Communication attitude of Italian children who do and do not stutter

Communication attitude of Italian children

who do and do not stutter

Simona Bernardini a,*, Martine Vanryckeghem b, Gene J. Brutten b,Luisella Cocco c, Claudio Zmarich d

a Centro Medico di Foniatria, Via Bergamo 10, 35134 Padova, Italyb University of Central Florida, United States

c National Health Service ASL 7, Chiavasso, Torino, Italyd Institute of Cognitive Sciences and Technologies (ISTC), CNR, Padova, Italy

Received 7 July 2008; received in revised form 24 October 2008; accepted 31 October 2008

Abstract

The purpose of this factorial study was to establish normative data for the Italian version of the Communication Attitude Test

(CAT) in order to determine whether or not the speech-associated attitude reported by Italian children who stutter (CWS) differs

significantly from that of their nonstuttering peers (CWNS). Toward this end, the Italian CATwas administered to 149 CWS and 148

CWNS between the ages of 6 and 14. The results showed that the mean CAT score of the CWS sampled is higher, to a statistically

significant extent, than that of their nonstuttering peers. Moreover, age and gender did not differentially affect this result. Together,

these findings and the large between-group effect size suggest that the CAT is a useful clinical aid in evaluating the attitude of Italian

children whose fluency is problematic. It can serve well to determine if a child’s speech-associated belief system needs to be

addressed in therapy and, if so, whether or not the cognitive change tactics employed have been effective.

# 2008 Published by Elsevier Inc.

It has been well established that speech disruption is but one component of the stuttering syndrome (Brutten &

Shoemaker, 1967; Cooper, 1979; Williams, 1957; Wingate, 1964). Indeed, research has shown that the speech-

associated attitudinal, emotional and coping reactions of those who stutter need to be assessed to fully highlight the

multi-dimensional nature of this disorder. Moreover, clinicians and applied researchers have come to view the attitude

of the person who stutters (PWS) as playing an important role in both the instatement and maintenance of fluency

(Guitar, 1976, 2006; Peters & Guitar, 1991). In this regard, there is evidence that a PWS’ negative attitude toward

speech increases the likelihood of relapse (Andrews & Cutler, 1974) while a positive belief about one’s verbal ability

tends to aide long-term maintenance of improvement (Guitar, 1976, 2006; Guitar & Bass, 1978). The therapeutic

importance of improving the attitude of PWS has been echoed by Ryan (1974, 1979), Cooper (1979), Perkins (1979),

Boberg (1981), among others. The therapeutic value of improving attitude has been supported by a survey of members

of the National Stuttering Association (McClure & Yaruss, 2003). They rated therapy that incorporated attitude change

as resulting in a ‘very successful’ outcome, compared to stuttering modification (30% very successful) and fluency

shaping (19% very successful).

Available online at www.sciencedirect.com

Journal of Communication Disorders 42 (2009) 155–161

* Corresponding author.

E-mail address: [email protected] (S. Bernardini).

0021-9924/$ – see front matter # 2008 Published by Elsevier Inc.

doi:10.1016/j.jcomdis.2008.10.003

mailto:[email protected]

http://dx.doi.org/10.1016/j.jcomdis.2008.10.003

Self-report test procedures have long been used to measure the attitude toward speech of adults who stutter

(Andrews & Cutler, 1974; Erickson, 1969; Johnson, Darley, & Spriestersbach, 1952; Lanyon, 1967; Shumak, 1955).

However, it was not until a couple of decades later that inventories of this type were fully developed so that the speech-

related belief of children who stutter could be adequately measured. The delay appears, in part, to have resulted from

the concern that directly asking children about their attitude might draw attention to their speech and worsen their

condition (Johnson, 1961; Johnson, Brown, Curtis, Edney, & Keaster, 1967).

Grims (1978) and Guitar and Grims (1979) were the first to propose a scale that directly assessed the attitude of

children about their speech through their response to 19 speech-specific statements. The A-19 scale did not prove to

significantly differentiate the attitude of children who stuttered from those who did not. Some years later, Brutten

(1984) re-opened the issue of whether or not the speech-associated attitude of grade-school children who stutter differs

from that of their peers who do not. Toward this end he designed the Communication Attitude Test (CAT), a self-report

test containing 35 statements that children are to answer with true or false depending upon whether or not they reflect

the way they think about their speech. The first investigation that employed the Communication Attitude Test involved

518 nonstuttering grade-school children (Brutten & Dunham, 1989). The results indicated both that nonstutterers

display very little in the way of a negative attitude toward speech and that the CAT provided considerable room for

measuring the attitude of children whose belief system might be more negative.

