Stuttering severity and educational attainment

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Abstract

Purpose

This study investigated the relationship between self-reported stuttering severity ratings and educational attainment.

Method

Participants were 147 adults seeking treatment for stuttering. At pretreatment assessment, each participant reported the highest educational level they had attained and rated their typical and worst stuttering severity on a 9-point scale for a range of speaking situations. These included: (1) talking with a family member, (2) talking with a familiar person, not a family member, (3) talking in a group of people, (4) talking with a stranger, (5) talking with an authority figure such as a work manager or teacher, (6) talking on the telephone, (7) ordering food or drink, and (8) giving their name and address.

Results

There was a significant negative relationship between highest educational achievement and mean self-reported stuttering severity rating for the eight situations.

Conclusions

Future research is needed to investigate how this result should be addressed in educational institutions.

Educational objectives: The reader will be able to: (1) describe the negative effects of stuttering through childhood to adulthood; (2) identify some of the negative consequences associated with stuttering on peer and teacher relationships, and academic performance at school; and (3) summarise the relationship between stuttering severity and educational attainment.

Highlights

► Stuttering negatively impacts school life. ► Negative relationship between stuttering severity and educational achievement. ► Association does not imply causality.

Introduction

Verbal communication is a fundamental part of everyday life. It influences the day-to-day interactions with others, around which all social, educational and occupational networks are established and maintained. Stuttering involves disruptions to verbal behavior and hence interferes with the process of normal communication. This can affect the development of relationships, the way an individual functions and quality of life for the short and the long-term (Craig et al., 2009, Craig and Calver, 1991, Klein and Hood, 2004, Klompas and Ross, 2004). In adults, stuttering is often associated with social maladjustment, under-achievement and qualitative and quantitative impairment of verbal communication (Bloodstein and Bernstein Ratner, 2008, Craig and Calver, 1991, Crichton-Smith, 2002, Hayhow et al., 2002). Around 50% of adults who stutter qualify for a diagnosis of social phobia (Iverach et al., 2009, Kraaimaat et al., 2002, Menzies et al., 2008, Stein et al., 1996). It is known that social phobia in adults is caused, at least in part, by negative social experiences during the school age years. In this report, we review how these early negative experiences may affect the educational attainment of people who stutter.

Educational institutions, from preschool to university, place a major emphasis on verbal communication skills. Such skills form an integral part of most classroom activities. As well as the development of social skills, there are requirements to read aloud, to discuss activities with peers, to ask and answer questions from authority figures and to speak in front of a group. These activities place excessive demands on those who have a stuttering problem. For example, normal speech rate in adults is around 250 syllables per minute, but stuttering can significantly reduce this verbal information transfer rate, sometimes to below 50 syllables per minute. In severe cases, the disruptions of stuttering can last up to 30 s and render the speaker functionally mute. This, coupled with the frequently associated extraneous body movements, the unpredictable nature of the disorder, and the fear of negative evaluation by peers can make apparently routine educational activities challenging and fraught with anxiety.

Stuttering is known to evoke negative peer reactions and to disturb peer interactions as early as the preschool years (Ezrati-Vinacour et al., 2001, Langevin et al., 2009). For example, Langevin et al. provide video evidence of preschool peers reacting to stuttering with confusion, and interrupting, ignoring and walking away from stuttering children. Stuttering children were also observed to have difficulty leading peers in play, participating in pretend play, resolving conflicts, participating in problem solving discussions, and providing explanations. There is ample documentation of the distressing effects of early stuttering on affected children (Bernstein-Ratner, 1997, Onslow et al., 2003, Yairi, 1983). At the end of the preschool years, there is already evidence that these early conditioning experiences promote negative attitudes to speech and communication (Vanryckeghem, Brutten, & Hernandez, 2005).

Such early negative conditioning experiences extend through the school years. Negative attitudes to speech and communication are measurable in 6 and 7 year olds (De Nil and Brutten, 1991, Vanryckeghem and Brutten, 1992). For stuttering children, they worsen progressively during the school years, whereas attitudes to communication in non-stuttering children become healthier (De Nil & Brutten, 1991). Replicated findings show that primary school children who stutter are more susceptible to teasing and bullying than others (Langevin, 2009, Langevin et al., 1998, Langevin and Hagler, 2004), are perceived negatively by non-stuttering peers (Langevin et al., 2009), and are rejected more often and have more difficulty establishing peer relationships than those who do not stutter (Davis, Howell, & Cooke, 2002). In addition, a recent study by Eggers, De Nil, and Van den Bergh (2010) shows that children who stutter have more sensitive temperaments than those who do not stutter. Young stuttering children are more likely to show higher levels of frustration and anger while being less able to maintain attention or control emotions and behavior. Such temperaments have been shown to influence the development of anxiety and other disorders.

During the final years of school, these difficult experiences are exacerbated by the physical, social and emotional changes of adolescence along with the pressure to conform to group norms and the need for peer acceptance (Heaven, 2001, Spear, 2000). Adolescents who stutter have been shown to have significantly greater fear of speaking in group discussions and interpersonal conversations––a higher incidence of heightened communication apprehension––than their non-stuttering counterparts (Blood, Blood, Tellis, & Gabel, 2001). They also perceive their communication competence to be much lower when talking to strangers. These deficits have in turn been correlated with negative attitudes to school and overall poorer academic performance (Blood et al., 2001). Not surprisingly, a significant positive relationship has been found between stuttering severity, communication apprehension, and self-perceived communication competence scores (Blood et al., 2001) although this finding was not subsequently confirmed in a later study by the same group (Blood, Blood, Tellis, & Gabel, 2003).

