Faculty of Cognitive Sciences and Human … influences on...I, HANNAH KUMAR, FACULTY OF COGNITIVE...
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Faculty of Cognitive Sciences and Human Development
CULTURAL INFLUENCES ON ATTITUDES TOWARD SPEECH DISORDERS AOS DYSARTHRIA AND STUTTERING
Hannah Kumar
RJ Bachelor of Science with Honours 496 (Cognitive Science) S7 2015 K96 2015
UNIVERSITI MALAYSIA SARAWAK
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This declaration is made on the 15th day of JUNE year 2015
Students Declaration
I HANNAH KUMAR FACULTY OF COGNITIVE SCIENCES AND HUMAN DEVELOPMENT hereby declare that the work entitled CULTURAL INFLUENCES ON ATTITUDES TOWARD SPEECH DISORDERS AOS DYSARTHRIA AND STUTTERING is my original work I have not copied from any other students work or from any other sources with the exception where due reference or acknowledgement is made explicitly in the text nor has any part of the work been written for me by another person
15 JUNE 2015
HANNAH KUMAR (36184)
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970A JALAN SELESA 6 HAPPY GARDEN OFF OLD KLANG ROAD 58200 KUALA LUMPUR
Pusat Kbidmat Maklumat Akadcmi~ UN ERSm MALltYSIA SARAWAK
CUL TURAL INFLUENCES ON ATTITUDES TOWARD SPEECH DISORDERS AOS DYSARTHRIA AND STUTTERING
HANNAH KUMAR
This project is submitted in partial fulfillment of the requirements for a
Bachelor of Science with Honours (Cognitive Science)
Faculty of Cognitive Sciences and Human Development UNIVERSITI MALAYSIA SARA W AK
(2015)
The project entitled Cultural Influences on Attitudes Toward Speech Disorders AOS Dysarthria and Stuttering was prepared by Hannah Kumar and submitted to the Faculty of Cognitive Sciences and Human Development in partial fulfillment of the requirements for a
Bachelor of Science with Honours (Cognitive Science)
Received for examination by
(ASSOC PROF DR FITRI ~RAY MOHAMAD)
dfej Grade
A
11
ACKNOWLEDGEMENTS
Whatever you do work at it with all your heart as workingfor the Lord Colossians 323
All glory honour and praise be to my Lord Jesus Christ who granted me the wisdom
strength and discipline to successfully complete this thesis The One who has been with me
from the very beginning till the very end of this project The One who opened doors for me
when I felt like I was facing dead ends I give thanks to Him without whom I would not be
writing this today
Secondly I want to thank my supervisor Assoc Prof Dr Fitri Suraya Mohamad for
her patient guidance and words of advice and wisdom for the completion of this project Not
forgetting her personal assistant Ms Nommy Kerry for her kindness and help throughout the
project
Next I would like to thank my dear parents Mr Kumar Pal any and Ms Lydia Kumar
for their continuous words of encouragement motivation and persistent prayers that
sustained me through the entire process of completing this project My heartfelt gratitude aiso
goes to Aaron Dason for his unending support inspiration ideas and prayers that played an
important role in keeping me going as I worked on this project I would also like to thank my
friend Selina Maniraj for her patient assistance in my data collection and for proofreading
my report I want to thank my housemates Barbara Michael and Katrina Anne de Rozario
for their resourceful ideas and assistance
I also want to extend my gratitude to all my friends in UNIMAS for their patience and
cooperation and my housemates for their love and encouragement Finally I want to thank
my family my pastors and their wives and all my church friends for their continuous love
and prayers
III
Pusat Khidmat MakJumat Akademi~ VNiVERSm MALAYS[A S RAWAi
TABLE OF CONTENTS
LIST OF TABLES v
LIST OF FIGURES vi
ABSTRACT vii
CHAPTER ONE INTRODUCTION 1
CHAPTER TWO LITERATURE REVIEW 8
CHAPTER THREE METHOD 18
CHAPTER FOUR FINDINGS 24
CHAPTER FIVE DISCUSSIONS RECOMMENDATIONS AND CONCLUSION 36
REFERENCES 41
APPENDIX 44
IV
1
2
3
4
5
6
7
8
9
10
LIST OF TABLES
Table Cronbachs Alpha Reliability Test Result 21
Table Summary of Demographic Distribution of Respondents 24
Table Assumption Testing for One-Way ANOVA 29
Table Test for Homogeneity of Variances for Ethnic Groups 30
Table ANOVA Test Based on Ethnic Groups 31
Table Test for Homogeneity of Variances for Language Groups 31
Table ANOV A Test Based on Language Groups 32
Table Test for Homogeneity of Variances for Hometowns 32
Table ANOV A Test Based on Hometowns 33
Table Summary of Overall Findings 34
v
1
2
3
4
5
6
7
LIST OF FIGURES
Figure Conceptual framework 4
Figure Research procedure 18
Figure Pie chart according to gender 25
Figure Pie chart according to faculty 26
Figure Pie chart according to ethnicity 26
Figure Pie chart according to language 27
Figure Pie chart according to hometown 28
VI
ABSTRACT In a multicultural country like Malaysia culture is an important element that has great
influences on the peoples attitudes and behavior significantly Therefore a multicultural
population in which the prevalence of speech disorders is on the rise may have various
attitudes toward these disorders and the individuals with these disorders Consequently this
study was conducted among UNIMAS students with Malaysian citizenship to see if there
were any differences in attitudes toward three speech disorders namely AOS dysarthria and
stuttering based on their various cultural groups Data was collected via questionnaires that
measured the attitudes of respondents based on a 5 point Likert scale One-Way Analysis of
Variance (ANOVA) in SPSS was used to analyze the data in order to determine if differences
did exist Findings showed that attitudes toward speech disorders did not vary according to
culture in this subpopulation In addition data analysis indicated that respondents generally
have positive attitudes toward speech disorders Improvements like expanding the population
under study and using qualitative measures to measure attitudes should be employed in future
research to obtain more accurate and representative findings To conclude different cultures
do not affect Malaysian university students attitudes toward speech disorders
Keywords cultural influences attitudes toward speech disorders ethnicity language groups
hometowns AOS dysarthria stuttering
Vll
ABSTRAK Malaysia merupakan sebuah negara yang berbilang kaum dan budaya merupakan satu
elemen yang penting dalam sikap dan pandangan masyarakat negara ini Tambahan pula
individu yang mengalami masalah pertuturan semakin meningkat dalam masyarakat ini Oleh
itu pandangan dan sikap mereka terhadap masalah ini mungkin berbeza mengikut budaya
Justeru kajian ini telah dijalankan dalam kalangan pelajar UNIMAS yang berwarganegara
Malaysia untuk menentukan kewujudan perbezaan sikap terhadap tiga masalah pertuturan
iaitu AOS Dysarthria dan kegagapan berdasarkan budaya Data telah dikumpulkan melalui
borang soal selidik yang mengukur sikap responden berdasarkan skala Likert 5 mata One-
Way ANOVA dalam SPSS telah digunakan untuk menganalisis data bagi menentukan sarna
ada perbezaan itu wujud Dapatan kajian telah menunjukkan bahawa tiada perbezaan sikap
terhadap masalah pertuturan berdasarkan budaya dalam subpopulasi ini Di samping itu
analisis data ini menunjukkan bahawa responden secara umurnnya mempunyai sikap yang
positif terhadap masalah pertuturan Penarnbahbaikan seperti memperluaskan populasi yang
dikaji dan menggunakan kaedah kualitatif untuk mengukur sikap harus digunakan dalam
kajian akan datang untuk mendapatkan hasil yang lebih tepat Kesimpulannya budaya yang
berbeza tidak memberi kesan kepada sikap pelajar universiti Malaysia terhadap masalah
pertuturan
Kala kunci pengaruh budaya sikap terhadap masalah pertuturan etnik bahasa tempat asal
AOS dysarthria kegagapan
Vlll
I
CHAPTER ONE INTRODUCTION
Background of Study
Speech disorders are becoming increasingly prevalent among Malaysians these days At
the same time Malaysia is a country consisting of diverse cultures and ways of life Since
culture significantly shapes how one views the world and everything in it (Jandt 2015) it is
important to study if culture plays an important role in Malaysians attitudes toward speech
disorders
Initially many researches have focused on analysing societyS general awareness of
and perceptions toward speech disorders and its treatment However as the field of speech
disorders continued to develop new areas were probed in this aspect One of those areas
being cultural influences on the perceptions and attitudes toward this issue However all
these studies were done in countries other than Malaysia Thus far only South Americans
North Americans Kenyans Africans Indians and Chinese have been studied
Consequently the purpose of this research is to study the effects of different cultures on
Malaysians attitudes toward speech disorders namely apraxia of speech (AOS) dysarthria
and stuttering This research which is a quantitative study was conducted among UNIMAS
students representing the diverse cultures in Malaysia
Problem Statement
The prevalence of speech disorders among Malaysian children is quite alanning
Research extrapolates (based on the prevalence rate of speech disorders in the USA) that
around 235224 Malaysians could be suffering from speech disorders (Statistics by Country
for Speech Impainnent 2014) This makes 078 of the population of Malaysia which is
30073353 as of July 2014 (Malaysia Demographics Profile 2014 2014) However many
Malaysians are still oblivious to this issue In Malaysia it is only the well-educated and those
of high social economic status who are aware of speech disorders and the interventions
1
available Studies have shown that Malaysia is one of the countries in which speech disorders
are taken rather lightly whereby treatment is not sought if the severity of the disorder is not
perceived as high (as cited in Wilkerson amp Bakker 2010) Apart from the varying education
levels and socioeconomic status among Malaysian citizens cultural background is yet
another factor that contributes significantly to the diversity of Malaysians It is a wellshy
established fact that culture shapes ones view of the world and everything in it Crossshy
cultural differences significantly outline individuals perceptions and inter-personal attitudes
A persons reactions and attitudes are greatly affected by their religious beliefs and
demographical differences (Loh amp Ascoli 2011) While some cultures are more open and
receptive towards new findings in medicine and health science some may remain resistant
and less receptive toward these developments According to Wilkerson and Bakker (2010)
cultural beliefs can stand in the way of peoples awareness of speech disorders Culture also
plays an important role in the recognizing of speech disorders and the accepted treatment and
intervention for these conditions
Most studies on awareness and perception of speech disorders focus on general
awareness and perception rather than the factors that influence these elements However
substantial research has been conducted to suggest the existence of a relationship between
culture and the attitudes of individuals toward speech disorders Findings from a study
conducted by Bebout and Arthur (1992) in North America indicate that cultural variations do
affect attitudes toward speech disorders Another studyon the Cross-Cultural Attitudes and
Perception Towards Cleft Lip Palate and Deformities done among the Chinese in Africa and
in India highlighted that cultural and religious beliefs do impact ones perceptions and
attitudes toward cleft palate and its treatment (Loh amp Ascoli 2011) In their study on Cultural
Perspectives in Language and Speech Disorders conducted in Kenya Ndung and Kinyua
2
(2009) found that there is a prominent connection between cultural beliefs and language and
speech disorders
While all these studies provide evidence for a relationship between culture and attitudes
toward speech disorders none of the studies have investigated the connection of cultural
backgrounds with attitudes toward speech disorders like apraxia of speech (AOS) and
dysarthria The multicultural population of Malaysia makes this study unique and necessary
Furthermore no studies have addressed cross-cultural influences on attitudes toward speech
disorders among Malaysians Consequently there is a need to investigate if cultural
backgrounds influence Malaysians attitudes toward speech disorders
Objectives
General Objective The general objective of this research is to study the effects of
different cultural backgrounds on attitudes of Malaysian university students toward speech
disorders
Specific Objectives The specific objectives of this research are as follows
1 To find out if there is any difference in attitudes toward speech disorders based on
ethnicity
2 To find out if there is any difference in attitudes toward speech disorders based on
language groups
3 To find out if there IS any difference in attitudes toward speech disorders based on
hometowns
Hypotheses
Hypothesis 1 There is a significant difference in attitudes toward speech disorders based on
ethnicity
Hypothesis 2 There is a significant difference in attitudes toward speech disorders based on
language groups
3
Hypothesis 3 There is a significant difference in attitudes toward speech disorders based on
hometowns
Conceptual Framework
Independent Variables Dependent Variable
ethnic group bull attitudes toward Speechbull language group disorders bull hometown
Figure 1 Conceptual framework
Significance of Study
This research illustrates how cultural diversity influences an individuals attitude
toward speech disorders Findings from this research will also provide important information
for Malaysian Speech-Language Pathologists (SLPs) as they provide services for a
multicultural population This is because the attitudes of society (patient with a speech
disorder patients family and patients community) as a whole toward speech disorders is
central in the treatment process (Bebout amp Arthur 1992)
Limitations of Study
There are several limitations of this study that have been addressed in terms of the
methodology and the topic Necessary measures have been taken to curb these limitations
For example although this research consists of a selected subpopulation the subpopulation is
selected with great diversity to avoid biased results Besides since the topic of this research
limits the types of disorders explored the disorders to be explored are carefully selected so
that the results are significant
Methodological Limitation The sample of this research consists of a selected
subpopulation The sample of the population under study is chosen based on convenience of
access The respondents consist of an academically advantaged group as they are all
4
Pusat Khidmat MakJumat Akademik VNlVERSm MALAYSIA SARAWltJ(
university students Consequently they might not represent their cultures very accurately and
precisely as education may have an influence on their knowledge and awareness and hence
their attitudes toward speech disorders
The quantitative method employed in this research may lack accuracy Respondents are
required to self-rate their attitudes toward speech disorders based on a five-point Likert scale
Self-rating is often biased due to many reasons Therefore attitudes measured in this research
may not correspond with how the respondents actually behave towards an individual with
speech disorders
Topical Limitation The speech disorders discussed in this study are limited to only
three types of disorders This research only focuses on attitudes of Malaysian university
students toward four specific speech disorders namely AOS Dysarthria and Stuttering
There are other speech disorders that will not be looked into in this study Hence findings
from this study cannot be generalized to attitudes toward all speech disorders
Definition of Terms
Speech disorder
Conceptual Definition
MedicineNetcom (2013) defines speech disorder as
a disorder affecting the ability to produce normal speech Speech disorders may affect articulation (phonetic or phonological disorders) fluency (stuttering or cluttering) andor voice (tone pitch volume or rate) Speech disorders may have their roots in oral-motor difficulties although some involve language processing problems (para 1)
Carter and Musher (2013) state that speech disorder is a type of communication
