- Email: [email protected]
The communication attitudes and stuttering controversy revisited: Comment on Vanryckeghem and Brutten (1996)
ELSEVIER
COMMENTARIES
THE C O M M U N I C A T I O N ATTITUDES AND STUTTERING CONTROVERSY REVISITED: C O M M E N T ON V A N R Y C K E G H E M AND BRUTTEN (1996) ROGER J. I N G H A M Universit3, of Cali~brnia Santa Barbara
At various times over the past 20 years efforts have been made to learn not only whether attitudes toward speech and stuttering are independent variables (Andrews & Cutler, 1974; Erickson, 1969), but also whether such attitudes may influence either stuttering (Guitar, 1976) or the recovery from stuttering therapy (Guitar & Bass, 1978), The results of those earlier studies prompted a vigorous debate about the validity of their findings (Guitar, 1979, 1981; Ingham, 1979; Young, 1981) and at least one investigation that showed that "communication attitudes" of persons who stutter may simply reflect their frequency of stuttering in certain speaking situations (Ulliana & Ingham, 1984). A recent study by Vanryckeghem and Brutten (1996) reports the results of an investigation into the communication attitudes of children who stutter (n = 55; 6-13 years) and matched controls using the Communication Attitudes Test (C.A.T.), a scale devised for children who stutter (Brutten & Dunham, 1989; De Nil & Brutten, 1986, 1991). Their findings were interpreted to show that measures of "mal-attitudes" and "fluency failure" in children who stutter "do not reflect one and the same process" (Vanryckeghem & Brutten, 1996, p. 115), even though they were significantly correlated. It is of interest, therefore, to find that neither the rationale nor the methodology of this study takes account of the issues that arose out of the earlier debate about communication attitudes and stuttering. Some recognition of those issues may have provided additional clarity to Vanryckeghem and Brutten's findings.
Addresscorrespondenceto author, Departmentof Speechand HearingSciences,Universityof California, SantaBarbara,CA 93106.e-mail:[email protected] J. FLUENCYDISORD.22 (1997), 323-326 © 1997Elsevier ScienceInc. All rights reserved. 655 Avenueof the Americas,New York, NY 10010
0094-730X/97/$17.00 PII S0094-730X(97)00024-7
324
R.J. INGHAM
In the introduction to their study Vanryckeghem and Brutten argue (1996, p. 110) that "... research has shown that there is a partially dependent relationship between improved attitude about speech and the maintenance of fluency following therapy (Andrews & Cutler, 1974). . . . Among adults who stutter, a statistically significant (+ 0.42) correlation has been found between the Erickson $24 Scale of Communication Attitudes (Guitar, 1976) and the percentage of syllables stuttered during conversation. In addition, Guitar and Bass (1978) reported a significant inverse relationship between improvement in speech-specific attitude and the percentage of syllables stuttered for those who were helped by therapy. Conversely, those whose attitude toward speech did not improve during the course of therapy did not evidence a significant decrease in the display of syllables stuttered." Such an account of the relevant research on communication attitudes among adult stutterers hardly reflects the status of that research. The findings of the Guitar (1976) and Guitar and Bass (1978) studies were based on the use of a self-report scale originally devised by Erickson (1969) to "assess communication attitudes among stutterers" (Erickson, 1969, p. 713). The scale was subsequently amended by Andrews and Cutler (1974) and became known as the $24 Scale. It was then strongly argued that the $24 provided a measure that was independent of speech behavior (Andrews & Cutler, 1974; Guitar, 1976; Guitar & Bass, 1978; Helps & Dalton, 1979; Silverman, 1980). However, the very design of the $24 Scale made it highly likely that this scale would be influenced by changes in speech behavior: Andrews and Cutler (1974) actually tailored Erickson's S-Scale so that the $24 included only those items that changed as stutterers' speech improved during a behavioral treatment. And to some extent that was confirmed in studies by Guitar (1976) and Helps and Dalton (1979), albeit on the basis of one measure of stuttering obtained in one speaking situation. As the present writer pointed out (Ingham, 1979), however, the measures of the speakers' stuttering in virtually all studies on the $24 failed to measure the level or severity of stuttering in speech situations that were clearly referred to among the Scale's items. The importance of that oversight became clear in a reanalysis of the Guitar and Bass (1978) study and a subsequent investigation on the $24 Scale by