Virtually every adult who stutters confirms experiencing the disabling effects of the condition during their school years (Crichton-Smith, 2002, Hayhow et al., 2002, Hearne et al., 2008, Hugh-Jones and Smith, 1999, Klompas and Ross, 2004). The majority report that stuttering affected their relationships with teachers and peers, their self-confidence and their academic performance (Hayhow et al., 2002, Klompas and Ross, 2004, Silverman and Zimmer, 1982). Many feel that stuttering did not allow them to reach their full academic potential, limiting their educational achievements (Hugh-Jones & Smith, 1999). Stuttering resulted in excessive anxiety and avoidant behavior, and in extreme cases individuals have reported leaving school prematurely due to difficulties associated with performing routine speaking activities (Corcoran and Stewart, 1998, Crichton-Smith, 2002). At the very least, many report difficulties with concentration and learning as a result of expending lots of energy towards the thought of stuttering or controlling it (Daniels, 2007). As many as 83% confirm being teased or bullied at school (Hugh-Jones & Smith, 1999) beginning a destructive path of increased anxiety, low self-esteem, difficulties with schoolwork and reduced educational enjoyment and fulfillment.

According to Van Riper (1982), many people who stutter may strive for lower levels of achievement than their normally speaking colleagues due to low self-esteem and fear of failure. Certainly, Williams, Melrose, & Woods (1969) and Guitar (1998) reported that children who stutter, in general, perform slightly below average in school. If effective communication is an important skill for academic progress and success, then one would expect those who stutter to have reduced academic success.

In short, those who stutter are more likely to be teased and bullied, to be socially isolated, have lower self-confidence, to achieve lower academic grades, and generally to perceive their school years more negatively than their non-stuttering peers. Such negative experiences are likely to influence whether, and for how long, older children and adults remain in the educational system and continue to benefit from it. That is, such experiences are likely to influence their ultimate educational attainment. It is also the case that increased stuttering severity may compound these issues and be a predictor of educational success. Although some research has shown a relationship between stuttering severity, communication apprehension and communication competence (Blood et al., 2001), to date there has been no research to investigate any direct association between stuttering severity and educational attainment.

The aim of the current study therefore was to investigate the relationship between stuttering severity and educational achievement. Specifically, we ask the question: is stuttering severity, as measured by self-reported severity ratings, correlated with educational attainment?

Section snippets

Participants

Participants were 147 adults seeking treatment for stuttering. They were drawn from treatment waiting lists of seven university-affiliated stuttering treatment clinics in four Australian cities and one New Zealand city. There were 116 men (78.9%) and 31 women (21.1%) ranging in age from 18 to 73 years (mean = 31.7). One hundred and twenty of the participants (81.6%) had received treatment for their stuttering previously.

Procedure

Each participant attended an assessment with a speech-language pathologist

Results

There were some missing data due to some participants failing to provide either a typical or a worst self-report stuttering severity rating. In total, typical self-report severity data were analyzed for 144 participants, worst self-report severity data were analyzed for 145 participants. Table 1 and Fig. 1, Fig. 2 show a negative relationship between highest educational achievement and typical SR (co-efficient −0.19, p = 0.035) as well as between highest educational achievement and worst SR

Discussion

Results of this study indicate a significant inverse relationship between stuttering severity and educational attainment. Overall, this is not a surprising result given the many studies that have reported the negative impact of stuttering during the school years. It is well-documented that experiences in the formative years influence the way a person's personality and attitudes develop as well as the way they continue to deal with everyday life. It is self-evident that the negative effects of

Acknowledgements

This research was supported by Program Grant #402763 from the National Health and Medical Research Council of Australia.
CONTINUING EDUCATION
Multiple-choice questions
QUESTIONS

  • 1.

    Evidence has shown negative peer reactions to stuttering in people as young as

    • (a)

      Preschool-age children

    • (b)

      School-age children

    • (c)

      Adolescents

    • (d)

      Adults

  • 2.

    What percentage of adults who stutter are diagnosed with social phobia?

    • (a)

      0%

    • (b)

      Around 25%

    • (c)

      Around 50%

    • (d)

      100%

  • 3.

    Children who stutter

    • (a)

      Perform slightly below average in school

    • (b)

      Perform slightly above average

Sue O’Brian is a Senior Researcher at the Australian Stuttering Research Centre. She has extensive experience in the field of stuttering treatment and research. Her current interests include the effectiveness of early stuttering intervention in community settings, development of treatments for adults who stutter and stuttering measurement.

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  • Cited by (0)

    Sue O’Brian is a Senior Researcher at the Australian Stuttering Research Centre. She has extensive experience in the field of stuttering treatment and research. Her current interests include the effectiveness of early stuttering intervention in community settings, development of treatments for adults who stutter and stuttering measurement.

    Mark Jones works as a statistician for the Centre for Healthcare Related Infection Surveillance and Prevention, Queensland Health, and is also an Adjunct Senior Lecturer with the School of Population Health, The University of Queensland. He has a strong interest in stuttering treatment research, clinical trials, and biostatistics.

    Ann Packman is a Senior Research Officer at the Australian Stuttering Research Centre. She has worked for more than 30 years in the area of stuttering as a clinician, teacher and researcher. One of her current interests is theories of the cause of stuttering.

    Ross Menzies is a clinical psychologist with an interest in the origins and management of anxiety. He has developed cognitive behavior therapy packages for the treatment of obsessive compulsive disorders and published theories of the origins of phobias. He is currently the director of the Anxiety Clinic at The University of Sydney

    Mark Onslow is the Director of the Australian Stuttering Research Centre. He is an Adjunct Professor at the University of Canterbury, New Zealand, and an Honorary Professor at the University of Queensland, Australia.

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