2003 IFA Congress: Montreal, Canada

Perceptions of African-American Middle and High School Students About Stuttering

Susan Roesti1, Glen Tellis1, and Rodney Gable2
1Indiana University of Pennsylvania, Dept. of Special Education, 259 Davis Hall, Indiana, PA I 5 705
2Bowling Green State University, 242 Health Centetg Dept of Communication Disorders, Bowling Green, OH, 43402

SUMMARY

The Stuttering Inventory for African-American Students was administered to 168 African-American middle and high school students to determine their perceptions about stuttering. Results indicate that the scale is a reliable and valid instrument. The 25-item, three-factor scale adequately examines concepts that relate to perceptions, causes of, cures for, reactions to stuttering, and social perceptions about stuttering. Results also indicate that females are more likely than males to disagree about the causes of, cures for, and reactions to stuttering and that the race of the therapist is not important when treating persons who stutter. Implications for assessment and treatment are discussed.

  1. Introduction
There has been a growing interest in gathering information about African-American perceptions about stuttering (Cooper & Cooper, 1998; Leith & Mims, 1975; Robinson & Crowe, 1998, Madding, 1995; Tellis, 2002; Tellis & Tellis, 2003). African-Americans are the second largest minority in the United States (U.S. Bureau of the Census, 2000). According to the recent U.S. Census estimates there are 33.9 million African-Americans in the United States, or about 13% of the total U.S. population (U.S. Bureau of the Census, 2000). By 2050, it is projected that the African-American population will increase to 15% of the U.S. population (Day, 1996). Experts have indicated that the prevalence of stuttering in the population is about 1% (Bloodstein, 1995); however, prevalence estimates of 2.8% for African-American high school students who stutter (Gillespie & Cooper, 1973) and 2% for African-American preschoolers who stutter (Proctor et al., 2001) have been reported.

Results from previous studies indicate that some African-Americans may believe that stuttering may be caused: when a mother eats improper foods while nursing, when an infant looks in a mirror, if a child is tickled too much, if a child gets a haircut before saying the first word. Other causes that African-Americans attribute to stuttering include: a mother seeing a snake during pregnancy, a mother dropping a baby, a child being scared, and a dog biting a child (Robinson & Crowe, 1998). According to Madding (1995), a majority of African-Americans males in her study indicated that they were less likely to date or marry a person who stutters. Also, white-collar African-American workers reported they were less likely to mock or make fun of a person who stutters.

The previous studies are important, however, there are a few drawbacks. A limitation of the Robinson and Crowe (1998) study is that the authors obtained data from the Children’s National Medical Center in Washington, DC but did not test the information empirically. Madding (1995) failed to conduct test-retest reliability or factor analysis in her study. In the present study, the Stuttering Inventory for African-Americans Students (Roesti & Tellis, 2001) was designed to measure African-American student perceptions about stuttering. This scale was specifically administered to middle and high school students. Factor analysis, reliability, and validity measures were performed.

The rapidly increasing number of African-Americans and the lack of research that addresses their perceptions about stuttering makes it critical to study this population. Basic research is needed before appropriate assessment and treatment can be conducted on this population. The purpose of this paper, therefore, is to present information about African-American middle and high school students’ perceptions about stuttering.

  1. Method
Sample

The sample for this study was selected from the Pittsburgh Public School District - the largest in Allegheny County, Pennsylvania. The district consists of 97 public schools serving approximately 40,000 students throughout Pittsburgh, Pennsylvania. Facilities include 11 high schools (Grades 9-12), two alternative programs, 19 middle schools (Grades 6-8), 59 elementary schools (Grades K-5), five special use schools, and one adult education school (Pittsburgh Public School District Homepage, 2001); The Pittsburgh Public School District consists of 56.4 % African-American students and 43.6% White/Other students (Pittsburgh Public School District Homepage, 2001).