disorder that refers to an impairment of the articulation of speech sounds fluency
andor voice (para 3)
5
Operational Definition
In this research speech disorder refers to motor speech disorders (apraxia of speech and
dysarthria) and fluency disorders (stuttering)
Culture
Definition
Culture is defined as a term to describe behaviors beliefs and values of a group of
people who are brought together by commonalities (Johnson 1996 p 270)
Operational Definition
In this research a culture refers to a group of people either of the same ethnic group
same language group or same hometown
Attitude
Conceptual Definition
The Merriam-Webter Online Dictionary (2014) defines attitude as the way you think
and feel about someone or something or a feeling or way of thinking that affects a persons
behaviour Attitude is also defined as a psychological tendency that is expressed by
evaluating a particular entity with some degree of favor or disfavour (as cited in Schwarz amp
Bohner 2001 p2)
Operational Definition
In this research attitude refers to the way individuals understand think about and react
to speech disorders and individuals with speech disorders
Ethnicity
Conceptual Definition
Ethnic group or ethnicity is defined as a group of people whose heritage and group
membership are based on race origin characteristics and institutions An ethnic group
mayor may not consist of individuals of the same race (Johnson 1996 p 270)
6
Operational Definition
In this research ethnic group refers to individuals of similar biological and physical
characteristics
Language group
Conceptual Definition
Language group is defined as a group of languages related by descent from a common
ancestor called the proto-language of that family (Language group 2011)
Operational Definition
In this research language group refers to a group of people categorized by the same
first language they speak
Hometown
Conceptual Definition
Hometown is defined as the town of ones birth or early life or present fixed
residence (H~me town 2014) or the city or town where one was born or grew up
(Hometown 2014)
Operational Definition
In this research hometown refers to the region in Malaysia for West Malaysia and
Sarawak - Northern Central or Southern and for Sabah - Northern or Southern where
participants of the study were born and raised
Summary
In a multicultural country like Malaysia it is vital to study cultural influences on
attitudes toward speech disorders especially because this area has not been probed yet This
study aims to see if different cultures in Malaysia have different attitudes toward speech
disorders The findings from this research would provide key information for the treatment of
these disorders The next chapter discusses literature related to this research
7
CHAPTER TWO LITERATURE REVIEW
Speech Disorders
Communication comprises of voice speech language hearing and cognition Thus
communication disorders refer to a broad area encompassing conditions in an individual that
impairs the individuals communication These conditions can either completely impede or
merely weaken the persons ability to communicate (Melfi amp Garrison 2013) Speech and
language are two major factors involved in the classification of communication disorders
Consequently there are two major types of communication disorders speech disorders and
language disorders (Carter amp Musher 2013)
However speech disorders itself is another wide branch that is further divided into
articulation disorders fluency disorders and voice disorders According to Musher and Carter
(2013) articulation disorders are speech conditions involving substitutions omissions
additions or distortions of speech sounds that interfere with intelligibility Fluency disorder is
present when an individuals speech flow is disrupted by an atypical rate rhythm and
repetitions in sounds syllables words and phrases These may also include excessive
tension struggle behaviour and secondary mannerisms Finally voice disorder refers to
abnormal production of vocal quality pitch loudness resonance andor duration that is
inappropriate for the childs age and sex
While speech disorders and language disorders are often viewed together it is
important to understand that the two are distinct from each other and the occurrence of one
does not necessarily correspond with the occurrence of the other The American Speechshy
Language-Hearing Association (ASHA) makes it clear that an individual with speech
disorders is incapable of constructing speech sounds properly or smoothly using his or her
voice On the other hand language disorders impairs ones ability to understand others
(receptive language) or to share thoughts ideas and feelings completely (expressive
8
language) (ASHA 2014) Speech disorders affect an individuals phonetics skills These
individuals may be able to construct a grammatically correct sentence but they fail to
artioulate it On the other hand language disorder affects the pragmatics skills of an
individual These individuals may be capable of articulating meaningful sounds but lack the
intellectual ability to produce grammatically correct sentences (Lewis et aI 2007)
Another important point to note about speech disorders is that it is distinct from speech
delays (NICHCY 2011) Speech delay refers to speech and language development that
occurs slowly but in the correct sequence of development Speech delay is very common
among children but does not have a lasting effect on the child as the child eventually
develops the necessary speech and language skills (Daines 2014) On the contrary speech
disorder refers to abnormal language [speech] progress (Cas 2011 para 11) According to
Daines (2014) speech disorder is language [speech] development which is not only severely
delayed but also atypical and uneven (para 6) He also mentions that unresolved speech
delay can result in speech disorder This significantly affects an individuals co~munication
abilities if proper intervention is not applied In other words speech disorder is not eventually
resolved by itself instead it impedes an individuals speech permanently (Daines 2014)
Although speech delays and speech disorders are different from each other Daines (2014)
states that it is rather difficult to differentiate one from the other in the beginning of a childs
language acquisition Hence a certified speech-language pathologist is the most reliable to
differentiate between the two (NICHCY 2011)
In this research the focus is only on three speech disorders (AOS dysarthria and
stuttering) out of the many speech disorders that exist This is because there has been no
similar study done on AOS and dysarthria At the same time although similar studies have
been done on stuttering it has never been done in a Malaysian context ASHA classifies the
selected disorders as follows
9
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
UNIVERSITI MALAYSIA SARAWAK
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DECLARATION OF ORIGINAL WORK
This declaration is made on the 15th day of JUNE year 2015
Students Declaration
I HANNAH KUMAR FACULTY OF COGNITIVE SCIENCES AND HUMAN DEVELOPMENT hereby declare that the work entitled CULTURAL INFLUENCES ON ATTITUDES TOWARD SPEECH DISORDERS AOS DYSARTHRIA AND STUTTERING is my original work I have not copied from any other students work or from any other sources with the exception where due reference or acknowledgement is made explicitly in the text nor has any part of the work been written for me by another person
15 JUNE 2015
HANNAH KUMAR (36184)
Supervisors Declaration
I ASSOO PROF DR FITRI SURAYA MOHAMAD hereby certify that the work entitled CULTURAL INFLUENCES ON ATTITUDES TOWARD SPEECH DISORDERS AOS DYSARTHRIA AND STUTTERING was prepared by the aforementioned or above mentioned student and was submitted to the FACULTY as a partial fulfillment for the conferment of BACHELOR OF SCIENCE WITH HONOURS (COGNITIVE SCIENCE) and the aforementioned work to the best of my knowledge is the said students work
~~~~ V 15 JUNE 2015 Received for examination by L-- Date _____
(ASSOC PROF D FITRl SURAYA MOHAMAD)
I declare this ProjectThesis is classified as (Please tick (-Yraquo)
o CONFIDENTIAL (Contains confidential information under the Official Secret Act 1972)
o RESTRI CTED (Contains restricted information as specified by the organisation where research was done)
~ OPEN ACCESS
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o NO
Validation of ProjectThesis
I hereby duly affirmed with free consent and willingness declared that this said ProjectThesis shall be placed officially in the Centre for Academic Information Services with the abide interest and rights as follows
bull This ProjectThesis is the sole legal property ofUniversiti Malaysia Sarawak (UNIMAS) bull The Centre for Academic Information Services has the lawful right to make copies of the
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bull No dispute or any claim shall arise from the student himself herself neither a third party on this ProjectThesis once it becomes the sole property of UNlMAS
bull This ProjectlThesis or any material data and information related to it shall not be distributed published or disclosed to any party by the student himselflherself without first obtaining approval from UNIMAS
Students ~ignature ----O~~~==------shy Supervisors signature --~--+-lJjt--==J--shy Date 15 JUNE 2015 Date 1~~
Current Address
970A JALAN SELESA 6 HAPPY GARDEN OFF OLD KLANG ROAD 58200 KUALA LUMPUR
Pusat Kbidmat Maklumat Akadcmi~ UN ERSm MALltYSIA SARAWAK
CUL TURAL INFLUENCES ON ATTITUDES TOWARD SPEECH DISORDERS AOS DYSARTHRIA AND STUTTERING
HANNAH KUMAR
This project is submitted in partial fulfillment of the requirements for a
Bachelor of Science with Honours (Cognitive Science)
Faculty of Cognitive Sciences and Human Development UNIVERSITI MALAYSIA SARA W AK
(2015)
The project entitled Cultural Influences on Attitudes Toward Speech Disorders AOS Dysarthria and Stuttering was prepared by Hannah Kumar and submitted to the Faculty of Cognitive Sciences and Human Development in partial fulfillment of the requirements for a
Bachelor of Science with Honours (Cognitive Science)
Received for examination by
(ASSOC PROF DR FITRI ~RAY MOHAMAD)
dfej Grade
A
11
ACKNOWLEDGEMENTS
Whatever you do work at it with all your heart as workingfor the Lord Colossians 323
All glory honour and praise be to my Lord Jesus Christ who granted me the wisdom
strength and discipline to successfully complete this thesis The One who has been with me
from the very beginning till the very end of this project The One who opened doors for me
when I felt like I was facing dead ends I give thanks to Him without whom I would not be
writing this today
Secondly I want to thank my supervisor Assoc Prof Dr Fitri Suraya Mohamad for
her patient guidance and words of advice and wisdom for the completion of this project Not
forgetting her personal assistant Ms Nommy Kerry for her kindness and help throughout the
project
Next I would like to thank my dear parents Mr Kumar Pal any and Ms Lydia Kumar
for their continuous words of encouragement motivation and persistent prayers that
sustained me through the entire process of completing this project My heartfelt gratitude aiso
goes to Aaron Dason for his unending support inspiration ideas and prayers that played an
important role in keeping me going as I worked on this project I would also like to thank my
friend Selina Maniraj for her patient assistance in my data collection and for proofreading
my report I want to thank my housemates Barbara Michael and Katrina Anne de Rozario
for their resourceful ideas and assistance
I also want to extend my gratitude to all my friends in UNIMAS for their patience and
cooperation and my housemates for their love and encouragement Finally I want to thank
my family my pastors and their wives and all my church friends for their continuous love
and prayers
III
Pusat Khidmat MakJumat Akademi~ VNiVERSm MALAYS[A S RAWAi
TABLE OF CONTENTS
LIST OF TABLES v
LIST OF FIGURES vi
ABSTRACT vii
CHAPTER ONE INTRODUCTION 1
CHAPTER TWO LITERATURE REVIEW 8
CHAPTER THREE METHOD 18
CHAPTER FOUR FINDINGS 24
CHAPTER FIVE DISCUSSIONS RECOMMENDATIONS AND CONCLUSION 36
REFERENCES 41
APPENDIX 44
IV
1
2
3
4
5
6
7
8
9
10
LIST OF TABLES
Table Cronbachs Alpha Reliability Test Result 21
Table Summary of Demographic Distribution of Respondents 24
Table Assumption Testing for One-Way ANOVA 29
Table Test for Homogeneity of Variances for Ethnic Groups 30
Table ANOVA Test Based on Ethnic Groups 31
Table Test for Homogeneity of Variances for Language Groups 31
Table ANOV A Test Based on Language Groups 32
Table Test for Homogeneity of Variances for Hometowns 32
Table ANOV A Test Based on Hometowns 33
Table Summary of Overall Findings 34
v
1
2
3
4
5
6
7
LIST OF FIGURES
Figure Conceptual framework 4
Figure Research procedure 18
Figure Pie chart according to gender 25
Figure Pie chart according to faculty 26
Figure Pie chart according to ethnicity 26
Figure Pie chart according to language 27
Figure Pie chart according to hometown 28
VI
ABSTRACT In a multicultural country like Malaysia culture is an important element that has great
influences on the peoples attitudes and behavior significantly Therefore a multicultural
population in which the prevalence of speech disorders is on the rise may have various
attitudes toward these disorders and the individuals with these disorders Consequently this
study was conducted among UNIMAS students with Malaysian citizenship to see if there
were any differences in attitudes toward three speech disorders namely AOS dysarthria and
stuttering based on their various cultural groups Data was collected via questionnaires that
measured the attitudes of respondents based on a 5 point Likert scale One-Way Analysis of
Variance (ANOVA) in SPSS was used to analyze the data in order to determine if differences
did exist Findings showed that attitudes toward speech disorders did not vary according to
culture in this subpopulation In addition data analysis indicated that respondents generally
have positive attitudes toward speech disorders Improvements like expanding the population
under study and using qualitative measures to measure attitudes should be employed in future
research to obtain more accurate and representative findings To conclude different cultures
do not affect Malaysian university students attitudes toward speech disorders
Keywords cultural influences attitudes toward speech disorders ethnicity language groups
hometowns AOS dysarthria stuttering
Vll
ABSTRAK Malaysia merupakan sebuah negara yang berbilang kaum dan budaya merupakan satu
elemen yang penting dalam sikap dan pandangan masyarakat negara ini Tambahan pula
individu yang mengalami masalah pertuturan semakin meningkat dalam masyarakat ini Oleh
itu pandangan dan sikap mereka terhadap masalah ini mungkin berbeza mengikut budaya
Justeru kajian ini telah dijalankan dalam kalangan pelajar UNIMAS yang berwarganegara
Malaysia untuk menentukan kewujudan perbezaan sikap terhadap tiga masalah pertuturan
iaitu AOS Dysarthria dan kegagapan berdasarkan budaya Data telah dikumpulkan melalui
borang soal selidik yang mengukur sikap responden berdasarkan skala Likert 5 mata One-
Way ANOVA dalam SPSS telah digunakan untuk menganalisis data bagi menentukan sarna
ada perbezaan itu wujud Dapatan kajian telah menunjukkan bahawa tiada perbezaan sikap
terhadap masalah pertuturan berdasarkan budaya dalam subpopulasi ini Di samping itu
analisis data ini menunjukkan bahawa responden secara umurnnya mempunyai sikap yang
positif terhadap masalah pertuturan Penarnbahbaikan seperti memperluaskan populasi yang
dikaji dan menggunakan kaedah kualitatif untuk mengukur sikap harus digunakan dalam
kajian akan datang untuk mendapatkan hasil yang lebih tepat Kesimpulannya budaya yang
berbeza tidak memberi kesan kepada sikap pelajar universiti Malaysia terhadap masalah
pertuturan
Kala kunci pengaruh budaya sikap terhadap masalah pertuturan etnik bahasa tempat asal
AOS dysarthria kegagapan
Vlll
I
CHAPTER ONE INTRODUCTION
Background of Study
Speech disorders are becoming increasingly prevalent among Malaysians these days At
the same time Malaysia is a country consisting of diverse cultures and ways of life Since
