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The development of stuttering: A reply to bloodstein
LETTER TO THE EDITOR
It is evident that Bloodstein’s remarks in his letter to the editor do not primarily concern our study of the test-retest reliability of the Communication Attitude Test (C.A.T.). They are not directed at either the internal validity of the investigation‘s repeated measures design or at the external validity of the findings which indicate that the C.A.T. scores of the stutterers tend to be positionally stable over a period of at least three months. It was not the reliability of the C.A.T. that led to Bloodstein’s letter. Instead. it was our statement that according to his developmental model of stuttering “malattitudes toward speech grnc~r.rrll~ (italics ours) are not formed before high school age (Bloodstein, 19X7. p. 42)“. In other words. we interpreted his description of phase 2 stutterers as indicating that this feature of the stuttering “problem” is not typicrilly present among elementary school children. We certainly did not say that Bloodstein takes the position that elementary school stutterers will not evidence negative attitudes about their speech. Our interpretation. to which Bloodstein has apparently taken exception. seems now. as it did before, to be consistent with his statements that “phase 2 stutterers are to be found for the most part among children of elementary school age (Bloodstein. 1987. p. 43) and that the phase 3 stutterer “usually envinces little or no concern about the speech difficulty” (Bloodstein. 19X7. p. 42). So. too. do the data-based figures reported in his letter. for they indicate that only 2X percent of the children he saw showed signs of speech-specific avoidance by the time they reached eleven and only forty percent. considerably less than half of those that he interviewed. did so by the time they were thirteen years of age. In his letter to the editor. Bloodstein also stated that the data of his classic cross-sectional study indicated that though phase 2 stutterers are “for the most part” of elementary school age this does not mean ( 191); h!
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LETTER TO THE EDITOR
that “most stutterers of that age exhibit the features of phase 2”. We have found this statement surprising given the fact that his developmental model is based on the descriptive co-relationship between age and the features of the disorder (Bloodstein, 1960a, 1960b). Co-relations, like that which are the basis of his developmental phases, are non-directional (Neale and Liebert, 1986, p. 89). Thus, if the age-tofeatures developmental relationship described by Bloodstein exists, age would be as likely to predict the presence of particular features of stuttering as the specific features would be likely to be predictive of age. Bloodstein has rightly taken great pains throughout the years to highlight the fact that the “developmental process may actually vary a great deal from case to case . . .” (Bloodstein, 1987, p. 44). However, he has indicated that it is “possible to discern a broad trend” (Bloodstein, 1987, p. 41) that may be conveniently “described in terms of relatively distincr (italics ours) steps or phases” (Bloodstein, 1960a, p. 366). Despite Bloodstein’s attempt to view the development of stuttering in relatively distinct terms he has, with characteristic forthrightness, made it clear that the age ranges of each of his proposed phases are “very broad” and that they “overlap greatly”. This suggests to us that the concept of developmental phases is based on data that show a relatively low co-relationship between age and features and, thus, a notable amount of unaccounted for variance. Undoubtedly, the fact that Bloodstein collected his data cross-sectionally rather than longitudinally (Van Riper, 1992; Neale and Liebert, 1986) contributed somewhat to the variance that he reported. This source aside, the considerable variability in the reported relationship between age and features of stuttering in the phases proposed by Bloodstein suggests that his developmental model does not serve us well. We probably would be better off if we turned to a behavioral model in which the observed variations in age and features among stuttering children is seen as a function of difference in their experience history rather than as a somewhat atypical aspect of an underlying developmental process (Brutten, 1975).
REFERENCES Bloodstein, 0. (1960a) The development nine basic features. Journal of Speech 219-237.
of stuttering: and Hearing
I. Changes in Disorders, 25,
Bloodstein, 0. (1960b) The development of stuttering: II. Developmental phases. Journal of Speech and Hearing Disorders, 25, 366-376.
LETTEK TO THE EDITOR
Bloodstein, National
0. (1987) A htr~tclhook Ott .strrrtctitt,y, (4th ed.). Easter Seal Society.
409
Chicago:
Bruttcn, G. (1975) Stuttering: Topography. assessment and behavior change strategies. In Eiscnson. J. (ed). Stllfrc~/.iu,q: A Sccottd Sytnpo.,itcttt. New York: Harper & Row. Neale, J. and Liebert. Jersey: Prentice-Hall.