Since its development, the CAT has been translated into various languages and has been subject to extensive

international use by clinicians and applied researchers. Moreover, the results of a series of investigations have shown

that the CAT is an internally reliable instrument (Brutten & Dunham, 1989; Brutten & Vanryckeghem, 2003, 2007; De

Nil & Brutten, 1991) that has good test–retest reliability (Vanryckeghem & Brutten, 1992a, 1992b), and is sensitive to

behavior change (Johannisen & Wennerfeldt, 2000; Vanryckeghem & Brutten, 1992a, 1992b). In addition, the CAT

has been shown to have content, criterion and construct validity (Brutten & Vanryckeghem, 2003, 2007; DeKort,

1997).

Between-group studies of the CAT have also shown that it is helpful in differentiating normally fluent children

(CWNS) from those who stutter (CWS). As a group, youngsters who stutter report a significantly more negative

speech-associated attitude than their peers who do not stutter (Boutsen & Brutten, 1990; Brutten & Vanryckeghem,

2003, 2007; De Nil & Brutten, 1991; De Nil, Brutten, & Claeys, 1985; Jaksic Jelcic & Brestovci, 2000; Vanryckeghem

& Brutten, 1992a). Still more, within-group comparisons have shown that, cross-culturally, the mean CAT scores of

the CWS studied fall well within 1 standard deviation of each other. This is also true for the CWNS sampled.

The clinical utility of the CAT as a supplementary means of differentiating children who stutter from those who do

not also serves to highlight the speech-specific attitude change needed by a CWS. This test procedure also makes it

possible to determine if the therapy tactics employed have served to improve a child’s speech-associated belief system.

With regard to these and similar matters, it is noteworthy that Italian clinicians have become increasingly concerned in

recent years with the measurement of the speech-associated attitude of CWS as it relates to the cognitive aspect of the

stuttering syndrome. It is this which has led to the present normative investigation whose purpose is to determine if the

communicative attitude of Italian CWS and CWNS differs significantly, and if this difference, should it be observed, is

affected by age and gender.

1. Methods

1.1. Participants

The Italian translation of the CAT was administered to 149 children who stutter and 148 nonstuttering children

between the ages of 6 and 14. Seventy-one of the CWS were in elementary school and seventy-eight were in secondary

school. Seventy-six of the CWNS were in elementary and seventy-two in secondary education. The mean age of the

participants in the CWS group was 10 years 1 month, and in the CWNS group, it was 10 years 15 days. The CWS group

was composed of 116 males and 33 females. There were 87 males and 61 females in the CWNS sample. A more

specific breakdown in terms of age and gender can be found in Table 1.

Both the CWS and CWNS who served in this study were recruited from the northern and middle provinces of Italy.

The CWS were referred over a 5-year period by a National Health Service’s pediatrician or phoniatrist to either the

Centro Medico di Foniatria in Padova or in Turin, because of concerns about their fluency. Their concern was

confirmed by the assessment made during conversation, oral reading and play-related tasks. In each of these

S. Bernardini et al. / Journal of Communication Disorders 42 (2009) 155–161156

conditions, the CWS displayed the silent and oral within-word multiple repetitions and tense prolongations that are

characteristic of the fluency failures that both lay listeners (Boehmler, 1958; Schiavetti, 1975; Williams & Kent, 1958)

and fluency specialists (Brutten, 1975; Conture, 2001; Gregory, 2003; Van Riper, 1982) view as stuttering behaviors.

The children in the control group had no history of any form of speech or language disorder and had not previously

been or currently were not in therapy. This was confirmed by their educational records and teacher reports.

1.2. Materials

The Communication Attitude Test (Brutten & Vanryckeghem, 2003) is made up of 35 statements to which the

children are to respond by circling ‘true’ or ‘false’ relative to whether or not they describe what they think about their

speech (e.g. I like the way I talk, my words come out easily, my friends’ speech is better than mine, I am not a good

talker). Answers indicative of a speech-related negative attitude receive a score of 1. Those which do not indicate a

negative attitude receive a score of 0. It follows from this that the possible range of scores is 0–35.