culture significantly shapes how one views the world and everything in it (Jandt 2015) it is
important to study if culture plays an important role in Malaysians attitudes toward speech
disorders
Initially many researches have focused on analysing societyS general awareness of
and perceptions toward speech disorders and its treatment However as the field of speech
disorders continued to develop new areas were probed in this aspect One of those areas
being cultural influences on the perceptions and attitudes toward this issue However all
these studies were done in countries other than Malaysia Thus far only South Americans
North Americans Kenyans Africans Indians and Chinese have been studied
Consequently the purpose of this research is to study the effects of different cultures on
Malaysians attitudes toward speech disorders namely apraxia of speech (AOS) dysarthria
and stuttering This research which is a quantitative study was conducted among UNIMAS
students representing the diverse cultures in Malaysia
Problem Statement
The prevalence of speech disorders among Malaysian children is quite alanning
Research extrapolates (based on the prevalence rate of speech disorders in the USA) that
around 235224 Malaysians could be suffering from speech disorders (Statistics by Country
for Speech Impainnent 2014) This makes 078 of the population of Malaysia which is
30073353 as of July 2014 (Malaysia Demographics Profile 2014 2014) However many
Malaysians are still oblivious to this issue In Malaysia it is only the well-educated and those
of high social economic status who are aware of speech disorders and the interventions
1
available Studies have shown that Malaysia is one of the countries in which speech disorders
are taken rather lightly whereby treatment is not sought if the severity of the disorder is not
perceived as high (as cited in Wilkerson amp Bakker 2010) Apart from the varying education
levels and socioeconomic status among Malaysian citizens cultural background is yet
another factor that contributes significantly to the diversity of Malaysians It is a wellshy
established fact that culture shapes ones view of the world and everything in it Crossshy
cultural differences significantly outline individuals perceptions and inter-personal attitudes
A persons reactions and attitudes are greatly affected by their religious beliefs and
demographical differences (Loh amp Ascoli 2011) While some cultures are more open and
receptive towards new findings in medicine and health science some may remain resistant
and less receptive toward these developments According to Wilkerson and Bakker (2010)
cultural beliefs can stand in the way of peoples awareness of speech disorders Culture also
plays an important role in the recognizing of speech disorders and the accepted treatment and
intervention for these conditions
Most studies on awareness and perception of speech disorders focus on general
awareness and perception rather than the factors that influence these elements However
substantial research has been conducted to suggest the existence of a relationship between
culture and the attitudes of individuals toward speech disorders Findings from a study
conducted by Bebout and Arthur (1992) in North America indicate that cultural variations do
affect attitudes toward speech disorders Another studyon the Cross-Cultural Attitudes and
Perception Towards Cleft Lip Palate and Deformities done among the Chinese in Africa and
in India highlighted that cultural and religious beliefs do impact ones perceptions and
attitudes toward cleft palate and its treatment (Loh amp Ascoli 2011) In their study on Cultural
Perspectives in Language and Speech Disorders conducted in Kenya Ndung and Kinyua
2
(2009) found that there is a prominent connection between cultural beliefs and language and
speech disorders
While all these studies provide evidence for a relationship between culture and attitudes
toward speech disorders none of the studies have investigated the connection of cultural
backgrounds with attitudes toward speech disorders like apraxia of speech (AOS) and
dysarthria The multicultural population of Malaysia makes this study unique and necessary
Furthermore no studies have addressed cross-cultural influences on attitudes toward speech
disorders among Malaysians Consequently there is a need to investigate if cultural
backgrounds influence Malaysians attitudes toward speech disorders
Objectives
General Objective The general objective of this research is to study the effects of
different cultural backgrounds on attitudes of Malaysian university students toward speech
disorders
Specific Objectives The specific objectives of this research are as follows
1 To find out if there is any difference in attitudes toward speech disorders based on
ethnicity
2 To find out if there is any difference in attitudes toward speech disorders based on
language groups
3 To find out if there IS any difference in attitudes toward speech disorders based on
hometowns
Hypotheses
Hypothesis 1 There is a significant difference in attitudes toward speech disorders based on
ethnicity
Hypothesis 2 There is a significant difference in attitudes toward speech disorders based on
language groups
3
Hypothesis 3 There is a significant difference in attitudes toward speech disorders based on
hometowns
Conceptual Framework
Independent Variables Dependent Variable
ethnic group bull attitudes toward Speechbull language group disorders bull hometown
Figure 1 Conceptual framework
Significance of Study
This research illustrates how cultural diversity influences an individuals attitude
toward speech disorders Findings from this research will also provide important information
for Malaysian Speech-Language Pathologists (SLPs) as they provide services for a
multicultural population This is because the attitudes of society (patient with a speech
disorder patients family and patients community) as a whole toward speech disorders is
central in the treatment process (Bebout amp Arthur 1992)
Limitations of Study
There are several limitations of this study that have been addressed in terms of the
methodology and the topic Necessary measures have been taken to curb these limitations
For example although this research consists of a selected subpopulation the subpopulation is
selected with great diversity to avoid biased results Besides since the topic of this research
limits the types of disorders explored the disorders to be explored are carefully selected so
that the results are significant
Methodological Limitation The sample of this research consists of a selected
subpopulation The sample of the population under study is chosen based on convenience of
access The respondents consist of an academically advantaged group as they are all
4
Pusat Khidmat MakJumat Akademik VNlVERSm MALAYSIA SARAWltJ(
university students Consequently they might not represent their cultures very accurately and
precisely as education may have an influence on their knowledge and awareness and hence
their attitudes toward speech disorders
The quantitative method employed in this research may lack accuracy Respondents are
required to self-rate their attitudes toward speech disorders based on a five-point Likert scale
Self-rating is often biased due to many reasons Therefore attitudes measured in this research
may not correspond with how the respondents actually behave towards an individual with
speech disorders
Topical Limitation The speech disorders discussed in this study are limited to only
three types of disorders This research only focuses on attitudes of Malaysian university
students toward four specific speech disorders namely AOS Dysarthria and Stuttering
There are other speech disorders that will not be looked into in this study Hence findings
from this study cannot be generalized to attitudes toward all speech disorders
Definition of Terms
Speech disorder
Conceptual Definition
MedicineNetcom (2013) defines speech disorder as
a disorder affecting the ability to produce normal speech Speech disorders may affect articulation (phonetic or phonological disorders) fluency (stuttering or cluttering) andor voice (tone pitch volume or rate) Speech disorders may have their roots in oral-motor difficulties although some involve language processing problems (para 1)
Carter and Musher (2013) state that speech disorder is a type of communication
disorder that refers to an impairment of the articulation of speech sounds fluency
andor voice (para 3)
5
Operational Definition
In this research speech disorder refers to motor speech disorders (apraxia of speech and
dysarthria) and fluency disorders (stuttering)
Culture
Definition
Culture is defined as a term to describe behaviors beliefs and values of a group of
people who are brought together by commonalities (Johnson 1996 p 270)
Operational Definition
In this research a culture refers to a group of people either of the same ethnic group
same language group or same hometown
Attitude
Conceptual Definition
The Merriam-Webter Online Dictionary (2014) defines attitude as the way you think
and feel about someone or something or a feeling or way of thinking that affects a persons
behaviour Attitude is also defined as a psychological tendency that is expressed by
evaluating a particular entity with some degree of favor or disfavour (as cited in Schwarz amp
Bohner 2001 p2)
Operational Definition
In this research attitude refers to the way individuals understand think about and react
to speech disorders and individuals with speech disorders
Ethnicity
Conceptual Definition
Ethnic group or ethnicity is defined as a group of people whose heritage and group
membership are based on race origin characteristics and institutions An ethnic group
mayor may not consist of individuals of the same race (Johnson 1996 p 270)
6
Operational Definition
In this research ethnic group refers to individuals of similar biological and physical
characteristics
Language group
Conceptual Definition
Language group is defined as a group of languages related by descent from a common
ancestor called the proto-language of that family (Language group 2011)
Operational Definition
In this research language group refers to a group of people categorized by the same
first language they speak
Hometown
Conceptual Definition
Hometown is defined as the town of ones birth or early life or present fixed
residence (H~me town 2014) or the city or town where one was born or grew up
(Hometown 2014)
Operational Definition
In this research hometown refers to the region in Malaysia for West Malaysia and
Sarawak - Northern Central or Southern and for Sabah - Northern or Southern where
participants of the study were born and raised
Summary
In a multicultural country like Malaysia it is vital to study cultural influences on
attitudes toward speech disorders especially because this area has not been probed yet This
study aims to see if different cultures in Malaysia have different attitudes toward speech
disorders The findings from this research would provide key information for the treatment of
these disorders The next chapter discusses literature related to this research
7
CHAPTER TWO LITERATURE REVIEW
Speech Disorders
Communication comprises of voice speech language hearing and cognition Thus
communication disorders refer to a broad area encompassing conditions in an individual that
impairs the individuals communication These conditions can either completely impede or
merely weaken the persons ability to communicate (Melfi amp Garrison 2013) Speech and
language are two major factors involved in the classification of communication disorders
Consequently there are two major types of communication disorders speech disorders and
language disorders (Carter amp Musher 2013)
However speech disorders itself is another wide branch that is further divided into
articulation disorders fluency disorders and voice disorders According to Musher and Carter
(2013) articulation disorders are speech conditions involving substitutions omissions
additions or distortions of speech sounds that interfere with intelligibility Fluency disorder is
present when an individuals speech flow is disrupted by an atypical rate rhythm and
repetitions in sounds syllables words and phrases These may also include excessive
tension struggle behaviour and secondary mannerisms Finally voice disorder refers to
abnormal production of vocal quality pitch loudness resonance andor duration that is
inappropriate for the childs age and sex
While speech disorders and language disorders are often viewed together it is
important to understand that the two are distinct from each other and the occurrence of one
does not necessarily correspond with the occurrence of the other The American Speechshy
Language-Hearing Association (ASHA) makes it clear that an individual with speech
disorders is incapable of constructing speech sounds properly or smoothly using his or her
voice On the other hand language disorders impairs ones ability to understand others
(receptive language) or to share thoughts ideas and feelings completely (expressive
8
language) (ASHA 2014) Speech disorders affect an individuals phonetics skills These
individuals may be able to construct a grammatically correct sentence but they fail to
artioulate it On the other hand language disorder affects the pragmatics skills of an
individual These individuals may be capable of articulating meaningful sounds but lack the
intellectual ability to produce grammatically correct sentences (Lewis et aI 2007)
Another important point to note about speech disorders is that it is distinct from speech
delays (NICHCY 2011) Speech delay refers to speech and language development that
occurs slowly but in the correct sequence of development Speech delay is very common
among children but does not have a lasting effect on the child as the child eventually
develops the necessary speech and language skills (Daines 2014) On the contrary speech
disorder refers to abnormal language [speech] progress (Cas 2011 para 11) According to
Daines (2014) speech disorder is language [speech] development which is not only severely
delayed but also atypical and uneven (para 6) He also mentions that unresolved speech
delay can result in speech disorder This significantly affects an individuals co~munication
abilities if proper intervention is not applied In other words speech disorder is not eventually
resolved by itself instead it impedes an individuals speech permanently (Daines 2014)
Although speech delays and speech disorders are different from each other Daines (2014)
states that it is rather difficult to differentiate one from the other in the beginning of a childs
language acquisition Hence a certified speech-language pathologist is the most reliable to
differentiate between the two (NICHCY 2011)
In this research the focus is only on three speech disorders (AOS dysarthria and
stuttering) out of the many speech disorders that exist This is because there has been no
similar study done on AOS and dysarthria At the same time although similar studies have
been done on stuttering it has never been done in a Malaysian context ASHA classifies the
selected disorders as follows
9
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
I declare this ProjectThesis is classified as (Please tick (-Yraquo)
o CONFIDENTIAL (Contains confidential information under the Official Secret Act 1972)
o RESTRI CTED (Contains restricted information as specified by the organisation where research was done)
~ OPEN ACCESS
I declare this ProjectThesis is to be submitted to the Centre for Academic Information Services (CAIS) and uploaded into UNlMAS Institutional Repository (UNIMAS IR) (Please tick (-vraquo)
IZI YES
o NO
Validation of ProjectThesis
I hereby duly affirmed with free consent and willingness declared that this said ProjectThesis shall be placed officially in the Centre for Academic Information Services with the abide interest and rights as follows
bull This ProjectThesis is the sole legal property ofUniversiti Malaysia Sarawak (UNIMAS) bull The Centre for Academic Information Services has the lawful right to make copies of the
ProjectThesis for academic and research purposes only and not for other purposes bull The Centre for Academic Information Services has the lawful right to digitize the content