R. (1986) ScicJttcc (ttzd B~Iz~t~~ior, (3rd ed.). New
It is evident that Bloodstein’s remarks in his letter to the editor do not primarily concern our study of the test-retest reliability of the Communication Attitude Test (C.A.T.). They are not directed at either the internal validity of the investigation‘s repeated measures design or at the external validity of the findings which indicate that the C.A.T. scores of the stutterers tend to be positionally stable over a period of at least three months. It was not the reliability of the C.A.T. that led to Bloodstein’s letter. Instead. it was our statement that according to his developmental model of stuttering “malattitudes toward speech grnc~r.rrll~ (italics ours) are not formed before high school age (Bloodstein, 19X7. p. 42)“. In other words. we interpreted his description of phase 2 stutterers as indicating that this feature of the stuttering “problem” is not typicrilly present among elementary school children. We certainly did not say that Bloodstein takes the position that elementary school stutterers will not evidence negative attitudes about their speech. Our interpretation. to which Bloodstein has apparently taken exception. seems now. as it did before, to be consistent with his statements that “phase 2 stutterers are to be found for the most part among children of elementary school age (Bloodstein. 1987. p. 43) and that the phase 3 stutterer “usually envinces little or no concern about the speech difficulty” (Bloodstein. 19X7. p. 42). So. too. do the data-based figures reported in his letter. for they indicate that only 2X percent of the children he saw showed signs of speech-specific avoidance by the time they reached eleven and only forty percent. considerably less than half of those that he interviewed. did so by the time they were thirteen years of age. In his letter to the editor. Bloodstein also stated that the data of his classic cross-sectional study indicated that though phase 2 stutterers are “for the most part” of elementary school age this does not mean ( 191); h!
tlwv~el-
hi< :I\enue 01the
Scwnce .4menca\.
Puhh\tm~
(‘II
NC\\ \‘mI\.
407
Inc. N\I’ lO(110
0~1Y-I~~1~IX’Yi~~i.i~I
408
LETTER TO THE EDITOR
that “most stutterers of that age exhibit the features of phase 2”. We have found this statement surprising given the fact that his developmental model is based on the descriptive co-relationship between age and the features of the disorder (Bloodstein, 1960a, 1960b). Co-relations, like that which are the basis of his developmental phases, are non-directional (Neale and Liebert, 1986, p. 89). Thus, if the age-tofeatures developmental relationship described by Bloodstein exists, age would be as likely to predict the presence of particular features of stuttering as the specific features would be likely to be predictive of age. Bloodstein has rightly taken great pains throughout the years to highlight the fact that the “developmental process may actually vary a great deal from case to case . . .” (Bloodstein, 1987, p. 44). However, he has indicated that it is “possible to discern a broad trend” (Bloodstein, 1987, p. 41) that may be conveniently “described in terms of relatively distincr (italics ours) steps or phases” (Bloodstein, 1960a, p. 366). Despite Bloodstein’s attempt to view the development of stuttering in relatively distinct terms he has, with characteristic forthrightness, made it clear that the age ranges of each of his proposed phases are “very broad” and that they “overlap greatly”. This suggests to us that the concept of developmental phases is based on data that show a relatively low co-relationship between age and features and, thus, a notable amount of unaccounted for variance. Undoubtedly, the fact that Bloodstein collected his data cross-sectionally rather than longitudinally (Van Riper, 1992; Neale and Liebert, 1986) contributed somewhat to the variance that he reported. This source aside, the considerable variability in the reported relationship between age and features of stuttering in the phases proposed by Bloodstein suggests that his developmental model does not serve us well. We probably would be better off if we turned to a behavioral model in which the observed variations in age and features among stuttering children is seen as a function of difference in their experience history rather than as a somewhat atypical aspect of an underlying developmental process (Brutten, 1975).
REFERENCES Bloodstein, 0. (1960a) The development nine basic features. Journal of Speech 219-237.
of stuttering: and Hearing
I. Changes in Disorders, 25,
Bloodstein, 0. (1960b) The development of stuttering: II. Developmental phases. Journal of Speech and Hearing Disorders, 25, 366-376.
LETTEK TO THE EDITOR
Bloodstein, National
0. (1987) A htr~tclhook Ott .strrrtctitt,y, (4th ed.). Easter Seal Society.
409
Chicago:
Bruttcn, G. (1975) Stuttering: Topography. assessment and behavior change strategies. In Eiscnson. J. (ed). Stllfrc~/.iu,q: A Sccottd Sytnpo.,itcttt. New York: Harper & Row. Neale, J. and Liebert. Jersey: Prentice-Hall.
R. (1986) ScicJttcc (ttzd B~Iz~t~~ior, (3rd ed.). New