Seven middle schools and seven high schools within the Pittsburgh Public School District initially agreed to participate in the study; however, only one middle school and one high school finally agreed to participate. After receiving permission from the school administrators and parents, the investigators began recruiting students. The middle school (Arsenal Middle School) had 611 students enrolled, with 485 (79.3%) African-American students and 126 (20.7%) White non- Hispanic/other students. The high school (Oliver High School) had an enrollment of 1,178, with 717 (60.9%) African-American students and 461 (39.1%) White non-Hispanic/other students.

Participants

Participants included 168 African-American middle and high school students from the two schools. Males constituted 45.2% (N=75) of the participants and females comprised 54.8% (N=9l) of the total. The mean age of participants was 13.14 years. From the sample, 62% (N=l03) were middle school (Grades 6-8) students and 38% (N=63) were high school (Grades 9-12) students. Also, 30.7% (N=5 1) were sixth graders, 8.4% (N=14) were seventh graders, 22.9% (N=38) were eighth graders, 30.7% (N=5l) were ninth graders, 4.8% (N :8) were tenth graders, 1.2% (N :2) were eleventh graders, and 1.2% (N=2) were twelfth graders. ,

Procedures

The Stuttering Inventory for African-American Students (Roesti & Tellis, 2001) was administered. This scale was adapted from the Stuttering Inventory for Hispanic-Americans (Tellis & Blood, 1999). The scale was developed using a 9-stage process. During Stage I, an extensive literature review of studies pertaining to the African-American population and their views about stuttering was conducted. Items were created for inclusion based on the most commonly reoccurring themes in the literature.

Stage 2 included focus groups to gather information regarding African-American perceptions about disability, communication, and stuttering. Middle and high school students were assigned to separate groups. Group 1 had nine participants (5 females, 4 males) from the middle school and group 2 had six participants (3 females, 3 males) from the high school. The high school and middle school students stated that speaking too fast and not thinking while speaking caused stuttering. These students also mentioned that speech therapy would help a person who stutters. The middle school students stated that persons who stutter were less intelligent than fluent speakers and that stuttering may be caused by being dropped on the head as a baby, being tickled too much, or being born prematurely. The middle school students also thought that it would be difficult to get dates or get married if a person stuttered. These students described a person who stutters as annoying and less confident, with low self-esteem and/or high social anxiety. The middle school students said it was very important to talk without stuttering. They also indicated that obtaining a job may be difficult for a person who stutters.

The high school students thought that being “tongue-tied” may cause stuttering and that talking slower could treat stuttering. All of the participants in the high school focus group knew a person who stuttered and stated that stuttering wouldnot have an effect on dating or marriage. This information from the two focus groups was analyzed and additional items were added to the Stuttering Inventory for African-American Students (Roesti & Tellis, 2001) based on the focus group information. The scale now contained a total of 31 items/questions.

During Stage 3, African-American students were given copies of the Stuttering Inventory for African-American Students (Roesti & Tellis, 2001) and were asked to review the items for clarity, content, organization, comprehension of directions, and sensitivity of the questions to the African- American community. The purpose of stage 3 was to investigate face, content, and construct validity. This stage was initiated to reduce ambiguous and redundant items. A new group of nine participants from the high school and 12 participants from the middle school were given the Stuttering Inventory for African-American Students and were asked to review the questions. This new group was asked to read through the items and discuss any items they deemed inappropriate. They also were asked to indicate whether they found the wording of any item difficult to understand. An item retention criterion of >90% agreement by judges was employed.

During Stage 4, the 31 revised items/questions were converted into a 5-point Likert-type scale with responses ranging from “Strongly Agree” to “Strongly Disagree.” During Stage 5, participants were recruited for the study from the two schools. The African-American students from the middle school totaled 485 and from the high school totaled 717. From these two schools, 168 African-American middle and high school students were administered the Stuttering Inventory for African- American Students (Roesti & Tellis, 2001).