Ulliana and Ingham (1984). A critical reanalysis of data reported by Guitar and Bass (Ingham, 1979) showed that, in fact, there were n o significant differences between the $24 scores of those who apparently maintained therapy gains and those who did not--a conclusion that was ultimately acknowledged by Guitar (1981). That reevaluation of the Guitar and Bass study also focused attention on the content of items within the scale, noting that respondents to $24 items may have been reporting judgments of the quality and fluency of their current speech, or speech in certain situations, rather than an attitude toward their speech. To test this possibility Ulliana and Ingham (1984) arranged for three adults who stuttered to
COMMENTARIES
325
be recorded speaking in situations that they indicated were the basis of their $24 item responses. It emerged that their frequency of stuttering in those situations varied in accordance with their item responses, thereby suggesting that a communication attitude may simply be a composite of judgments about speech performance. The latter possibility may also be an important factor when considering the findings reported by Vanryckeghem and Brutten (1996). In their study oral reading and conversational speech performance data were gathered from a single audio recording obtained under unspecified conditions. During the same session subjects responded to the 32-item C.A.T. Given the issues raised by an item inspection of the $24, it seems reasonable to consider that children may also report judgments of the quality and fluency of their current speech, or speech in certain situations, rather than an attitude toward their speech when responding to items on the C.A.T. Indeed, the scale asks for true or false responses to numerous statements about the child's speech in certain situations (e.g., "It is hard for me to talk to strangers" or "Reading out loud in class is easy for me"). For that reason it would seem appropriate to ask whether the child's speech performance in such situations, rather than attitudes toward speech, might have been a principal source of variance in data derived from the C.A.T. At the very least, such issues should be considered not only in drawing any conclusions from studies employing the C.A.T., but also in designing studies on the contentious issue of communication attitudes and their role is stuttering.
REFERENCES Andrews, (3. & Cutler, J. (1974). Stuttering therapy: The relation between changes in symptom level and attitudes. Journal of Speech and Hearing Disorders 39, 312-319. Brutten, G. & Dunham, S. (1989). The communication attitude test. A normative study of grade school children. Journal of Fluency Disorders 14, 371377. De Nil, L. & Brutten, (3. (1986). Stutterers and nonstutterers: A preliminary investigation of children's speech-associated attitudes. Tijdschrift voor Logopedie en Audiologie 16, 85-92. De Nil, L. & Brutten, (3. (1991). Speech associated attitudes of stuttering and nonstuttering children. Journal of Speech and Hearing Research' 34, 60-66. Erickson, R.L. (1969). Assessing communication attitudes among stutterers. Journal of Speech and Hearing Research 12, 711-724. Guitar, B. (1976). Pretreatment factors associated with the outcome of stuttering therapy. Journal of Speech and Hearing Research 19, 590-600.
326
R.J. INGHAM
Guitar, B. (1979). A response to Ingham's critique. Journal of Speech and Hearing Disorders 44, 400-403. Guitar, B. (1981). A correction to "A response to Ingham's critique." Journal of Speech and Hearing Disorders 46, 440. Guitar, B. & Bass, C. (1978). Stuttering therapy: The relation between attitude change and long-term outcome. Journal of Speech and Hearing Disorders 43, 392--400. Helps, R. & Dalton, P. (1979). The effectiveness of an intensive speech therapy programme for adult stammerers. British Journal of Disorders of Communication 14, 17-30. Ingham, R.J. (1979). Comment on "Stuttering therapy: The relation between attitude change and long-term outcome." Journal of Speech and Hearing Disorders 44, 397400. Silverman, E. (1980). Communication attitudes of women who stutter. Journal of Speech and Hearing Disorders 45, 533-539. Ulliana, L. & Ingham, R.J. (1984). Behavioral and non-behavioral variables in the measurement of stutterer's communication attitudes. Journal of Speech and Hearing Disorders 49, 83-93. Vanryckeghem, M. & Brutten, G.J. (1996). The relationship between communication attitude and fluency failure of stuttering and nonstuttering children. Journal of Fluency Disorders 21, 109-118. Young, M.A. (1981). A reanalysis of "Stuttering therapy: The relation between attitude change and long-term outcome." Journal of Speech and Hearing Disorders 46, 221-222.
