education, and familiarity with PWS are taken into account. At first, this was surprising given that teachers are specifically trained to work with children, a subset of whom demonstrate a variety of speech, language, and other impairments. However, upon further consideration, the breadth and depth of impairments that K-12 teachers encounter (e.g., autism, attention deficit disorder, dyslexia, etc.) may actually make it more challenging for teachers to develop more accurate beliefs about any single disorder. Another challenge is that teachers and others may make incorrect inferences that PWS are shy or fearful, for example, when they observe avoidance toward speaking. Indeed, adolescents who stutter are more likely than their typically fluent peers to report apprehension about communication (Blood, Blood, Tellis, & Gabel, 2001). Teachers tend to associate communication apprehension in their students with lower competence (McCroskey & Daly, 1976). These perceptions of lower competence may then be perceived by the student and result in even more communication apprehension and avoidance. Outside the stuttering literature, students’ beliefs that their teachers have lower expectations for them have been shown to negatively impact academic achievement (Steele & Aronson, 1995). Thus, teachers holding more accurate beliefs about the full potential of their students who stutter may positively influence student academic achievement. Beyond supporting academic achievement, teachers may also be important in helping their students who stutter cope with social challenges related to peers’ negative beliefs (Franck, Jackson, Pimentel, & Greenwood, 2003), social distancing (Davis, Howell, & Cooke, 2002; Evans, Healey, Kawai, & Rowland, 2008; Langevin, 2009), and bullying (Blood & Blood, 2004; Blood, Blood, Maloney, Meyer, & Qualls, 2007; Davis et al., 2002). Although these are problems with peer relationships, evidence indicates that teacher preference for students in general is a greater predictor of peer inclusion than peer preference (Ladd, Birch, & Buhs, 1999; White & Kistner, 1992; White, Sherman, & Jones, 1996). Thus, more accurate teacher beliefs about PWS may indirectly result in improved peer relationships. Furthermore, teachers with knowledge and openness to stuttering can be central to reducing the bullying of their students who stutter (e.g., Bauer, Lozano, & Rivara, 2007; Langevin & Narasimha Prasad, 2012). This adds to the need for the accuracy in teachers’ beliefs about PWS to improve. 4.3. Clinical implications for improving teachers’ beliefs How might this situation be improved? Yeakle and Cooper (1986) reported that teachers who have had a class on speech disorders viewed PWS slightly more positively than teachers who have not. However, such a class may not have enough of a positive effect on improving beliefs and may not be practical or available for teachers or teachers in training. Informational videos about stuttering, which may be more practical for teachers, have been shown to have little to no effect on teachers’ beliefs about PWS (Abdalla and St. Louis, 2014). One of the most successful interventions for improving beliefs about PWS that has been empirically studied involved a film about stuttering, coupled with a live, informative, and humorous speech given by an adult PWS to high school students (Flynn and St. Louis, 2011). This indicates that use of multiple methods such as live contact with an individual who stutters and viewing an educational video, may provide the important combination of education and interpersonal contact that helps to break down previously held beliefs. Such interpersonal contact increases people’s familiarity with stuttering and, as discussed below, appears to be associated with more accurate beliefs about PWS. 4.4. Familiarity and beliefs about PWS Overall, respondents who knew one or more PWS had more accurate beliefs about them than respondents who knew no PWS. These findings are consistent with past research (Betz et al., 2008; Hurst & Cooper, 1983; Schlagheck et al., 2009; Yeakle & Cooper, 1986). Yeakle and Cooper (1986) reported that teachers, who had more children who stutter as students, were more likely to have accurate beliefs about PWS. This finding may also help to explain why having a PWS speak to a group about stuttering may be one of the most effective ways to improve beliefs about PWS (Flynn and St. Louis, 2011). It may be that increasing familiarity through interpersonal contact between the student who stutters and the teacher may be an excellent mechanism by which to improve beliefs of teachers about PWS. 4.5. Associations with age, education, and beliefs about PWS Educational attainment and age were found to positively relate to beliefs about PWS. That is, the more educated and older the respondents were, the more accurate their beliefs about PWS. Findings that respondents’ educational attainment is associated with more accurate beliefs were consistent with studies in the US (St. Louis et al., 2014) and beyond (de Britto Pereira et al., 2008). Relative to age, previous evidence was based on samples outside the US, with some indicating that older individuals have more inaccurate beliefs about stuttering (de Britto Pereira et al., 2008; Ming et al., 2001; Van Borsel et al., 1999). However, one study indicated older individuals’ beliefs are more accurate than younger respondents (Al-Khaledi Please cite this article in press as: Arnold, H. S., et al. Beliefs of teachers versus non-teachers about people who stutter. Journal of Fluency Disorders (2015), http://dx.doi.org/10.1016/j.jfludis.2014.12.001