1.3. Procedure

The CWS were administered the Italian form of the CAT (Brutten & Vanryckeghem, 2003) by the fluency specialist

in Padova and the one in Turin who ran this study. The very same researchers administered the CAT to the CWNS.

Each of them carefully followed the test’s administrative protocol.

Both the CWS and the CWNS were individually administered the CAT in a private setting. There, in accord with the

CAT’s protocol, the test’s instructions were read aloud as the children followed along silently. In addition, for children

in first and second grade, each of the test items to which they responded were read aloud as they once more followed

along on the test form in front of them. From third grade on, the children filled out the test procedure on their own by

circling the answer (True or False) that best reflected what they thought about their speech and speech ability.

All of the children were given two practice items before the test was administered. This was done in order to

determine if they understood what they were to do. They were then asked if there were any questions. They were also

instructed to ask for clarification if they could not read something or did not understand the meaning of a word or

sentence. If a word or sentence needed to be explained, it was done in a neutral way so as not to imply an answer.

2. Results

A group � age � gender factorial design and an analysis of variance were used to determine if there was a between-

group difference in the attitude that CWS and CWNS held about their speech and if it was differentially affected by age

and gender. As can be seen in Fig. 1, the distribution of CAT scores for the CWS ranged from 7 to 35. Their modal

score was 25 and their median score was 21. In contrast, the CWNS scored from a low of 1 to a high of 16. The modal

and median scores of the CWNS were 6 and 7, respectively.

S. Bernardini et al. / Journal of Communication Disorders 42 (2009) 155–161 157

Table 1

CAT scores’ measures of central tendency and variation for 149 children who stutter (CWS) and 148 children who do not stutter (CWNS) between

the ages of 6 and 14.

Age CWS CWNS d.f. t p Effect size

N Mean S.D. N Mean S.D.

M F M F

6 8 2 20.50 6.65 4 6 5.50 3.63 18 6.26 .000 2.67

7 18 3 20.67 5.24 13 9 9.36 3.05 41 8.60 .000 2.59

8 9 4 18.77 5.45 7 7 7.43 3.67 25 6.38 .000 2.38

9 15 4 17.74 6.32 10 9 8.11 3.31 36 5.85 .000 1.87

10 11 5 21.88 6.31 9 7 6.13 2.31 30 9.37 .000 3.27

11 10 6 21.06 5.78 9 7 6.13 2.73 30 9.35 .000 3.21

12 21 4 20.24 6.64 16 7 6.70 2.64 46 9.42 .000 2.59

13 13 1 20.36 6.49 8 6 4.86 2.74 26 8.23 .000 3.01

14 11 4 20.93 7.77 11 3 6.57 3.44 30 6.51 .000 2.38

The mean CAT score for the CWS was 20.21 (S.D. = 6.25) and that of the CWNS was 6.93 (S.D. = 3.23). In other

words, on average, the CWS had a negative attitude toward speech that was more than 4 standard deviations above that

of the CWNS. Stated differently, the attitude of the average stuttering child sampled was more negative than that of

99% of his or her nonstuttering peers. The main effect difference, which was statistically significant (F

(1,296) = 390.31, p = .000), indicates that CWS and CWNS sampled were representative of two clinically different

populations. Moreover, the obtained effect size of 2.45 (95% CI = +2.1517/+2.7538) indicates that the magnitude of

the difference in speech-associated attitude between the two groups was very large (Cohen, 1988). That is to say, the

difference in attitude was largely attributable to group membership.

2.1. Age effect

As Table 1 makes clear, the mean CAT scores of the CWS was statistically higher than that of the CWNS at each of

the nine age levels studied. In addition, the effect size was very large (Cohen, 1988) at each age level and the effect of

group membership on attitude remained relatively the same from age 6–14. It follows that there was not a statistically

significant group by age interaction (F (1,16) = 1.23, p = .244). That is to say that the difference in the attitude of

grade-school children who stuttered and those who did not was not differentially affected by age.

2.2. Gender effect

As far as the between-group effect of gender is concerned, the mean CAT score of the male CWS was 19.89

(S.D. = 6.17). It was 7.15 (S.D. = 3.19) for the male CWNS. This difference proved to be statistically significant (F

(1,1) = 309.17, p = .000). The mean score of the female CWS was 21.36 (S.D. = 6.51) and 6.62 (S.D. = 3.30) for the

female CWNS. This difference in the negativity of their speech-associated attitude was also statistically significant (F

(1,1) = 212.77, p = .000).