COMMENTARIES
THE C O M M U N I C A T I O N ATTITUDES AND STUTTERING CONTROVERSY REVISITED: C O M M E N T ON V A N R Y C K E G H E M AND BRUTTEN (1996) ROGER J. I N G H A M Universit3, of Cali~brnia Santa Barbara
At various times over the past 20 years efforts have been made to learn not only whether attitudes toward speech and stuttering are independent variables (Andrews & Cutler, 1974; Erickson, 1969), but also whether such attitudes may influence either stuttering (Guitar, 1976) or the recovery from stuttering therapy (Guitar & Bass, 1978), The results of those earlier studies prompted a vigorous debate about the validity of their findings (Guitar, 1979, 1981; Ingham, 1979; Young, 1981) and at least one investigation that showed that "communication attitudes" of persons who stutter may simply reflect their frequency of stuttering in certain speaking situations (Ulliana & Ingham, 1984). A recent study by Vanryckeghem and Brutten (1996) reports the results of an investigation into the communication attitudes of children who stutter (n = 55; 6-13 years) and matched controls using the Communication Attitudes Test (C.A.T.), a scale devised for children who stutter (Brutten & Dunham, 1989; De Nil & Brutten, 1986, 1991). Their findings were interpreted to show that measures of "mal-attitudes" and "fluency failure" in children who stutter "do not reflect one and the same process" (Vanryckeghem & Brutten, 1996, p. 115), even though they were significantly correlated. It is of interest, therefore, to find that neither the rationale nor the methodology of this study takes account of the issues that arose out of the earlier debate about communication attitudes and stuttering. Some recognition of those issues may have provided additional clarity to Vanryckeghem and Brutten's findings.
Addresscorrespondenceto author, Departmentof Speechand HearingSciences,Universityof California, SantaBarbara,CA 93106.e-mail:[email protected] J. FLUENCYDISORD.22 (1997), 323-326 © 1997Elsevier ScienceInc. All rights reserved. 655 Avenueof the Americas,New York, NY 10010
0094-730X/97/$17.00 PII S0094-730X(97)00024-7
324
R.J. INGHAM
In the introduction to their study Vanryckeghem and Brutten argue (1996, p. 110) that "... research has shown that there is a partially dependent relationship between improved attitude about speech and the maintenance of fluency following therapy (Andrews & Cutler, 1974). . . . Among adults who stutter, a statistically significant (+ 0.42) correlation has been found between the Erickson $24 Scale of Communication Attitudes (Guitar, 1976) and the percentage of syllables stuttered during conversation. In addition, Guitar and Bass (1978) reported a significant inverse relationship between improvement in speech-specific attitude and the percentage of syllables stuttered for those who were helped by therapy. Conversely, those whose attitude toward speech did not improve during the course of therapy did not evidence a significant decrease in the display of syllables stuttered." Such an account of the relevant research on communication attitudes among adult stutterers hardly reflects the status of that research. The findings of the Guitar (1976) and Guitar and Bass (1978) studies were based on the use of a self-report scale originally devised by Erickson (1969) to "assess communication attitudes among stutterers" (Erickson, 1969, p. 713). The scale was subsequently amended by Andrews and Cutler (1974) and became known as the $24 Scale. It was then strongly argued that the $24 provided a measure that was independent of speech behavior (Andrews & Cutler, 1974; Guitar, 1976; Guitar & Bass, 1978; Helps & Dalton, 1979; Silverman, 1980). However, the very design of the $24 Scale made it highly likely that this scale would be influenced by changes in speech behavior: Andrews and Cutler (1974) actually tailored Erickson's S-Scale so that the $24 included only those items that changed as stutterers' speech improved during a behavioral treatment. And to some extent that was confirmed in studies by Guitar (1976) and Helps and Dalton (1979), albeit on the basis of one measure of stuttering obtained in one speaking situation. As the present writer pointed out (Ingham, 1979), however, the measures of the speakers' stuttering in virtually all studies on the $24 failed to measure the level or severity of stuttering in speech situations that were clearly referred to among the Scale's items. The importance of that oversight became clear in a reanalysis of the Guitar and Bass (1978) study and a subsequent investigation on the $24 Scale by Ulliana and Ingham (1984). A critical reanalysis of data reported by Guitar and Bass (Ingham, 1979) showed that, in fact, there were n o significant differences between the $24 scores of those who apparently maintained therapy gains and those who did not--a conclusion that was ultimately acknowledged by Guitar (1981). That reevaluation of the Guitar and Bass study also focused attention on the content of items within the scale, noting that respondents to $24 items may have been reporting judgments of the quality and fluency of their current speech, or speech in certain situations, rather than an attitude toward their speech. To test this possibility Ulliana and Ingham (1984) arranged for three adults who stuttered to