to be uploaded into Local Content Database bull The Centre for Academic Information Services has the lawful right to make copies of the
ProjectThesis if required for use by other parties for academic purposes or by other Higher Learning Institutes
bull No dispute or any claim shall arise from the student himself herself neither a third party on this ProjectThesis once it becomes the sole property of UNlMAS
bull This ProjectlThesis or any material data and information related to it shall not be distributed published or disclosed to any party by the student himselflherself without first obtaining approval from UNIMAS
Students ~ignature ----O~~~==------shy Supervisors signature --~--+-lJjt--==J--shy Date 15 JUNE 2015 Date 1~~
Current Address
970A JALAN SELESA 6 HAPPY GARDEN OFF OLD KLANG ROAD 58200 KUALA LUMPUR
Pusat Kbidmat Maklumat Akadcmi~ UN ERSm MALltYSIA SARAWAK
CUL TURAL INFLUENCES ON ATTITUDES TOWARD SPEECH DISORDERS AOS DYSARTHRIA AND STUTTERING
HANNAH KUMAR
This project is submitted in partial fulfillment of the requirements for a
Bachelor of Science with Honours (Cognitive Science)
Faculty of Cognitive Sciences and Human Development UNIVERSITI MALAYSIA SARA W AK
(2015)
The project entitled Cultural Influences on Attitudes Toward Speech Disorders AOS Dysarthria and Stuttering was prepared by Hannah Kumar and submitted to the Faculty of Cognitive Sciences and Human Development in partial fulfillment of the requirements for a
Bachelor of Science with Honours (Cognitive Science)
Received for examination by
(ASSOC PROF DR FITRI ~RAY MOHAMAD)
dfej Grade
A
11
ACKNOWLEDGEMENTS
Whatever you do work at it with all your heart as workingfor the Lord Colossians 323
All glory honour and praise be to my Lord Jesus Christ who granted me the wisdom
strength and discipline to successfully complete this thesis The One who has been with me
from the very beginning till the very end of this project The One who opened doors for me
when I felt like I was facing dead ends I give thanks to Him without whom I would not be
writing this today
Secondly I want to thank my supervisor Assoc Prof Dr Fitri Suraya Mohamad for
her patient guidance and words of advice and wisdom for the completion of this project Not
forgetting her personal assistant Ms Nommy Kerry for her kindness and help throughout the
project
Next I would like to thank my dear parents Mr Kumar Pal any and Ms Lydia Kumar
for their continuous words of encouragement motivation and persistent prayers that
sustained me through the entire process of completing this project My heartfelt gratitude aiso
goes to Aaron Dason for his unending support inspiration ideas and prayers that played an
important role in keeping me going as I worked on this project I would also like to thank my
friend Selina Maniraj for her patient assistance in my data collection and for proofreading
my report I want to thank my housemates Barbara Michael and Katrina Anne de Rozario
for their resourceful ideas and assistance
I also want to extend my gratitude to all my friends in UNIMAS for their patience and
cooperation and my housemates for their love and encouragement Finally I want to thank
my family my pastors and their wives and all my church friends for their continuous love
and prayers
III
Pusat Khidmat MakJumat Akademi~ VNiVERSm MALAYS[A S RAWAi
TABLE OF CONTENTS
LIST OF TABLES v
LIST OF FIGURES vi
ABSTRACT vii
CHAPTER ONE INTRODUCTION 1
CHAPTER TWO LITERATURE REVIEW 8
CHAPTER THREE METHOD 18
CHAPTER FOUR FINDINGS 24
CHAPTER FIVE DISCUSSIONS RECOMMENDATIONS AND CONCLUSION 36
REFERENCES 41
APPENDIX 44
IV
1
2
3
4
5
6
7
8
9
10
LIST OF TABLES
Table Cronbachs Alpha Reliability Test Result 21
Table Summary of Demographic Distribution of Respondents 24
Table Assumption Testing for One-Way ANOVA 29
Table Test for Homogeneity of Variances for Ethnic Groups 30
Table ANOVA Test Based on Ethnic Groups 31
Table Test for Homogeneity of Variances for Language Groups 31
Table ANOV A Test Based on Language Groups 32
Table Test for Homogeneity of Variances for Hometowns 32
Table ANOV A Test Based on Hometowns 33
Table Summary of Overall Findings 34
v
1
2
3
4
5
6
7
LIST OF FIGURES
Figure Conceptual framework 4
Figure Research procedure 18
Figure Pie chart according to gender 25
Figure Pie chart according to faculty 26
Figure Pie chart according to ethnicity 26
Figure Pie chart according to language 27
Figure Pie chart according to hometown 28
VI
ABSTRACT In a multicultural country like Malaysia culture is an important element that has great
influences on the peoples attitudes and behavior significantly Therefore a multicultural
population in which the prevalence of speech disorders is on the rise may have various
attitudes toward these disorders and the individuals with these disorders Consequently this
study was conducted among UNIMAS students with Malaysian citizenship to see if there
were any differences in attitudes toward three speech disorders namely AOS dysarthria and
stuttering based on their various cultural groups Data was collected via questionnaires that
measured the attitudes of respondents based on a 5 point Likert scale One-Way Analysis of
Variance (ANOVA) in SPSS was used to analyze the data in order to determine if differences
did exist Findings showed that attitudes toward speech disorders did not vary according to
culture in this subpopulation In addition data analysis indicated that respondents generally
have positive attitudes toward speech disorders Improvements like expanding the population
under study and using qualitative measures to measure attitudes should be employed in future
research to obtain more accurate and representative findings To conclude different cultures
do not affect Malaysian university students attitudes toward speech disorders
Keywords cultural influences attitudes toward speech disorders ethnicity language groups
hometowns AOS dysarthria stuttering
Vll
ABSTRAK Malaysia merupakan sebuah negara yang berbilang kaum dan budaya merupakan satu
elemen yang penting dalam sikap dan pandangan masyarakat negara ini Tambahan pula
individu yang mengalami masalah pertuturan semakin meningkat dalam masyarakat ini Oleh
itu pandangan dan sikap mereka terhadap masalah ini mungkin berbeza mengikut budaya
Justeru kajian ini telah dijalankan dalam kalangan pelajar UNIMAS yang berwarganegara
Malaysia untuk menentukan kewujudan perbezaan sikap terhadap tiga masalah pertuturan
iaitu AOS Dysarthria dan kegagapan berdasarkan budaya Data telah dikumpulkan melalui
borang soal selidik yang mengukur sikap responden berdasarkan skala Likert 5 mata One-
Way ANOVA dalam SPSS telah digunakan untuk menganalisis data bagi menentukan sarna
ada perbezaan itu wujud Dapatan kajian telah menunjukkan bahawa tiada perbezaan sikap
terhadap masalah pertuturan berdasarkan budaya dalam subpopulasi ini Di samping itu
analisis data ini menunjukkan bahawa responden secara umurnnya mempunyai sikap yang
positif terhadap masalah pertuturan Penarnbahbaikan seperti memperluaskan populasi yang
dikaji dan menggunakan kaedah kualitatif untuk mengukur sikap harus digunakan dalam
kajian akan datang untuk mendapatkan hasil yang lebih tepat Kesimpulannya budaya yang
berbeza tidak memberi kesan kepada sikap pelajar universiti Malaysia terhadap masalah
pertuturan
Kala kunci pengaruh budaya sikap terhadap masalah pertuturan etnik bahasa tempat asal
AOS dysarthria kegagapan
Vlll
I
CHAPTER ONE INTRODUCTION
Background of Study
Speech disorders are becoming increasingly prevalent among Malaysians these days At
the same time Malaysia is a country consisting of diverse cultures and ways of life Since
culture significantly shapes how one views the world and everything in it (Jandt 2015) it is
important to study if culture plays an important role in Malaysians attitudes toward speech
disorders
Initially many researches have focused on analysing societyS general awareness of
and perceptions toward speech disorders and its treatment However as the field of speech
disorders continued to develop new areas were probed in this aspect One of those areas
being cultural influences on the perceptions and attitudes toward this issue However all
these studies were done in countries other than Malaysia Thus far only South Americans
North Americans Kenyans Africans Indians and Chinese have been studied
Consequently the purpose of this research is to study the effects of different cultures on
Malaysians attitudes toward speech disorders namely apraxia of speech (AOS) dysarthria
and stuttering This research which is a quantitative study was conducted among UNIMAS
students representing the diverse cultures in Malaysia
Problem Statement
The prevalence of speech disorders among Malaysian children is quite alanning
Research extrapolates (based on the prevalence rate of speech disorders in the USA) that
around 235224 Malaysians could be suffering from speech disorders (Statistics by Country
for Speech Impainnent 2014) This makes 078 of the population of Malaysia which is
30073353 as of July 2014 (Malaysia Demographics Profile 2014 2014) However many
Malaysians are still oblivious to this issue In Malaysia it is only the well-educated and those
of high social economic status who are aware of speech disorders and the interventions
1
available Studies have shown that Malaysia is one of the countries in which speech disorders
are taken rather lightly whereby treatment is not sought if the severity of the disorder is not
perceived as high (as cited in Wilkerson amp Bakker 2010) Apart from the varying education
levels and socioeconomic status among Malaysian citizens cultural background is yet
another factor that contributes significantly to the diversity of Malaysians It is a wellshy
established fact that culture shapes ones view of the world and everything in it Crossshy
cultural differences significantly outline individuals perceptions and inter-personal attitudes
A persons reactions and attitudes are greatly affected by their religious beliefs and
demographical differences (Loh amp Ascoli 2011) While some cultures are more open and
receptive towards new findings in medicine and health science some may remain resistant
and less receptive toward these developments According to Wilkerson and Bakker (2010)
cultural beliefs can stand in the way of peoples awareness of speech disorders Culture also
plays an important role in the recognizing of speech disorders and the accepted treatment and
intervention for these conditions
Most studies on awareness and perception of speech disorders focus on general
awareness and perception rather than the factors that influence these elements However
substantial research has been conducted to suggest the existence of a relationship between
culture and the attitudes of individuals toward speech disorders Findings from a study
conducted by Bebout and Arthur (1992) in North America indicate that cultural variations do
affect attitudes toward speech disorders Another studyon the Cross-Cultural Attitudes and
Perception Towards Cleft Lip Palate and Deformities done among the Chinese in Africa and
in India highlighted that cultural and religious beliefs do impact ones perceptions and
attitudes toward cleft palate and its treatment (Loh amp Ascoli 2011) In their study on Cultural
Perspectives in Language and Speech Disorders conducted in Kenya Ndung and Kinyua
2
(2009) found that there is a prominent connection between cultural beliefs and language and
speech disorders
While all these studies provide evidence for a relationship between culture and attitudes
toward speech disorders none of the studies have investigated the connection of cultural
backgrounds with attitudes toward speech disorders like apraxia of speech (AOS) and
dysarthria The multicultural population of Malaysia makes this study unique and necessary
Furthermore no studies have addressed cross-cultural influences on attitudes toward speech
disorders among Malaysians Consequently there is a need to investigate if cultural
backgrounds influence Malaysians attitudes toward speech disorders
Objectives
General Objective The general objective of this research is to study the effects of
different cultural backgrounds on attitudes of Malaysian university students toward speech
disorders
Specific Objectives The specific objectives of this research are as follows
1 To find out if there is any difference in attitudes toward speech disorders based on
ethnicity
2 To find out if there is any difference in attitudes toward speech disorders based on
language groups
3 To find out if there IS any difference in attitudes toward speech disorders based on
hometowns
Hypotheses
Hypothesis 1 There is a significant difference in attitudes toward speech disorders based on
ethnicity
Hypothesis 2 There is a significant difference in attitudes toward speech disorders based on
language groups
3
Hypothesis 3 There is a significant difference in attitudes toward speech disorders based on
hometowns
Conceptual Framework
Independent Variables Dependent Variable
ethnic group bull attitudes toward Speechbull language group disorders bull hometown
Figure 1 Conceptual framework
Significance of Study
This research illustrates how cultural diversity influences an individuals attitude
toward speech disorders Findings from this research will also provide important information
for Malaysian Speech-Language Pathologists (SLPs) as they provide services for a
multicultural population This is because the attitudes of society (patient with a speech
disorder patients family and patients community) as a whole toward speech disorders is
central in the treatment process (Bebout amp Arthur 1992)
Limitations of Study
There are several limitations of this study that have been addressed in terms of the
methodology and the topic Necessary measures have been taken to curb these limitations
For example although this research consists of a selected subpopulation the subpopulation is
selected with great diversity to avoid biased results Besides since the topic of this research
limits the types of disorders explored the disorders to be explored are carefully selected so
that the results are significant
Methodological Limitation The sample of this research consists of a selected
subpopulation The sample of the population under study is chosen based on convenience of
access The respondents consist of an academically advantaged group as they are all
4
Pusat Khidmat MakJumat Akademik VNlVERSm MALAYSIA SARAWltJ(
university students Consequently they might not represent their cultures very accurately and
precisely as education may have an influence on their knowledge and awareness and hence
their attitudes toward speech disorders
The quantitative method employed in this research may lack accuracy Respondents are
required to self-rate their attitudes toward speech disorders based on a five-point Likert scale
Self-rating is often biased due to many reasons Therefore attitudes measured in this research
may not correspond with how the respondents actually behave towards an individual with
speech disorders
Topical Limitation The speech disorders discussed in this study are limited to only
three types of disorders This research only focuses on attitudes of Malaysian university
students toward four specific speech disorders namely AOS Dysarthria and Stuttering
There are other speech disorders that will not be looked into in this study Hence findings
from this study cannot be generalized to attitudes toward all speech disorders
Definition of Terms
Speech disorder
Conceptual Definition
MedicineNetcom (2013) defines speech disorder as
a disorder affecting the ability to produce normal speech Speech disorders may affect articulation (phonetic or phonological disorders) fluency (stuttering or cluttering) andor voice (tone pitch volume or rate) Speech disorders may have their roots in oral-motor difficulties although some involve language processing problems (para 1)
Carter and Musher (2013) state that speech disorder is a type of communication
disorder that refers to an impairment of the articulation of speech sounds fluency
andor voice (para 3)
5
Operational Definition
In this research speech disorder refers to motor speech disorders (apraxia of speech and