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et al., 2009). This difference in findings may have to do with the age groups these studies compared. de Britto Pereira et al. (2008) and Van Borsel et al. (1999) compared three groups of respondents who were less than age 21, 21 to 55, and 55 and older. Ming et al. (2001) included two groups who were less than 21 and 21–55. In contrast, Al-Khaledi et al. (2009) compared two age groups (39 and under, 40 and above), both of whom were the parents of preschool and school-age children, which in effect may have limited the proportion of people younger than 21 and older than 55 in the sample. Similarly, our youngest respondents were 18, with a mean age of 36, indicating a largely young adult to middle-aged adult sample. Another important difference between our study and previous studies is that age served as a continuous, rather than a categorical variable. It may be that each year of maturity is associated with more experience with PWS through work, family, or other life experiences, perhaps resulting in more accurate beliefs about PWS. 4.6. Limitations and future directions Despite this study’s contribution to research on teachers’ and the general public’s beliefs about PWS, some limitations should be acknowledged. This study was cross-sectional and correlational in nature. For this reason, the results do not address whether, for example, beliefs about PWS change as people age. Another limitation related to the cross-sectional design of this study is that we do not know the directionality of associations between particular variables and beliefs about PWS. For example, it may be that increased familiarity with PWS improves respondents’ beliefs about them. Alternatively, respondents who have accurate beliefs about PWS may be more inclined to initiate conversations with and eventually befriend them, thereby increasing their degree of familiarity with stuttering. Additionally, although at least one previous study has addressed both the beliefs teachers have about PWS and their recommended or anticipated reactions to stuttering (Crowe & Walton, 1981), we did not investigate how teachers may differ from their non-teaching counterparts in their reactions to PWS. Pre-service teachers have been found to be more open, more agreeable, and more conscientious than their counterparts who are not training to be teachers (Ripski, LoCasaleCrouch, & Decker, 2011). Thus, even if their beliefs are similar to the general public, teachers may still be more helpful to and less likely to distance themselves from PWS (Ripski et al., 2011). Investigation of teachers’ reactions to PWS is currently underway. Finally, because our findings regarding the association between beliefs about PWS and other variables in the model, including gender, age, and familiarity with PWS, were in conflict with some previous findings (de Britto Pereira et al., 2008; Ming et al., 2001), it would seem that these associations and their underlying mechanisms warrant further study. 4.7. Conclusion Findings indicate that although teachers are no more accurate in their beliefs about PWS than the general public, there may be some promising mechanisms such as increased education and familiarity, which could improve their ability to counteract prevailing beliefs about PWS. Further research is needed to better understand differences in beliefs based on gender, age, education, and familiarity. Such may help to identify mechanisms of belief formation about PWS. With better knowledge of these mechanisms, PWS, their family members, speech–language pathologists, and others can more effectively open up opportunities for PWS to participate fully in society. Acknowledgements A preliminary version of this project helped to fulfill the M.A. degree requirements for one of this study’s co-authors. We wish to acknowledge our university’s School of Health Science graduate student grant committee, which awarded her funding support for this project. We would also like thank Kenneth St. Louis from West Virginia University for permitting us access to the POSHA-S database as well as consulting with us regarding this study. We would also like to thank our colleague, Kelly Cichy, for her feedback regarding this manuscript. Conflict of interest: None declared. CONTINUING EDUCATION Beliefs of teachers versus non-teachers about people who stutter QUESTIONS 1. The World Health Organization’s (WHO) International Classification of Functioning, Disability, and Health (ICF) framework is useful when describing stuttering because it incorporates which of the following? a. Impact of stuttering on ability to participate in society. b. Mechanisms which are believed to cause stuttering. c. Only overt, physical characteristics of stuttering. d. Predictors of stuttering persistence versus recovery. e. Theoretical accounts of onset and maintenance of stuttering. 2. The focus of this study was on which of the following?

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a. Beliefs of children about their peers who stutter. b. Beliefs of teachers and non-teaching counterparts about people who stutter (PWS). c. Internal reactions that adults have to their stuttering. d. Internal reactions that children have to their stuttering. e. Personality characteristics of PWS. 3. Which of the following was a finding of this study regarding gender? a. Men had more accurate and sensitive beliefs about PWS than women. b. Men who are teachers have more accurate beliefs about PWS than men in other professions. c. Women who are teachers have more accurate beliefs about PWS than men in other professions. d. Women had more accurate beliefs about PWS than men. e. Gender was not a significant variable predicting beliefs about PWS. 4. Which of the following was a finding of this study regarding teachers’ beliefs about PWS? a. Teachers are less likely to recommend professions involving speech to their students who stutter than their students who do not stutter. b. Teachers are well-versed in modifying required speech tasks for their students who stutter. c. Teachers had less accurate beliefs about PWS than the general public. d. Teachers had more accurate beliefs about PWS than the general public. e. Teachers were not different from the general public in their beliefs about PWS. 5. What are the current study’s findings about familiarity with PWS? a. Getting to know one or more PWS results in less accurate beliefs about them. b. Having more accurate beliefs about PWS results in getting to know them better. c. Knowing one or more PWS is associated with less accurate beliefs about them. d. Knowing one or more PWS is associated with more accurate beliefs about them. e. Knowing one or more PWS is not associated with beliefs about them.

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Hayley Arnold is an assistant professor in the Speech Pathology and Audiology program at Kent State University in Kent, Ohio. Her research, which focuses on developmental stuttering, investigates how internal mechanisms, such as linguistic and emotional processes, and external mechanisms, such as public opinions about stuttering, impact individuals who stutter. Jian Li is an assistant professor in Evaluation and Measurement at Kent State University. Her general research interests focus on methodological issues when quantitative statistical methods are applied to data that have complex structures. She is also interested in the relationships between students’ achievement and their overall well-being. Kathryn Goltl is a December 2013 graduate of the M.A. program in Speech–Language Pathology at Kent State University. Kathryn has research interests in the area of public opinion about individuals who stutter. She now works as a speech–language pathologist for Therapy in Motion in Cleveland, Ohio.

Please cite this article in press as: Arnold, H. S., et al. Beliefs of teachers versus non-teachers about people who stutter. Journal of Fluency Disorders (2015), http://dx.doi.org/10.1016/j.jfludis.2014.12.001