Relative to gender, a within-group statistical analysis revealed that the speech-associated attitude of the male

(19.89) and female (21.36) CWS did not differ significantly (F (1,1) = 1.44, p = .233). Similarly, the mean CAT scores

of the male (7.15) and female (6.62) CWNS did not differ significantly (F (1,1) = .95, p = .331). To an extent that was

much the same, the attitude of the CWS, regardless of gender, was more negative than that of the CWNS. It follows

from these data that the interaction between group and gender was not significant (F (1,2) = .21, p = .809). That is to

say, the difference in the attitude toward speech of CWS and CWNS was not differentially affected by gender.

3. Discussion

It was the purpose of the present investigation to obtain comparative and normative data on the Italian translation of

the Communication Attitude Test in order to determine if the speech-associated attitude of Italian grade-school

children who stutter differed from that of those who do not. Clearly, the statistically significant difference in the CAT

scores of our representative samples of these children indicate that they do. This finding of a between-group difference

is consistent with and confirms that of previous studies that have been conducted in various countries (Boutsen &

Brutten, 1990; Brutten & Vanryckeghem, 2003, 2007; De Nil & Brutten, 1991; Jaksic Jelcic & Brestovci, 2000;

Vanryckeghem & Brutten, 1992a,1997).

Research with the CAT has also concerned the age at which CWS first differ from their nonstuttering peers as far as

their speech-related belief system is concerned (Brutten & Vanryckeghem, 2003, 2007; De Nil & Brutten, 1991;


Fig. 1. Distribution in percentage of CAT scores for 149 children who stutter (CWS) and 148 who do not (CWNS).

Vanryckeghem & Brutten, 1997). The findings of these investigations have pointed to the presence of a significant

amount of negative attitude by the age of six or seven. The results of the present study serve to support these data. The

CAT scores of the CWS were statistically significantly higher than those of the CWNS as of the age of six. From a

clinical point of view this underlines the importance of investigating the speech-associated belief system of children at

least as young as 6 years of age. Indeed, data from the KiddyCAT (Vanryckeghem & Brutten, 2007), a newly

developed preschool version of the Communication Attitude Test, indicate that the attitude of preschool and

kindergarten CWS should be evaluated since their speech-associated belief system has been shown to be significantly

more negative than that of their nonstuttering peers (Vanryckeghem & Brutten, 2007; Vanryckeghem, Brutten, &

Hernandez, 2005).

The present findings differ in one instance from those generally reported. Specifically, the results of the current

study did not show a group by age interaction. The CAT scores of the Italian children who stuttered were not

differentially affected by age to a statistically significant extent. This finding is in contrast with previous data which

indicate that the CAT scores of the children who stutter tend to become more negative with age while that of the

nonstuttering children became less so (Brutten & Vanryckeghem, 2003, 2007; De Nil & Brutten, 1991; Vanryckeghem

& Brutten, 1997). This difference aside, it is important to note that the mean attitude of our sample of Italian CWS and

CWNS was like that found among their peers in other Western countries. Indeed, the mean of the Italian children

sampled fell within one standard deviation of those of their peers in the various countries where CAT studies have been

conducted (Brutten & Vanryckeghem, 2003, 2007). In any event, it would appear that the CAT is a useful instrument

for determining if a child’s speech-associated belief system needs to be addressed in therapy and, if so, for evaluating if

therapy has been effective in bringing about a more positive change in the attitude that children who stutter have about

their speech and speech ability. This is of considerable import since the attitude of children who stutter has been shown

to correlate significantly with the presence of negative emotion, speech disruption and the mal-adaptive coping

responses that are secondary to stuttering (Brutten & Vanryckeghem, 2003, 2007).

Appendix A. Educational objectives

The reader will be

(1) able to gain knowledge relative to the Communication Attitude Test, a reliable and valid instrument that has been

shown capable of differentiating children who stutter (CWS) from those who do not (CWNS) based on their

speech-associated attitude;

(2) provided with normative information relative to the Italian form of the CAT for CWS and CWNS. These data will

be compared with previous cross-cultural CAT findings.