dysarthria) and fluency disorders (stuttering)
Culture
Definition
Culture is defined as a term to describe behaviors beliefs and values of a group of
people who are brought together by commonalities (Johnson 1996 p 270)
Operational Definition
In this research a culture refers to a group of people either of the same ethnic group
same language group or same hometown
Attitude
Conceptual Definition
The Merriam-Webter Online Dictionary (2014) defines attitude as the way you think
and feel about someone or something or a feeling or way of thinking that affects a persons
behaviour Attitude is also defined as a psychological tendency that is expressed by
evaluating a particular entity with some degree of favor or disfavour (as cited in Schwarz amp
Bohner 2001 p2)
Operational Definition
In this research attitude refers to the way individuals understand think about and react
to speech disorders and individuals with speech disorders
Ethnicity
Conceptual Definition
Ethnic group or ethnicity is defined as a group of people whose heritage and group
membership are based on race origin characteristics and institutions An ethnic group
mayor may not consist of individuals of the same race (Johnson 1996 p 270)
6
Operational Definition
In this research ethnic group refers to individuals of similar biological and physical
characteristics
Language group
Conceptual Definition
Language group is defined as a group of languages related by descent from a common
ancestor called the proto-language of that family (Language group 2011)
Operational Definition
In this research language group refers to a group of people categorized by the same
first language they speak
Hometown
Conceptual Definition
Hometown is defined as the town of ones birth or early life or present fixed
residence (H~me town 2014) or the city or town where one was born or grew up
(Hometown 2014)
Operational Definition
In this research hometown refers to the region in Malaysia for West Malaysia and
Sarawak - Northern Central or Southern and for Sabah - Northern or Southern where
participants of the study were born and raised
Summary
In a multicultural country like Malaysia it is vital to study cultural influences on
attitudes toward speech disorders especially because this area has not been probed yet This
study aims to see if different cultures in Malaysia have different attitudes toward speech
disorders The findings from this research would provide key information for the treatment of
these disorders The next chapter discusses literature related to this research
7
CHAPTER TWO LITERATURE REVIEW
Speech Disorders
Communication comprises of voice speech language hearing and cognition Thus
communication disorders refer to a broad area encompassing conditions in an individual that
impairs the individuals communication These conditions can either completely impede or
merely weaken the persons ability to communicate (Melfi amp Garrison 2013) Speech and
language are two major factors involved in the classification of communication disorders
Consequently there are two major types of communication disorders speech disorders and
language disorders (Carter amp Musher 2013)
However speech disorders itself is another wide branch that is further divided into
articulation disorders fluency disorders and voice disorders According to Musher and Carter
(2013) articulation disorders are speech conditions involving substitutions omissions
additions or distortions of speech sounds that interfere with intelligibility Fluency disorder is
present when an individuals speech flow is disrupted by an atypical rate rhythm and
repetitions in sounds syllables words and phrases These may also include excessive
tension struggle behaviour and secondary mannerisms Finally voice disorder refers to
abnormal production of vocal quality pitch loudness resonance andor duration that is
inappropriate for the childs age and sex
While speech disorders and language disorders are often viewed together it is
important to understand that the two are distinct from each other and the occurrence of one
does not necessarily correspond with the occurrence of the other The American Speechshy
Language-Hearing Association (ASHA) makes it clear that an individual with speech
disorders is incapable of constructing speech sounds properly or smoothly using his or her
voice On the other hand language disorders impairs ones ability to understand others
(receptive language) or to share thoughts ideas and feelings completely (expressive
8
language) (ASHA 2014) Speech disorders affect an individuals phonetics skills These
individuals may be able to construct a grammatically correct sentence but they fail to
artioulate it On the other hand language disorder affects the pragmatics skills of an
individual These individuals may be capable of articulating meaningful sounds but lack the
intellectual ability to produce grammatically correct sentences (Lewis et aI 2007)
Another important point to note about speech disorders is that it is distinct from speech
delays (NICHCY 2011) Speech delay refers to speech and language development that
occurs slowly but in the correct sequence of development Speech delay is very common
among children but does not have a lasting effect on the child as the child eventually
develops the necessary speech and language skills (Daines 2014) On the contrary speech
disorder refers to abnormal language [speech] progress (Cas 2011 para 11) According to
Daines (2014) speech disorder is language [speech] development which is not only severely
delayed but also atypical and uneven (para 6) He also mentions that unresolved speech
delay can result in speech disorder This significantly affects an individuals co~munication
abilities if proper intervention is not applied In other words speech disorder is not eventually
resolved by itself instead it impedes an individuals speech permanently (Daines 2014)
Although speech delays and speech disorders are different from each other Daines (2014)
states that it is rather difficult to differentiate one from the other in the beginning of a childs
language acquisition Hence a certified speech-language pathologist is the most reliable to
differentiate between the two (NICHCY 2011)
In this research the focus is only on three speech disorders (AOS dysarthria and
stuttering) out of the many speech disorders that exist This is because there has been no
similar study done on AOS and dysarthria At the same time although similar studies have
been done on stuttering it has never been done in a Malaysian context ASHA classifies the
selected disorders as follows
9
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
Pusat Kbidmat Maklumat Akadcmi~ UN ERSm MALltYSIA SARAWAK
CUL TURAL INFLUENCES ON ATTITUDES TOWARD SPEECH DISORDERS AOS DYSARTHRIA AND STUTTERING
HANNAH KUMAR
This project is submitted in partial fulfillment of the requirements for a
Bachelor of Science with Honours (Cognitive Science)
Faculty of Cognitive Sciences and Human Development UNIVERSITI MALAYSIA SARA W AK
(2015)
The project entitled Cultural Influences on Attitudes Toward Speech Disorders AOS Dysarthria and Stuttering was prepared by Hannah Kumar and submitted to the Faculty of Cognitive Sciences and Human Development in partial fulfillment of the requirements for a
Bachelor of Science with Honours (Cognitive Science)
Received for examination by
(ASSOC PROF DR FITRI ~RAY MOHAMAD)
dfej Grade
A
11
ACKNOWLEDGEMENTS
Whatever you do work at it with all your heart as workingfor the Lord Colossians 323
All glory honour and praise be to my Lord Jesus Christ who granted me the wisdom
strength and discipline to successfully complete this thesis The One who has been with me
from the very beginning till the very end of this project The One who opened doors for me
when I felt like I was facing dead ends I give thanks to Him without whom I would not be
writing this today
Secondly I want to thank my supervisor Assoc Prof Dr Fitri Suraya Mohamad for
her patient guidance and words of advice and wisdom for the completion of this project Not
forgetting her personal assistant Ms Nommy Kerry for her kindness and help throughout the
project
Next I would like to thank my dear parents Mr Kumar Pal any and Ms Lydia Kumar
for their continuous words of encouragement motivation and persistent prayers that
sustained me through the entire process of completing this project My heartfelt gratitude aiso
goes to Aaron Dason for his unending support inspiration ideas and prayers that played an
important role in keeping me going as I worked on this project I would also like to thank my
friend Selina Maniraj for her patient assistance in my data collection and for proofreading
my report I want to thank my housemates Barbara Michael and Katrina Anne de Rozario
for their resourceful ideas and assistance
I also want to extend my gratitude to all my friends in UNIMAS for their patience and
cooperation and my housemates for their love and encouragement Finally I want to thank
my family my pastors and their wives and all my church friends for their continuous love
and prayers
III
Pusat Khidmat MakJumat Akademi~ VNiVERSm MALAYS[A S RAWAi
TABLE OF CONTENTS
LIST OF TABLES v
LIST OF FIGURES vi
ABSTRACT vii
CHAPTER ONE INTRODUCTION 1
CHAPTER TWO LITERATURE REVIEW 8
CHAPTER THREE METHOD 18
CHAPTER FOUR FINDINGS 24
CHAPTER FIVE DISCUSSIONS RECOMMENDATIONS AND CONCLUSION 36
REFERENCES 41
APPENDIX 44
IV
1
2
3
4
5
6
7
8
9
10
LIST OF TABLES
Table Cronbachs Alpha Reliability Test Result 21
Table Summary of Demographic Distribution of Respondents 24
Table Assumption Testing for One-Way ANOVA 29
Table Test for Homogeneity of Variances for Ethnic Groups 30
Table ANOVA Test Based on Ethnic Groups 31
Table Test for Homogeneity of Variances for Language Groups 31
Table ANOV A Test Based on Language Groups 32
Table Test for Homogeneity of Variances for Hometowns 32
Table ANOV A Test Based on Hometowns 33
Table Summary of Overall Findings 34
v
1
2
3
4
5
6
7
LIST OF FIGURES
Figure Conceptual framework 4
Figure Research procedure 18
Figure Pie chart according to gender 25
Figure Pie chart according to faculty 26
Figure Pie chart according to ethnicity 26
Figure Pie chart according to language 27
Figure Pie chart according to hometown 28
VI
ABSTRACT In a multicultural country like Malaysia culture is an important element that has great
influences on the peoples attitudes and behavior significantly Therefore a multicultural
population in which the prevalence of speech disorders is on the rise may have various
attitudes toward these disorders and the individuals with these disorders Consequently this
study was conducted among UNIMAS students with Malaysian citizenship to see if there
were any differences in attitudes toward three speech disorders namely AOS dysarthria and
stuttering based on their various cultural groups Data was collected via questionnaires that
measured the attitudes of respondents based on a 5 point Likert scale One-Way Analysis of
Variance (ANOVA) in SPSS was used to analyze the data in order to determine if differences
did exist Findings showed that attitudes toward speech disorders did not vary according to
culture in this subpopulation In addition data analysis indicated that respondents generally
have positive attitudes toward speech disorders Improvements like expanding the population
under study and using qualitative measures to measure attitudes should be employed in future
research to obtain more accurate and representative findings To conclude different cultures
do not affect Malaysian university students attitudes toward speech disorders
Keywords cultural influences attitudes toward speech disorders ethnicity language groups
hometowns AOS dysarthria stuttering
Vll
ABSTRAK Malaysia merupakan sebuah negara yang berbilang kaum dan budaya merupakan satu
elemen yang penting dalam sikap dan pandangan masyarakat negara ini Tambahan pula
individu yang mengalami masalah pertuturan semakin meningkat dalam masyarakat ini Oleh
itu pandangan dan sikap mereka terhadap masalah ini mungkin berbeza mengikut budaya
Justeru kajian ini telah dijalankan dalam kalangan pelajar UNIMAS yang berwarganegara
Malaysia untuk menentukan kewujudan perbezaan sikap terhadap tiga masalah pertuturan
iaitu AOS Dysarthria dan kegagapan berdasarkan budaya Data telah dikumpulkan melalui
borang soal selidik yang mengukur sikap responden berdasarkan skala Likert 5 mata One-
Way ANOVA dalam SPSS telah digunakan untuk menganalisis data bagi menentukan sarna
ada perbezaan itu wujud Dapatan kajian telah menunjukkan bahawa tiada perbezaan sikap
terhadap masalah pertuturan berdasarkan budaya dalam subpopulasi ini Di samping itu
analisis data ini menunjukkan bahawa responden secara umurnnya mempunyai sikap yang
positif terhadap masalah pertuturan Penarnbahbaikan seperti memperluaskan populasi yang
dikaji dan menggunakan kaedah kualitatif untuk mengukur sikap harus digunakan dalam
kajian akan datang untuk mendapatkan hasil yang lebih tepat Kesimpulannya budaya yang
berbeza tidak memberi kesan kepada sikap pelajar universiti Malaysia terhadap masalah
pertuturan
Kala kunci pengaruh budaya sikap terhadap masalah pertuturan etnik bahasa tempat asal
AOS dysarthria kegagapan
Vlll
I
CHAPTER ONE INTRODUCTION
Background of Study
Speech disorders are becoming increasingly prevalent among Malaysians these days At
the same time Malaysia is a country consisting of diverse cultures and ways of life Since
culture significantly shapes how one views the world and everything in it (Jandt 2015) it is
important to study if culture plays an important role in Malaysians attitudes toward speech
disorders
Initially many researches have focused on analysing societyS general awareness of
and perceptions toward speech disorders and its treatment However as the field of speech
disorders continued to develop new areas were probed in this aspect One of those areas
being cultural influences on the perceptions and attitudes toward this issue However all
these studies were done in countries other than Malaysia Thus far only South Americans
North Americans Kenyans Africans Indians and Chinese have been studied
Consequently the purpose of this research is to study the effects of different cultures on
Malaysians attitudes toward speech disorders namely apraxia of speech (AOS) dysarthria
and stuttering This research which is a quantitative study was conducted among UNIMAS
students representing the diverse cultures in Malaysia
Problem Statement
The prevalence of speech disorders among Malaysian children is quite alanning
Research extrapolates (based on the prevalence rate of speech disorders in the USA) that
around 235224 Malaysians could be suffering from speech disorders (Statistics by Country
for Speech Impainnent 2014) This makes 078 of the population of Malaysia which is
30073353 as of July 2014 (Malaysia Demographics Profile 2014 2014) However many
Malaysians are still oblivious to this issue In Malaysia it is only the well-educated and those
of high social economic status who are aware of speech disorders and the interventions
1
available Studies have shown that Malaysia is one of the countries in which speech disorders
are taken rather lightly whereby treatment is not sought if the severity of the disorder is not
perceived as high (as cited in Wilkerson amp Bakker 2010) Apart from the varying education
levels and socioeconomic status among Malaysian citizens cultural background is yet
another factor that contributes significantly to the diversity of Malaysians It is a wellshy
established fact that culture shapes ones view of the world and everything in it Crossshy
cultural differences significantly outline individuals perceptions and inter-personal attitudes
A persons reactions and attitudes are greatly affected by their religious beliefs and
demographical differences (Loh amp Ascoli 2011) While some cultures are more open and
receptive towards new findings in medicine and health science some may remain resistant
and less receptive toward these developments According to Wilkerson and Bakker (2010)
cultural beliefs can stand in the way of peoples awareness of speech disorders Culture also
plays an important role in the recognizing of speech disorders and the accepted treatment and
intervention for these conditions