COMMENTARIES
325
be recorded speaking in situations that they indicated were the basis of their $24 item responses. It emerged that their frequency of stuttering in those situations varied in accordance with their item responses, thereby suggesting that a communication attitude may simply be a composite of judgments about speech performance. The latter possibility may also be an important factor when considering the findings reported by Vanryckeghem and Brutten (1996). In their study oral reading and conversational speech performance data were gathered from a single audio recording obtained under unspecified conditions. During the same session subjects responded to the 32-item C.A.T. Given the issues raised by an item inspection of the $24, it seems reasonable to consider that children may also report judgments of the quality and fluency of their current speech, or speech in certain situations, rather than an attitude toward their speech when responding to items on the C.A.T. Indeed, the scale asks for true or false responses to numerous statements about the child's speech in certain situations (e.g., "It is hard for me to talk to strangers" or "Reading out loud in class is easy for me"). For that reason it would seem appropriate to ask whether the child's speech performance in such situations, rather than attitudes toward speech, might have been a principal source of variance in data derived from the C.A.T. At the very least, such issues should be considered not only in drawing any conclusions from studies employing the C.A.T., but also in designing studies on the contentious issue of communication attitudes and their role is stuttering.
REFERENCES Andrews, (3. & Cutler, J. (1974). Stuttering therapy: The relation between changes in symptom level and attitudes. Journal of Speech and Hearing Disorders 39, 312-319. Brutten, G. & Dunham, S. (1989). The communication attitude test. A normative study of grade school children. Journal of Fluency Disorders 14, 371377. De Nil, L. & Brutten, (3. (1986). Stutterers and nonstutterers: A preliminary investigation of children's speech-associated attitudes. Tijdschrift voor Logopedie en Audiologie 16, 85-92. De Nil, L. & Brutten, (3. (1991). Speech associated attitudes of stuttering and nonstuttering children. Journal of Speech and Hearing Research' 34, 60-66. Erickson, R.L. (1969). Assessing communication attitudes among stutterers. Journal of Speech and Hearing Research 12, 711-724. Guitar, B. (1976). Pretreatment factors associated with the outcome of stuttering therapy. Journal of Speech and Hearing Research 19, 590-600.
326
R.J. INGHAM
Guitar, B. (1979). A response to Ingham's critique. Journal of Speech and Hearing Disorders 44, 400-403. Guitar, B. (1981). A correction to "A response to Ingham's critique." Journal of Speech and Hearing Disorders 46, 440. Guitar, B. & Bass, C. (1978). Stuttering therapy: The relation between attitude change and long-term outcome. Journal of Speech and Hearing Disorders 43, 392--400. Helps, R. & Dalton, P. (1979). The effectiveness of an intensive speech therapy programme for adult stammerers. British Journal of Disorders of Communication 14, 17-30. Ingham, R.J. (1979). Comment on "Stuttering therapy: The relation between attitude change and long-term outcome." Journal of Speech and Hearing Disorders 44, 397400. Silverman, E. (1980). Communication attitudes of women who stutter. Journal of Speech and Hearing Disorders 45, 533-539. Ulliana, L. & Ingham, R.J. (1984). Behavioral and non-behavioral variables in the measurement of stutterer's communication attitudes. Journal of Speech and Hearing Disorders 49, 83-93. Vanryckeghem, M. & Brutten, G.J. (1996). The relationship between communication attitude and fluency failure of stuttering and nonstuttering children. Journal of Fluency Disorders 21, 109-118. Young, M.A. (1981). A reanalysis of "Stuttering therapy: The relation between attitude change and long-term outcome." Journal of Speech and Hearing Disorders 46, 221-222.