Appendix B. Continuing education questions

(1) The Communication Attitude Test

(a) Investigates the speech-associated belief system of adults who stutter.

(b) Investigates negative emotional reaction in children.

(c) Has been shown to be a reliable and valid test instrument.

(d) Investigates negative speech-associated attitude of children.

(e) b + c.

(f) c + d.

(2) (a) The Communication Attitude Test has, so far, only been utilized in the United States.

(b) Cross-cultural normative data for CWS as well as CWNS are all within one standard deviation of each other.

(c) Cross-cultural data are very diverse.

(d) The Italian CAT data deviate substantially from those of previous CAT studies.

(3) The current investigation with the Italian CAT indicates that

(a) CWS, as a group, score statistically significantly higher than CWNS.

(b) CWS have a CAT score that is only descriptively higher than that of CWNS.

(c) The CAT score of both groups is essentially the same.

(d) The speech-associated attitude of CWNS is statistically significantly higher than that of CWS.


(4) (a) The CAT score of CWS was not greater than that of CWNS at every age level.

(b) There was a statistically significant group by age interaction.

(c) The CAT score of CWS was statistically significantly higher than that of CWNS by as early as the age of six.

(5) (a) The Italian CAT data point to the fact that, although male CWS score significantly higher than male CWNS,

this was not the case among the female participants in the sample.

(b) The mean CAT score for the male CWS was greater than that of the female CWS, to an extent that was

statistically significant. However, that was not the case for the CWNS.

(c) There is a significant group by gender interaction.

(d) The mean CAT score of the male and female CWS did not differ significantly. Nor did the male and female

CWNS differ significantly.

References

Andrews, G., & Cutler, J. (1974). Stuttering therapy: The relation between changes in symptom level and attitudes. Journal of Speech and Hearing

Disorders, 39, 312–319.

Boehmler, R. (1958). Listener responses to nonfluencies. Journal of Speech and Hearing Research, 1, 132–141.

Boberg, E. (1981). Maintenance of fluency. New York: Elsevier.

Boutsen, F. & Brutten, G. (1990). Stutterers and nonstutterers: A normative investigation of children’s speech-associated attitudes. Unpublished

manuscript, Southern Illinois University.

Brutten, G. (1975). Stuttering: Topography, assessment and behavior change strategies. In J. Eisenson (Ed.), Stuttering: A second symposium (pp.

199–262). New York: Harper & Row.

Brutten, G. (1984). The Communication Attitude Test. Unpublished manuscript.

Brutten, G., & Dunham, S. (1989). The Communication Attitude Test: A normative study of grade school children. Journal of Fluency Disorders, 14,

371–377.

Brutten, G., & Shoemaker, D. (1967). The modification of stuttering. Englewood Cliffs, NJ: Prentice-Hall.

Brutten, G., & Vanryckeghem, M. (2003). Behavior Assessment Battery: A multi-dimensional and evidence-based approach to diagnostic and

therapeutic decision making for children who stutter. Belgium: Stichting Integratie Gehandicapten & Acco Publishers.

Brutten, G., & Vanryckeghem, M. (2007). Behavior Assessment Battery for school-age children who stutter. San Diego, CA: Plural Publishing, Inc.

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (Rev. ed.). Hillsdale, NJ: Lawrence Erlbaum.

Conture, E. (2001). Stuttering: Its nature, diagnosis, and treatment. Boston: Allyn & Bacon.

Cooper, E. (1979). Intervention procedures for the young stutterer. In H. Gregory (Ed.), Controversies about stuttering therapy (pp. 63–96).

Baltimore: University Park Press.

DeKort, C. (1997). Validity measures of the Communication Attitude Test. Unpublished Master’s Thesis, University of Alberta, Edmonton, Canada.

De Nil, L., & Brutten, G. (1991). Speech-associated attitudes of stuttering and nonstuttering children. Journal of Speech and Hearing Research, 34,

60–66.

De Nil, L., Brutten, G., & Claeys, M. (1985, November). Stutterers and nonstutterers: A normative investigation of children’s speech-associated

atttitudes. Paper presented at the ASHA convention, Washington, D.C.

Erickson, R. (1969). Assessing communication attitudes among stutterers. Journal of Speech and Hearing Research, 12, 711–724.

Gregory, H. (2003). Stuttering therapy: Rationale and procedures. Boston: Allyn & Bacon.