In Stage 6, the responses of the 168 participants were submitted to a common factor analysis with the maximum likelihood method with varimax rotation and Kaiser normalization (Gorsuch, 1974; Tabachnick & Fidell, 1989). Only items that had loadings of values that were .35 and above on at least one factor were retained. From these loadings the Stuttering Inventory for African-American Students (Roesti & Tellis, 2001) was developed. After factor analysis was completed, 25 items (with loadings that were .35 and above) were categorized by 3 factors. Factor 1 was labeled “causes of, cures for, and reactions to stuttering,” Factor 2 was labeled “social perceptions about stuttering,” and Factor 3 was labeled “perceptions about communication and stuttering.” In Stage 7, test-retest reliability was conducted. Internal consistency measures were obtained in Stage 8. During Stage 9, and based on the results of the factor analysis, the final version of the Stuttering Inventory for African-American Students was formed.

  1. Results
Three factors were obtained after completing a factor analysis on the Stuttering Inventory for African-American Students (Roesti & Tellis, 2001). The final scale had 25 items. Administration procedures for the scale are outlined in Appendix A. Factor 1 included 11 questions that related to whether stuttering is caused by: looking in the mirror as a baby, fate, being dropped on the head as a baby. Other questions in Factor 1 pertained to whether stuttering may be cured by not moving ones feet when speaking or scaring someone. This factor also included questions that pertained to the perceived intelligence of persons who stutter, whether it is worse to be a girl or a boy who stutters, if a person who stutters could be a teacher, and whether it is okay to make fun of a person who stutters.

Factor 2 included 10 items that pertained to whether speech therapy would help a person who stutters and if the race of the therapist does not matter when treating stuttering. Factor 2 also included items pertaining to whether stuttering is caused by psychological, genetic, or physical problems. A few items pertained to persons who stutter feeling shy or bad about themselves. Other items included Section 7. Multi-cultLtral and MLtlti-lingual-Aspects of Stuttering 399

perceptions about occupations a person who stutters may have such as being a professional singer and the importance of the race of the therapist in stuttering therapy. Another item addressed the importance of eye contact when speaking.

Factor 3 comprised 4 items that pertained to whether stuttering is caused when a person talks faster than he/she can think, persons who stutter do not improve their speech because they are not trying hard enough, stuttering is a bad habit learned in childhood, and a person who stutters will speak fluently after speech therapy.

Analyses of variance revealed that there was a significant main effect for gender and Factor 1 (causes of, cures for, and reactions to stuttering) (F = 15.93; df = 1, 158; p < .001). The average total score for the 11 items in Factor 1 for females was 46.11 and the average total score for males was 42.88. Scores closer to 55 indicate more disagreement with the factor. This may imply that African- American female students disagree more than males about the causes of, cures for, and reactions to stuttering. No main effect, however, was noted for Factor 2 (social perceptions about stuttering) or Factor 3 (perceptions about communication and stuttering). Analyses of variance also revealed that there was no significant main effect for middle and high school students and Factor 1, 2, and 3 related to stuttering. Test-retest reliability indicated that the percentage of agreement was 85% for the data. The Cronbach alpha coefficient of .81 indicated good internal consistency.

  1. Discussion
Results of the factor analysis indicate that the Stuttering Inventory for African-American Students with the final 25 items, is a reliable and valid measurement of African-American students’ perceptions about stuttering. It appears that African-American female students disagree more than males about the causes of, cures for, and reactions to stuttering. Overall, African-American middle and high school students indicated positive perceptions about persons who stutter. The majority of respondents agreed that it was not okay to make fun of a person who stutters (88.4%) (question 1) (Appendix B) and that a person who stutters would not have a harder time getting dates than a fluent speaker (46.0%) (question 20) (Appendix B). On certain issues, however, the results of this study (Appendix B) were different from those obtained by Madding (1995) and Robinson and Crowe (1998).

With regard to perceptions about speech therapy for a person who stutters, the results are conflicting. Even though the majority (78.9%) of respondents agreed that speech therapy may help a person who stutters (question 31) (Appendix B), 38.2% of the sample disagreed that after treatment, a person who stutters should speak fluently (question 16) (Appendix B).