Most studies on awareness and perception of speech disorders focus on general
awareness and perception rather than the factors that influence these elements However
substantial research has been conducted to suggest the existence of a relationship between
culture and the attitudes of individuals toward speech disorders Findings from a study
conducted by Bebout and Arthur (1992) in North America indicate that cultural variations do
affect attitudes toward speech disorders Another studyon the Cross-Cultural Attitudes and
Perception Towards Cleft Lip Palate and Deformities done among the Chinese in Africa and
in India highlighted that cultural and religious beliefs do impact ones perceptions and
attitudes toward cleft palate and its treatment (Loh amp Ascoli 2011) In their study on Cultural
Perspectives in Language and Speech Disorders conducted in Kenya Ndung and Kinyua
2
(2009) found that there is a prominent connection between cultural beliefs and language and
speech disorders
While all these studies provide evidence for a relationship between culture and attitudes
toward speech disorders none of the studies have investigated the connection of cultural
backgrounds with attitudes toward speech disorders like apraxia of speech (AOS) and
dysarthria The multicultural population of Malaysia makes this study unique and necessary
Furthermore no studies have addressed cross-cultural influences on attitudes toward speech
disorders among Malaysians Consequently there is a need to investigate if cultural
backgrounds influence Malaysians attitudes toward speech disorders
Objectives
General Objective The general objective of this research is to study the effects of
different cultural backgrounds on attitudes of Malaysian university students toward speech
disorders
Specific Objectives The specific objectives of this research are as follows
1 To find out if there is any difference in attitudes toward speech disorders based on
ethnicity
2 To find out if there is any difference in attitudes toward speech disorders based on
language groups
3 To find out if there IS any difference in attitudes toward speech disorders based on
hometowns
Hypotheses
Hypothesis 1 There is a significant difference in attitudes toward speech disorders based on
ethnicity
Hypothesis 2 There is a significant difference in attitudes toward speech disorders based on
language groups
3
Hypothesis 3 There is a significant difference in attitudes toward speech disorders based on
hometowns
Conceptual Framework
Independent Variables Dependent Variable
ethnic group bull attitudes toward Speechbull language group disorders bull hometown
Figure 1 Conceptual framework
Significance of Study
This research illustrates how cultural diversity influences an individuals attitude
toward speech disorders Findings from this research will also provide important information
for Malaysian Speech-Language Pathologists (SLPs) as they provide services for a
multicultural population This is because the attitudes of society (patient with a speech
disorder patients family and patients community) as a whole toward speech disorders is
central in the treatment process (Bebout amp Arthur 1992)
Limitations of Study
There are several limitations of this study that have been addressed in terms of the
methodology and the topic Necessary measures have been taken to curb these limitations
For example although this research consists of a selected subpopulation the subpopulation is
selected with great diversity to avoid biased results Besides since the topic of this research
limits the types of disorders explored the disorders to be explored are carefully selected so
that the results are significant
Methodological Limitation The sample of this research consists of a selected
subpopulation The sample of the population under study is chosen based on convenience of
access The respondents consist of an academically advantaged group as they are all
4
Pusat Khidmat MakJumat Akademik VNlVERSm MALAYSIA SARAWltJ(
university students Consequently they might not represent their cultures very accurately and
precisely as education may have an influence on their knowledge and awareness and hence
their attitudes toward speech disorders
The quantitative method employed in this research may lack accuracy Respondents are
required to self-rate their attitudes toward speech disorders based on a five-point Likert scale
Self-rating is often biased due to many reasons Therefore attitudes measured in this research
may not correspond with how the respondents actually behave towards an individual with
speech disorders
Topical Limitation The speech disorders discussed in this study are limited to only
three types of disorders This research only focuses on attitudes of Malaysian university
students toward four specific speech disorders namely AOS Dysarthria and Stuttering
There are other speech disorders that will not be looked into in this study Hence findings
from this study cannot be generalized to attitudes toward all speech disorders
Definition of Terms
Speech disorder
Conceptual Definition
MedicineNetcom (2013) defines speech disorder as
a disorder affecting the ability to produce normal speech Speech disorders may affect articulation (phonetic or phonological disorders) fluency (stuttering or cluttering) andor voice (tone pitch volume or rate) Speech disorders may have their roots in oral-motor difficulties although some involve language processing problems (para 1)
Carter and Musher (2013) state that speech disorder is a type of communication
disorder that refers to an impairment of the articulation of speech sounds fluency
andor voice (para 3)
5
Operational Definition
In this research speech disorder refers to motor speech disorders (apraxia of speech and
dysarthria) and fluency disorders (stuttering)
Culture
Definition
Culture is defined as a term to describe behaviors beliefs and values of a group of
people who are brought together by commonalities (Johnson 1996 p 270)
Operational Definition
In this research a culture refers to a group of people either of the same ethnic group
same language group or same hometown
Attitude
Conceptual Definition
The Merriam-Webter Online Dictionary (2014) defines attitude as the way you think
and feel about someone or something or a feeling or way of thinking that affects a persons
behaviour Attitude is also defined as a psychological tendency that is expressed by
evaluating a particular entity with some degree of favor or disfavour (as cited in Schwarz amp
Bohner 2001 p2)
Operational Definition
In this research attitude refers to the way individuals understand think about and react
to speech disorders and individuals with speech disorders
Ethnicity
Conceptual Definition
Ethnic group or ethnicity is defined as a group of people whose heritage and group
membership are based on race origin characteristics and institutions An ethnic group
mayor may not consist of individuals of the same race (Johnson 1996 p 270)
6
Operational Definition
In this research ethnic group refers to individuals of similar biological and physical
characteristics
Language group
Conceptual Definition
Language group is defined as a group of languages related by descent from a common
ancestor called the proto-language of that family (Language group 2011)
Operational Definition
In this research language group refers to a group of people categorized by the same
first language they speak
Hometown
Conceptual Definition
Hometown is defined as the town of ones birth or early life or present fixed
residence (H~me town 2014) or the city or town where one was born or grew up
(Hometown 2014)
Operational Definition
In this research hometown refers to the region in Malaysia for West Malaysia and
Sarawak - Northern Central or Southern and for Sabah - Northern or Southern where
participants of the study were born and raised
Summary
In a multicultural country like Malaysia it is vital to study cultural influences on
attitudes toward speech disorders especially because this area has not been probed yet This
study aims to see if different cultures in Malaysia have different attitudes toward speech
disorders The findings from this research would provide key information for the treatment of
these disorders The next chapter discusses literature related to this research
7
CHAPTER TWO LITERATURE REVIEW
Speech Disorders
Communication comprises of voice speech language hearing and cognition Thus
communication disorders refer to a broad area encompassing conditions in an individual that
impairs the individuals communication These conditions can either completely impede or
merely weaken the persons ability to communicate (Melfi amp Garrison 2013) Speech and
language are two major factors involved in the classification of communication disorders
Consequently there are two major types of communication disorders speech disorders and
language disorders (Carter amp Musher 2013)
However speech disorders itself is another wide branch that is further divided into
articulation disorders fluency disorders and voice disorders According to Musher and Carter
(2013) articulation disorders are speech conditions involving substitutions omissions
additions or distortions of speech sounds that interfere with intelligibility Fluency disorder is
present when an individuals speech flow is disrupted by an atypical rate rhythm and
repetitions in sounds syllables words and phrases These may also include excessive
tension struggle behaviour and secondary mannerisms Finally voice disorder refers to
abnormal production of vocal quality pitch loudness resonance andor duration that is
inappropriate for the childs age and sex
While speech disorders and language disorders are often viewed together it is
important to understand that the two are distinct from each other and the occurrence of one
does not necessarily correspond with the occurrence of the other The American Speechshy
Language-Hearing Association (ASHA) makes it clear that an individual with speech
disorders is incapable of constructing speech sounds properly or smoothly using his or her
voice On the other hand language disorders impairs ones ability to understand others
(receptive language) or to share thoughts ideas and feelings completely (expressive
8
language) (ASHA 2014) Speech disorders affect an individuals phonetics skills These
individuals may be able to construct a grammatically correct sentence but they fail to
artioulate it On the other hand language disorder affects the pragmatics skills of an
individual These individuals may be capable of articulating meaningful sounds but lack the
intellectual ability to produce grammatically correct sentences (Lewis et aI 2007)
Another important point to note about speech disorders is that it is distinct from speech
delays (NICHCY 2011) Speech delay refers to speech and language development that
occurs slowly but in the correct sequence of development Speech delay is very common
among children but does not have a lasting effect on the child as the child eventually
develops the necessary speech and language skills (Daines 2014) On the contrary speech
disorder refers to abnormal language [speech] progress (Cas 2011 para 11) According to
Daines (2014) speech disorder is language [speech] development which is not only severely
delayed but also atypical and uneven (para 6) He also mentions that unresolved speech
delay can result in speech disorder This significantly affects an individuals co~munication
abilities if proper intervention is not applied In other words speech disorder is not eventually
resolved by itself instead it impedes an individuals speech permanently (Daines 2014)
Although speech delays and speech disorders are different from each other Daines (2014)
states that it is rather difficult to differentiate one from the other in the beginning of a childs
language acquisition Hence a certified speech-language pathologist is the most reliable to
differentiate between the two (NICHCY 2011)
In this research the focus is only on three speech disorders (AOS dysarthria and
stuttering) out of the many speech disorders that exist This is because there has been no
similar study done on AOS and dysarthria At the same time although similar studies have
been done on stuttering it has never been done in a Malaysian context ASHA classifies the
selected disorders as follows
9
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
The project entitled Cultural Influences on Attitudes Toward Speech Disorders AOS Dysarthria and Stuttering was prepared by Hannah Kumar and submitted to the Faculty of Cognitive Sciences and Human Development in partial fulfillment of the requirements for a
Bachelor of Science with Honours (Cognitive Science)
Received for examination by
(ASSOC PROF DR FITRI ~RAY MOHAMAD)
dfej Grade
A
11
ACKNOWLEDGEMENTS
Whatever you do work at it with all your heart as workingfor the Lord Colossians 323
All glory honour and praise be to my Lord Jesus Christ who granted me the wisdom
strength and discipline to successfully complete this thesis The One who has been with me
from the very beginning till the very end of this project The One who opened doors for me
when I felt like I was facing dead ends I give thanks to Him without whom I would not be
writing this today
Secondly I want to thank my supervisor Assoc Prof Dr Fitri Suraya Mohamad for
her patient guidance and words of advice and wisdom for the completion of this project Not
forgetting her personal assistant Ms Nommy Kerry for her kindness and help throughout the
project
Next I would like to thank my dear parents Mr Kumar Pal any and Ms Lydia Kumar
for their continuous words of encouragement motivation and persistent prayers that
sustained me through the entire process of completing this project My heartfelt gratitude aiso
goes to Aaron Dason for his unending support inspiration ideas and prayers that played an
important role in keeping me going as I worked on this project I would also like to thank my
friend Selina Maniraj for her patient assistance in my data collection and for proofreading
my report I want to thank my housemates Barbara Michael and Katrina Anne de Rozario
for their resourceful ideas and assistance
I also want to extend my gratitude to all my friends in UNIMAS for their patience and
cooperation and my housemates for their love and encouragement Finally I want to thank
my family my pastors and their wives and all my church friends for their continuous love
and prayers
III
Pusat Khidmat MakJumat Akademi~ VNiVERSm MALAYS[A S RAWAi
TABLE OF CONTENTS
LIST OF TABLES v
LIST OF FIGURES vi
ABSTRACT vii
CHAPTER ONE INTRODUCTION 1
CHAPTER TWO LITERATURE REVIEW 8
CHAPTER THREE METHOD 18
CHAPTER FOUR FINDINGS 24
CHAPTER FIVE DISCUSSIONS RECOMMENDATIONS AND CONCLUSION 36
REFERENCES 41
APPENDIX 44
IV
1
2
3
4
5
6
7
8
9
10
LIST OF TABLES
Table Cronbachs Alpha Reliability Test Result 21
Table Summary of Demographic Distribution of Respondents 24
Table Assumption Testing for One-Way ANOVA 29
Table Test for Homogeneity of Variances for Ethnic Groups 30
Table ANOVA Test Based on Ethnic Groups 31
Table Test for Homogeneity of Variances for Language Groups 31
Table ANOV A Test Based on Language Groups 32
Table Test for Homogeneity of Variances for Hometowns 32
Table ANOV A Test Based on Hometowns 33
Table Summary of Overall Findings 34
v
1
2
3
4
5
6
7
LIST OF FIGURES
Figure Conceptual framework 4
Figure Research procedure 18
Figure Pie chart according to gender 25
Figure Pie chart according to faculty 26
Figure Pie chart according to ethnicity 26
Figure Pie chart according to language 27
Figure Pie chart according to hometown 28
VI
ABSTRACT In a multicultural country like Malaysia culture is an important element that has great
influences on the peoples attitudes and behavior significantly Therefore a multicultural
population in which the prevalence of speech disorders is on the rise may have various
attitudes toward these disorders and the individuals with these disorders Consequently this
study was conducted among UNIMAS students with Malaysian citizenship to see if there
were any differences in attitudes toward three speech disorders namely AOS dysarthria and
stuttering based on their various cultural groups Data was collected via questionnaires that