Grims, S. (1978). Development of a scale to assess communication attitudes of young stutterers. Unpublished Master’s Thesis, University of

Vermont, VT.

Guitar, B. (1976). Pretreatment factors associated with the outcome of stuttering therapy. Journal of Speech and Hearing Research, 19, 560–590.

Guitar, B. (2006). Stuttering: An integrated approach to its nature and treatment (3rd ed.). Philadelphia: Lippincott Williams & Wilkins.

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.

Guitar, B., & Grims, S. (1979). Assessing attitudes of children who stutter. ASHA, 21, 763.

Jaksic Jelcic, S., & Brestovci, B. (2000). Communication attitudes of children who stutter and those who do not. Journal of Fluency Disorders, 25,

208.

Johannisen, B., & Wennerfeldt, S. (2000). Intensive Stuttering Therapy for children: A comparative and descriptive study of stuttering in children

who have received or applied for therapy. Unpublished Master’s Thesis, Goteborg University at Goteborg, Sweden.

Johnson, W. (1961). Stuttering and what you can do about it. Minneapolis: University of Minnesota Press.

Johnson, W., Brown, S., Curtis, J., Edney, C., & Keaster, J. (1967). Speech handicapped school children (3rd ed.). New York: Harper & Row.

Johnson, W., Darley, F., & Spriestersbach, D. (1952). Diagnostic manual in speech correction. New York: Harper & Brothers.

Lanyon, R. I. (1967). The measurement of stuttering severity. Journal of Speech and Hearing Research, 10, 836–843.

McClure, J., & Yaruss, S. (2003). Stuttering survey suggests success of attitude-changing treatment. ASHA Leader, 8, 19.

Perkins, W. (1979). From psychoanalysis to discoordination. In H. Gregory (Ed.), Controversies about stuttering therapy (pp. 97–128). Baltimore:

University Park Press.

Peters, T., & Guitar, B. (1991). Stuttering: An integrated approach to its nature and treatment. Baltimore: Williams & Wilkins.

Ryan, B. (1974). Programmed therapy for stuttering in children and adults. Springfield, IL: Charles C Thomas.


Ryan, B. (1979). Stuttering therapy in a framework of operant conditioning and programmed learning. In H. Gregory (Ed.), Controversies about

stuttering therapy (pp. 129–173). Baltimore: University Park Press.

Schiavetti, N. (1975). Judgments of stuttering severity as a function of type and locus of disfluency. Folia Phoniatrica, 2726–2737.

Shumak, I. (1955). A speech situation rating sheet for stutterers. In W. Johnson & R. Leutenegger (Eds.), Stuttering in children and adults (pp. 341–

347). Minneapolis: University Minneapolis Press.

Van Riper, C. (1982). The nature of stuttering (2nd ed.). Englewood Cliffs, NJ: Prentice-Hall.

Vanryckeghem, M., & Brutten, G. (1992a). The Communication Attitude Test: A test–retest reliability investigation. Journal of Fluency Disorders,

17, 177–190.

Vanryckeghem, M., & Brutten, G. (1992b). Communication Attitude Test: A repeated measures reliability investigation of nonstutterers. ASHA, 34,

154.

Vanryckeghem, M., & Brutten, G. (1997). The speech-associated attitude of children who do and do not stutter and the differential effect of age.

American Journal of Speech-Language Pathology, 6, 67–73.

Vanryckeghem, M., & Brutten, G. (2007). The KiddyCAT: Communication attitude test for preschool and kindergarten children who stutter. San

Diego, CA: Plural Publishing.

Vanryckeghem, M., Brutten, G., & Hernandez, L. (2005). The KiddyCAT: A normative investigation of stuttering and nonstuttering preschoolers’

speech-associated attitude. Journal of Fluency Disorders, 30, 307–318.

Williams, D. (1957). A point of view about ‘‘stuttering’’. Journal of Speech and Hearing Disorders, 22, 390–397.

Williams, D., & Kent, R. (1958). Listener evaluations of speech interruptions. Journal of Speech and Hearing Research, 1, 124–131.

Wingate, M. (1964). A standard definition of stuttering. Journal of Speech and Hearing Disorders, 29, 484–489.


Communication attitude of Italian children who do and do not stutter

Documents

Transcript of Communication attitude of Italian children who do and do not stutter