The results also revealed interesting perceptions about the occupations a person who stutters may hold. Data indicate that 34.3% of the sample agreed and 48.8% disagreed that persons who stutter should not have jobs that require a lot of speaking (question 23) (Appendix B). In another item (question 9) (Appendix B), data indicate that only 11.6% of respondents agreed and 65.8 % disagreed that a person who stutters could ever be a teacher. Data also indicate that 38.8 % of the sample agreed and 41.2% disagreed that it is hard for a person who stutters to be a singer (question 25). These data imply that a majority of respondents disagree that occupational choice should be a limitation for a person who stutters.

Willis (1998) indicated that respect and attentiveness may be indicated in the African-American culture by using indirect Contact as a listener and direct eye contact as a speaker. Speech-language pathologists may interpret lack of eye contact as inattentive, uncaring, or disrespectful (Cooper & Cooper, 1993; Terrell & Terrell, 1993; Willis, 1998). In the present study, the majority (59.8%) of the respondents agreed that maintaining eye contact is important while speaking (question 30) (Appendix B). Future studies also should determine whether maintaining eye contact while listening is important for this population.

Some authors suggest that establishing client-clinician rapport may be a Challenge when the ethnicity of the clinician is different from the ethnicity of the client (Russel, 1970; Schumacher, Banikiotes, & Banikiotes,_ 1972). According to Dillard (1983) ethnicity is a factor in service delivery but should not be the dominant factor in the c1ient~clinician relationship. An awareness of cultural differences and attempts to modify behavior to adhere to the differences may be sufficient to eliminate cultural barriers. In the present study, the majority (56.4%) of the students indicated that when treating stuttering, the race of the therapist does not make a difference (question 29) (Appendix B). When this item was compared with other responses regarding biracial clinical dyads confiicting findings were noted. In response to an item (question 5) (Appendix B) that pertained to whether African-Americans who stutter should be treated by White non-Hispanic speech-language pathologists, 57.0% of respondents disagreed. In response to another item (question 11) (Appendix B) about whether African-Americans who stutter should be treated by African-American therapists, 66.1 % of respondents disagreed. Interestingly, both these items (question 5 and 11) had loadings below .35 and were not included in the final inventory after factor analysis was conducted.

Future inventories should include questions that pertain to whether (a) stuttering is caused because a child gets a haircut before saying the first word, (b) being born prematurely causes stuttering, (c) persons who stutter are annoying, less confident, have low self-esteem, and high social anxiety, ((1) being tongue-tied causes stuttering, (e) talking slower may reduce stuttering, and (f) a priest/minister could cure stuttering by praying over a person who stutters. Even though these questions appeared in the literature or appeared during focus group sessions, they were not included in the present study because 90% of respondents did not agree with the questions during stage 3 of the development process of the present scale. This scale also should be administered to middle and high school African-American students who stutter to determine whether their responses are similar to the respondents in the present study. Future studies also should include African-Americans from other populations. The participants from the present study were primarily urban dwellers and although they may share cultural characteristics with African-American culture, they may have different view about stuttering than children from rural areas. The participants of this study also were predominantly in middle school (grades 6-8) (N=l03) compared to high school (grades 9-12) (N=63). In future research, more balanced groups should be recruited.

There is an apparent need to expand the current research that pertains to African-Americans and their perceptions about stuttering. This study has obtained information about beliefs and causes of stuttering in the African-American community. Appropriate assessment and treatment is possible after data about perceptions about stuttering are compiled from this population. With changing demographics, it will become â_˜important for speech-language pathologists to gather as much information as possible about the African-American culture and their perceptions about stuttering so that improved services can be provided. I

As the United States continues to grow, increasing numbers of African-Americans will appear on clinician caseloads. Awareness of cultural differences will aid speech-language pathologists in assessing and treating communication disorders such as stuttering when the culture of the client differs from that of the clinician. Additional data on the African-American population will provide the African-American community with improved quality of services and increase the knowledge base of the profession. Hopefully, this research will lead to additional studies that pertain to the African-American population and their perceptions about stuttering.