measured the attitudes of respondents based on a 5 point Likert scale One-Way Analysis of
Variance (ANOVA) in SPSS was used to analyze the data in order to determine if differences
did exist Findings showed that attitudes toward speech disorders did not vary according to
culture in this subpopulation In addition data analysis indicated that respondents generally
have positive attitudes toward speech disorders Improvements like expanding the population
under study and using qualitative measures to measure attitudes should be employed in future
research to obtain more accurate and representative findings To conclude different cultures
do not affect Malaysian university students attitudes toward speech disorders
Keywords cultural influences attitudes toward speech disorders ethnicity language groups
hometowns AOS dysarthria stuttering
Vll
ABSTRAK Malaysia merupakan sebuah negara yang berbilang kaum dan budaya merupakan satu
elemen yang penting dalam sikap dan pandangan masyarakat negara ini Tambahan pula
individu yang mengalami masalah pertuturan semakin meningkat dalam masyarakat ini Oleh
itu pandangan dan sikap mereka terhadap masalah ini mungkin berbeza mengikut budaya
Justeru kajian ini telah dijalankan dalam kalangan pelajar UNIMAS yang berwarganegara
Malaysia untuk menentukan kewujudan perbezaan sikap terhadap tiga masalah pertuturan
iaitu AOS Dysarthria dan kegagapan berdasarkan budaya Data telah dikumpulkan melalui
borang soal selidik yang mengukur sikap responden berdasarkan skala Likert 5 mata One-
Way ANOVA dalam SPSS telah digunakan untuk menganalisis data bagi menentukan sarna
ada perbezaan itu wujud Dapatan kajian telah menunjukkan bahawa tiada perbezaan sikap
terhadap masalah pertuturan berdasarkan budaya dalam subpopulasi ini Di samping itu
analisis data ini menunjukkan bahawa responden secara umurnnya mempunyai sikap yang
positif terhadap masalah pertuturan Penarnbahbaikan seperti memperluaskan populasi yang
dikaji dan menggunakan kaedah kualitatif untuk mengukur sikap harus digunakan dalam
kajian akan datang untuk mendapatkan hasil yang lebih tepat Kesimpulannya budaya yang
berbeza tidak memberi kesan kepada sikap pelajar universiti Malaysia terhadap masalah
pertuturan
Kala kunci pengaruh budaya sikap terhadap masalah pertuturan etnik bahasa tempat asal
AOS dysarthria kegagapan
Vlll
I
CHAPTER ONE INTRODUCTION
Background of Study
Speech disorders are becoming increasingly prevalent among Malaysians these days At
the same time Malaysia is a country consisting of diverse cultures and ways of life Since
culture significantly shapes how one views the world and everything in it (Jandt 2015) it is
important to study if culture plays an important role in Malaysians attitudes toward speech
disorders
Initially many researches have focused on analysing societyS general awareness of
and perceptions toward speech disorders and its treatment However as the field of speech
disorders continued to develop new areas were probed in this aspect One of those areas
being cultural influences on the perceptions and attitudes toward this issue However all
these studies were done in countries other than Malaysia Thus far only South Americans
North Americans Kenyans Africans Indians and Chinese have been studied
Consequently the purpose of this research is to study the effects of different cultures on
Malaysians attitudes toward speech disorders namely apraxia of speech (AOS) dysarthria
and stuttering This research which is a quantitative study was conducted among UNIMAS
students representing the diverse cultures in Malaysia
Problem Statement
The prevalence of speech disorders among Malaysian children is quite alanning
Research extrapolates (based on the prevalence rate of speech disorders in the USA) that
around 235224 Malaysians could be suffering from speech disorders (Statistics by Country
for Speech Impainnent 2014) This makes 078 of the population of Malaysia which is
30073353 as of July 2014 (Malaysia Demographics Profile 2014 2014) However many
Malaysians are still oblivious to this issue In Malaysia it is only the well-educated and those
of high social economic status who are aware of speech disorders and the interventions
1
available Studies have shown that Malaysia is one of the countries in which speech disorders
are taken rather lightly whereby treatment is not sought if the severity of the disorder is not
perceived as high (as cited in Wilkerson amp Bakker 2010) Apart from the varying education
levels and socioeconomic status among Malaysian citizens cultural background is yet
another factor that contributes significantly to the diversity of Malaysians It is a wellshy
established fact that culture shapes ones view of the world and everything in it Crossshy
cultural differences significantly outline individuals perceptions and inter-personal attitudes
A persons reactions and attitudes are greatly affected by their religious beliefs and
demographical differences (Loh amp Ascoli 2011) While some cultures are more open and
receptive towards new findings in medicine and health science some may remain resistant
and less receptive toward these developments According to Wilkerson and Bakker (2010)
cultural beliefs can stand in the way of peoples awareness of speech disorders Culture also
plays an important role in the recognizing of speech disorders and the accepted treatment and
intervention for these conditions
Most studies on awareness and perception of speech disorders focus on general
awareness and perception rather than the factors that influence these elements However
substantial research has been conducted to suggest the existence of a relationship between
culture and the attitudes of individuals toward speech disorders Findings from a study
conducted by Bebout and Arthur (1992) in North America indicate that cultural variations do
affect attitudes toward speech disorders Another studyon the Cross-Cultural Attitudes and
Perception Towards Cleft Lip Palate and Deformities done among the Chinese in Africa and
in India highlighted that cultural and religious beliefs do impact ones perceptions and
attitudes toward cleft palate and its treatment (Loh amp Ascoli 2011) In their study on Cultural
Perspectives in Language and Speech Disorders conducted in Kenya Ndung and Kinyua
2
(2009) found that there is a prominent connection between cultural beliefs and language and
speech disorders
While all these studies provide evidence for a relationship between culture and attitudes
toward speech disorders none of the studies have investigated the connection of cultural
backgrounds with attitudes toward speech disorders like apraxia of speech (AOS) and
dysarthria The multicultural population of Malaysia makes this study unique and necessary
Furthermore no studies have addressed cross-cultural influences on attitudes toward speech
disorders among Malaysians Consequently there is a need to investigate if cultural
backgrounds influence Malaysians attitudes toward speech disorders
Objectives
General Objective The general objective of this research is to study the effects of
different cultural backgrounds on attitudes of Malaysian university students toward speech
disorders
Specific Objectives The specific objectives of this research are as follows
1 To find out if there is any difference in attitudes toward speech disorders based on
ethnicity
2 To find out if there is any difference in attitudes toward speech disorders based on
language groups
3 To find out if there IS any difference in attitudes toward speech disorders based on
hometowns
Hypotheses
Hypothesis 1 There is a significant difference in attitudes toward speech disorders based on
ethnicity
Hypothesis 2 There is a significant difference in attitudes toward speech disorders based on
language groups
3
Hypothesis 3 There is a significant difference in attitudes toward speech disorders based on
hometowns
Conceptual Framework
Independent Variables Dependent Variable
ethnic group bull attitudes toward Speechbull language group disorders bull hometown
Figure 1 Conceptual framework
Significance of Study
This research illustrates how cultural diversity influences an individuals attitude
toward speech disorders Findings from this research will also provide important information
for Malaysian Speech-Language Pathologists (SLPs) as they provide services for a
multicultural population This is because the attitudes of society (patient with a speech
disorder patients family and patients community) as a whole toward speech disorders is
central in the treatment process (Bebout amp Arthur 1992)
Limitations of Study
There are several limitations of this study that have been addressed in terms of the
methodology and the topic Necessary measures have been taken to curb these limitations
For example although this research consists of a selected subpopulation the subpopulation is
selected with great diversity to avoid biased results Besides since the topic of this research
limits the types of disorders explored the disorders to be explored are carefully selected so
that the results are significant
Methodological Limitation The sample of this research consists of a selected
subpopulation The sample of the population under study is chosen based on convenience of
access The respondents consist of an academically advantaged group as they are all
4
Pusat Khidmat MakJumat Akademik VNlVERSm MALAYSIA SARAWltJ(
university students Consequently they might not represent their cultures very accurately and
precisely as education may have an influence on their knowledge and awareness and hence
their attitudes toward speech disorders
The quantitative method employed in this research may lack accuracy Respondents are
required to self-rate their attitudes toward speech disorders based on a five-point Likert scale
Self-rating is often biased due to many reasons Therefore attitudes measured in this research
may not correspond with how the respondents actually behave towards an individual with
speech disorders
Topical Limitation The speech disorders discussed in this study are limited to only
three types of disorders This research only focuses on attitudes of Malaysian university
students toward four specific speech disorders namely AOS Dysarthria and Stuttering
There are other speech disorders that will not be looked into in this study Hence findings
from this study cannot be generalized to attitudes toward all speech disorders
Definition of Terms
Speech disorder
Conceptual Definition
MedicineNetcom (2013) defines speech disorder as
a disorder affecting the ability to produce normal speech Speech disorders may affect articulation (phonetic or phonological disorders) fluency (stuttering or cluttering) andor voice (tone pitch volume or rate) Speech disorders may have their roots in oral-motor difficulties although some involve language processing problems (para 1)
Carter and Musher (2013) state that speech disorder is a type of communication
disorder that refers to an impairment of the articulation of speech sounds fluency
andor voice (para 3)
5
Operational Definition
In this research speech disorder refers to motor speech disorders (apraxia of speech and
dysarthria) and fluency disorders (stuttering)
Culture
Definition
Culture is defined as a term to describe behaviors beliefs and values of a group of
people who are brought together by commonalities (Johnson 1996 p 270)
Operational Definition
In this research a culture refers to a group of people either of the same ethnic group
same language group or same hometown
Attitude
Conceptual Definition
The Merriam-Webter Online Dictionary (2014) defines attitude as the way you think
and feel about someone or something or a feeling or way of thinking that affects a persons
behaviour Attitude is also defined as a psychological tendency that is expressed by
evaluating a particular entity with some degree of favor or disfavour (as cited in Schwarz amp
Bohner 2001 p2)
Operational Definition
In this research attitude refers to the way individuals understand think about and react
to speech disorders and individuals with speech disorders
Ethnicity
Conceptual Definition
Ethnic group or ethnicity is defined as a group of people whose heritage and group
membership are based on race origin characteristics and institutions An ethnic group
mayor may not consist of individuals of the same race (Johnson 1996 p 270)
6
Operational Definition
In this research ethnic group refers to individuals of similar biological and physical
characteristics
Language group
Conceptual Definition
Language group is defined as a group of languages related by descent from a common
ancestor called the proto-language of that family (Language group 2011)
Operational Definition
In this research language group refers to a group of people categorized by the same
first language they speak
Hometown
Conceptual Definition
Hometown is defined as the town of ones birth or early life or present fixed
residence (H~me town 2014) or the city or town where one was born or grew up
(Hometown 2014)
Operational Definition
In this research hometown refers to the region in Malaysia for West Malaysia and
Sarawak - Northern Central or Southern and for Sabah - Northern or Southern where
participants of the study were born and raised
Summary
In a multicultural country like Malaysia it is vital to study cultural influences on
attitudes toward speech disorders especially because this area has not been probed yet This
study aims to see if different cultures in Malaysia have different attitudes toward speech
disorders The findings from this research would provide key information for the treatment of
these disorders The next chapter discusses literature related to this research
7
CHAPTER TWO LITERATURE REVIEW
Speech Disorders
Communication comprises of voice speech language hearing and cognition Thus
communication disorders refer to a broad area encompassing conditions in an individual that
impairs the individuals communication These conditions can either completely impede or
merely weaken the persons ability to communicate (Melfi amp Garrison 2013) Speech and
language are two major factors involved in the classification of communication disorders
Consequently there are two major types of communication disorders speech disorders and
language disorders (Carter amp Musher 2013)
However speech disorders itself is another wide branch that is further divided into
articulation disorders fluency disorders and voice disorders According to Musher and Carter
(2013) articulation disorders are speech conditions involving substitutions omissions
additions or distortions of speech sounds that interfere with intelligibility Fluency disorder is
present when an individuals speech flow is disrupted by an atypical rate rhythm and
repetitions in sounds syllables words and phrases These may also include excessive
tension struggle behaviour and secondary mannerisms Finally voice disorder refers to
abnormal production of vocal quality pitch loudness resonance andor duration that is
inappropriate for the childs age and sex
While speech disorders and language disorders are often viewed together it is
important to understand that the two are distinct from each other and the occurrence of one
does not necessarily correspond with the occurrence of the other The American Speechshy
Language-Hearing Association (ASHA) makes it clear that an individual with speech
disorders is incapable of constructing speech sounds properly or smoothly using his or her
voice On the other hand language disorders impairs ones ability to understand others
(receptive language) or to share thoughts ideas and feelings completely (expressive
8
language) (ASHA 2014) Speech disorders affect an individuals phonetics skills These
individuals may be able to construct a grammatically correct sentence but they fail to
artioulate it On the other hand language disorder affects the pragmatics skills of an
individual These individuals may be capable of articulating meaningful sounds but lack the
intellectual ability to produce grammatically correct sentences (Lewis et aI 2007)
Another important point to note about speech disorders is that it is distinct from speech
delays (NICHCY 2011) Speech delay refers to speech and language development that