References

Bloodstein, O. (1995). A handbook on stuttering (5th ed). San Diego, CA: Singular Publishing Group, Inc.

Cooper, 13., & Cooper, C. (1993). Multicultural considerations in the assessment and treatment of stuttering. In D. Battle (Ed.), Communication disorders in multicultural populations. Boston, MA: Butterworth-Heinemann.

Day, J. C. (1996). Population projections of the United States by age, sex, race, and Hispanic

origin: 1995 to 2050. U.S. Bureau of the Census, Current Population Reports, P25- 1130: U.S. Washington, DC: Government Printing Office. Section 7. Multi-cultural and Multi-lingual Aspects of Stuttering 40]

Dillard, J. (1983). Multicultural counseling: Toward ethnic and cultural relevance in human encounters. Chicago, IL: Nelson-Hall.

Gillespie, S., & Cooper E. (1973). Prevalence of speech problems in junior and senior high schools. Journal of Speech and Hearing Research, 34, 739-743.

Gorsuch, R. (1974). Factor analysisâ_˜. Philadelphia, PA: W.B. Saunders.

Leith, W. & Mims, H. (1975). Cultural influences in the development and treatment of stuttering: A preliminary report on the black stutterer. Journal of Speech and Hearing Disorders, 40, 459- 466. â_˜

Madding, C. C. (1995). The stuttering syndrome: Feelings and attitudes of stutterers and nonstutterers among four cultural groups. Dissertations Abstracts International.

Pittsburgh Public School Homepage, (2001â_˜. Ofiice of public afiairs, board of public education, Pittsburgh district information. Available: Internet WWW page at www.pps.pgh.pa.us/ mainframe.html

Proctor, A., Duff, M. C., Patterson. A., & Yairi, E. (2001). Stuttering in African American and European American preschoolers. ASHA Leader; 6, 141.

Robinson, T., & Crowe, T. (1998). Culture-based considerations in programming for stuttering intervention with African American clients and their families. Language, Speech and Hearing â_˜Services in Schools, 29, 172-179.

Roesti, S., & Tellis, G. M. (2001). Stuttering Inventory for African-American Students. In S. Roesti. African-American students’ perceptions about stuttering. Dissertations Abstracts International.

Russel, R. (1970). Black perspectives of guidance. Personnel and Guidance Journal, 48, 721-28.

Schumacher, L., Banikiotes, P., & Banikiotes, F. (1972). Language compatibility and minority group counseling. Journal of Counseling Psychology, 19, 390-96.

Tabachnick, B., & Fidell, L. (1989). Using multivariate statistics (2”â  Ed.). New York, NY: Harper & Row Publishers. '

Tellis, G. M. & Tellis, C. M. (2003). Multicultural issues in school settingsâ_˜. Seminars in Speech and Language, 24(1), 21-26. Thieme Medical Publishers, Inc.

Tellis, G. M. (2002). Multicultural aspects of stuttering. Perspectives on communication disorders and sciences in culturally and linguistically diverse populations, 8(2), 8-11. American Speech- Language Hearing Association, Division 14.

Tellis, G. M., & Blood, G. W. (1999). Stuttering Inventory for Hispanic-Americans. In G. M. Tellis. I-Iispanic-American college students’ perce ptions about stuttering. Dissertations Abstracts International.

Terrell, S., & Terrell, F. (1993). African American cultures. In D. Battle (Ed.), Communication disorders in multicultural populations. Boston, MA: Andover Medical Publications. .

U.S. Bureau of the Census. (2000). Census 2000 PHC-T-I Population by race and Hispanic or Latino Origin. Available: Internet WWW page, a: wwwcensus.gov/population/cen2000/phc- tl/tab04.pdf.

Willis, W. (1998). Families with African American roots. In E. Lynch & M. Hanson (Eds), Developing cross-cultural competence (pp. 135-155). Baltimore, MD: Paul H. Brookes Publishing Co.

Appendix A

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Appendix B

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