occurs slowly but in the correct sequence of development Speech delay is very common
among children but does not have a lasting effect on the child as the child eventually
develops the necessary speech and language skills (Daines 2014) On the contrary speech
disorder refers to abnormal language [speech] progress (Cas 2011 para 11) According to
Daines (2014) speech disorder is language [speech] development which is not only severely
delayed but also atypical and uneven (para 6) He also mentions that unresolved speech
delay can result in speech disorder This significantly affects an individuals co~munication
abilities if proper intervention is not applied In other words speech disorder is not eventually
resolved by itself instead it impedes an individuals speech permanently (Daines 2014)
Although speech delays and speech disorders are different from each other Daines (2014)
states that it is rather difficult to differentiate one from the other in the beginning of a childs
language acquisition Hence a certified speech-language pathologist is the most reliable to
differentiate between the two (NICHCY 2011)
In this research the focus is only on three speech disorders (AOS dysarthria and
stuttering) out of the many speech disorders that exist This is because there has been no
similar study done on AOS and dysarthria At the same time although similar studies have
been done on stuttering it has never been done in a Malaysian context ASHA classifies the
selected disorders as follows
9
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
ACKNOWLEDGEMENTS
Whatever you do work at it with all your heart as workingfor the Lord Colossians 323
All glory honour and praise be to my Lord Jesus Christ who granted me the wisdom
strength and discipline to successfully complete this thesis The One who has been with me
from the very beginning till the very end of this project The One who opened doors for me
when I felt like I was facing dead ends I give thanks to Him without whom I would not be
writing this today
Secondly I want to thank my supervisor Assoc Prof Dr Fitri Suraya Mohamad for
her patient guidance and words of advice and wisdom for the completion of this project Not
forgetting her personal assistant Ms Nommy Kerry for her kindness and help throughout the
project
Next I would like to thank my dear parents Mr Kumar Pal any and Ms Lydia Kumar
for their continuous words of encouragement motivation and persistent prayers that
sustained me through the entire process of completing this project My heartfelt gratitude aiso
goes to Aaron Dason for his unending support inspiration ideas and prayers that played an
important role in keeping me going as I worked on this project I would also like to thank my
friend Selina Maniraj for her patient assistance in my data collection and for proofreading
my report I want to thank my housemates Barbara Michael and Katrina Anne de Rozario
for their resourceful ideas and assistance
I also want to extend my gratitude to all my friends in UNIMAS for their patience and
cooperation and my housemates for their love and encouragement Finally I want to thank
my family my pastors and their wives and all my church friends for their continuous love
and prayers
III
Pusat Khidmat MakJumat Akademi~ VNiVERSm MALAYS[A S RAWAi
TABLE OF CONTENTS
LIST OF TABLES v
LIST OF FIGURES vi
ABSTRACT vii
CHAPTER ONE INTRODUCTION 1
CHAPTER TWO LITERATURE REVIEW 8
CHAPTER THREE METHOD 18
CHAPTER FOUR FINDINGS 24
CHAPTER FIVE DISCUSSIONS RECOMMENDATIONS AND CONCLUSION 36
REFERENCES 41
APPENDIX 44
IV
1
2
3
4
5
6
7
8
9
10
LIST OF TABLES
Table Cronbachs Alpha Reliability Test Result 21
Table Summary of Demographic Distribution of Respondents 24
Table Assumption Testing for One-Way ANOVA 29
Table Test for Homogeneity of Variances for Ethnic Groups 30
Table ANOVA Test Based on Ethnic Groups 31
Table Test for Homogeneity of Variances for Language Groups 31
Table ANOV A Test Based on Language Groups 32
Table Test for Homogeneity of Variances for Hometowns 32
Table ANOV A Test Based on Hometowns 33
Table Summary of Overall Findings 34
v
1
2
3
4
5
6
7
LIST OF FIGURES
Figure Conceptual framework 4
Figure Research procedure 18
Figure Pie chart according to gender 25
Figure Pie chart according to faculty 26
Figure Pie chart according to ethnicity 26
Figure Pie chart according to language 27
Figure Pie chart according to hometown 28
VI
ABSTRACT In a multicultural country like Malaysia culture is an important element that has great
influences on the peoples attitudes and behavior significantly Therefore a multicultural
population in which the prevalence of speech disorders is on the rise may have various
attitudes toward these disorders and the individuals with these disorders Consequently this
study was conducted among UNIMAS students with Malaysian citizenship to see if there
were any differences in attitudes toward three speech disorders namely AOS dysarthria and
stuttering based on their various cultural groups Data was collected via questionnaires that
measured the attitudes of respondents based on a 5 point Likert scale One-Way Analysis of
Variance (ANOVA) in SPSS was used to analyze the data in order to determine if differences
did exist Findings showed that attitudes toward speech disorders did not vary according to
culture in this subpopulation In addition data analysis indicated that respondents generally
have positive attitudes toward speech disorders Improvements like expanding the population
under study and using qualitative measures to measure attitudes should be employed in future
research to obtain more accurate and representative findings To conclude different cultures
do not affect Malaysian university students attitudes toward speech disorders
Keywords cultural influences attitudes toward speech disorders ethnicity language groups
hometowns AOS dysarthria stuttering
Vll
ABSTRAK Malaysia merupakan sebuah negara yang berbilang kaum dan budaya merupakan satu
elemen yang penting dalam sikap dan pandangan masyarakat negara ini Tambahan pula
individu yang mengalami masalah pertuturan semakin meningkat dalam masyarakat ini Oleh
itu pandangan dan sikap mereka terhadap masalah ini mungkin berbeza mengikut budaya
Justeru kajian ini telah dijalankan dalam kalangan pelajar UNIMAS yang berwarganegara
Malaysia untuk menentukan kewujudan perbezaan sikap terhadap tiga masalah pertuturan
iaitu AOS Dysarthria dan kegagapan berdasarkan budaya Data telah dikumpulkan melalui
borang soal selidik yang mengukur sikap responden berdasarkan skala Likert 5 mata One-
Way ANOVA dalam SPSS telah digunakan untuk menganalisis data bagi menentukan sarna
ada perbezaan itu wujud Dapatan kajian telah menunjukkan bahawa tiada perbezaan sikap
terhadap masalah pertuturan berdasarkan budaya dalam subpopulasi ini Di samping itu
analisis data ini menunjukkan bahawa responden secara umurnnya mempunyai sikap yang
positif terhadap masalah pertuturan Penarnbahbaikan seperti memperluaskan populasi yang
dikaji dan menggunakan kaedah kualitatif untuk mengukur sikap harus digunakan dalam
kajian akan datang untuk mendapatkan hasil yang lebih tepat Kesimpulannya budaya yang
berbeza tidak memberi kesan kepada sikap pelajar universiti Malaysia terhadap masalah
pertuturan
Kala kunci pengaruh budaya sikap terhadap masalah pertuturan etnik bahasa tempat asal
AOS dysarthria kegagapan
Vlll
I
CHAPTER ONE INTRODUCTION
Background of Study
Speech disorders are becoming increasingly prevalent among Malaysians these days At
the same time Malaysia is a country consisting of diverse cultures and ways of life Since
culture significantly shapes how one views the world and everything in it (Jandt 2015) it is
important to study if culture plays an important role in Malaysians attitudes toward speech
disorders
Initially many researches have focused on analysing societyS general awareness of
and perceptions toward speech disorders and its treatment However as the field of speech
disorders continued to develop new areas were probed in this aspect One of those areas
being cultural influences on the perceptions and attitudes toward this issue However all
these studies were done in countries other than Malaysia Thus far only South Americans
North Americans Kenyans Africans Indians and Chinese have been studied
Consequently the purpose of this research is to study the effects of different cultures on
Malaysians attitudes toward speech disorders namely apraxia of speech (AOS) dysarthria
and stuttering This research which is a quantitative study was conducted among UNIMAS
students representing the diverse cultures in Malaysia
Problem Statement
The prevalence of speech disorders among Malaysian children is quite alanning
Research extrapolates (based on the prevalence rate of speech disorders in the USA) that
around 235224 Malaysians could be suffering from speech disorders (Statistics by Country
for Speech Impainnent 2014) This makes 078 of the population of Malaysia which is
30073353 as of July 2014 (Malaysia Demographics Profile 2014 2014) However many
Malaysians are still oblivious to this issue In Malaysia it is only the well-educated and those
of high social economic status who are aware of speech disorders and the interventions
1
available Studies have shown that Malaysia is one of the countries in which speech disorders
are taken rather lightly whereby treatment is not sought if the severity of the disorder is not
perceived as high (as cited in Wilkerson amp Bakker 2010) Apart from the varying education
levels and socioeconomic status among Malaysian citizens cultural background is yet
another factor that contributes significantly to the diversity of Malaysians It is a wellshy
established fact that culture shapes ones view of the world and everything in it Crossshy
cultural differences significantly outline individuals perceptions and inter-personal attitudes
A persons reactions and attitudes are greatly affected by their religious beliefs and
demographical differences (Loh amp Ascoli 2011) While some cultures are more open and
receptive towards new findings in medicine and health science some may remain resistant
and less receptive toward these developments According to Wilkerson and Bakker (2010)
cultural beliefs can stand in the way of peoples awareness of speech disorders Culture also
plays an important role in the recognizing of speech disorders and the accepted treatment and
intervention for these conditions
Most studies on awareness and perception of speech disorders focus on general
awareness and perception rather than the factors that influence these elements However
substantial research has been conducted to suggest the existence of a relationship between
culture and the attitudes of individuals toward speech disorders Findings from a study
conducted by Bebout and Arthur (1992) in North America indicate that cultural variations do
affect attitudes toward speech disorders Another studyon the Cross-Cultural Attitudes and
Perception Towards Cleft Lip Palate and Deformities done among the Chinese in Africa and
in India highlighted that cultural and religious beliefs do impact ones perceptions and
attitudes toward cleft palate and its treatment (Loh amp Ascoli 2011) In their study on Cultural
Perspectives in Language and Speech Disorders conducted in Kenya Ndung and Kinyua
2
(2009) found that there is a prominent connection between cultural beliefs and language and
speech disorders
While all these studies provide evidence for a relationship between culture and attitudes
toward speech disorders none of the studies have investigated the connection of cultural
backgrounds with attitudes toward speech disorders like apraxia of speech (AOS) and
dysarthria The multicultural population of Malaysia makes this study unique and necessary
Furthermore no studies have addressed cross-cultural influences on attitudes toward speech
disorders among Malaysians Consequently there is a need to investigate if cultural
backgrounds influence Malaysians attitudes toward speech disorders
Objectives
General Objective The general objective of this research is to study the effects of
different cultural backgrounds on attitudes of Malaysian university students toward speech
disorders
Specific Objectives The specific objectives of this research are as follows
1 To find out if there is any difference in attitudes toward speech disorders based on
ethnicity
2 To find out if there is any difference in attitudes toward speech disorders based on
language groups
3 To find out if there IS any difference in attitudes toward speech disorders based on
hometowns
Hypotheses
Hypothesis 1 There is a significant difference in attitudes toward speech disorders based on
ethnicity
Hypothesis 2 There is a significant difference in attitudes toward speech disorders based on
language groups
3
Hypothesis 3 There is a significant difference in attitudes toward speech disorders based on
hometowns
Conceptual Framework
Independent Variables Dependent Variable
ethnic group bull attitudes toward Speechbull language group disorders bull hometown
Figure 1 Conceptual framework
Significance of Study
This research illustrates how cultural diversity influences an individuals attitude
toward speech disorders Findings from this research will also provide important information
for Malaysian Speech-Language Pathologists (SLPs) as they provide services for a
multicultural population This is because the attitudes of society (patient with a speech
disorder patients family and patients community) as a whole toward speech disorders is
central in the treatment process (Bebout amp Arthur 1992)
Limitations of Study
There are several limitations of this study that have been addressed in terms of the
methodology and the topic Necessary measures have been taken to curb these limitations
For example although this research consists of a selected subpopulation the subpopulation is
selected with great diversity to avoid biased results Besides since the topic of this research
limits the types of disorders explored the disorders to be explored are carefully selected so
that the results are significant
Methodological Limitation The sample of this research consists of a selected
subpopulation The sample of the population under study is chosen based on convenience of
access The respondents consist of an academically advantaged group as they are all
4
Pusat Khidmat MakJumat Akademik VNlVERSm MALAYSIA SARAWltJ(
university students Consequently they might not represent their cultures very accurately and
precisely as education may have an influence on their knowledge and awareness and hence
their attitudes toward speech disorders
The quantitative method employed in this research may lack accuracy Respondents are
required to self-rate their attitudes toward speech disorders based on a five-point Likert scale
Self-rating is often biased due to many reasons Therefore attitudes measured in this research
may not correspond with how the respondents actually behave towards an individual with
speech disorders
Topical Limitation The speech disorders discussed in this study are limited to only
three types of disorders This research only focuses on attitudes of Malaysian university
students toward four specific speech disorders namely AOS Dysarthria and Stuttering
There are other speech disorders that will not be looked into in this study Hence findings
from this study cannot be generalized to attitudes toward all speech disorders
Definition of Terms
Speech disorder
Conceptual Definition
MedicineNetcom (2013) defines speech disorder as
a disorder affecting the ability to produce normal speech Speech disorders may affect articulation (phonetic or phonological disorders) fluency (stuttering or cluttering) andor voice (tone pitch volume or rate) Speech disorders may have their roots in oral-motor difficulties although some involve language processing problems (para 1)
Carter and Musher (2013) state that speech disorder is a type of communication
disorder that refers to an impairment of the articulation of speech sounds fluency
andor voice (para 3)
5
Operational Definition
In this research speech disorder refers to motor speech disorders (apraxia of speech and
dysarthria) and fluency disorders (stuttering)
Culture
Definition
Culture is defined as a term to describe behaviors beliefs and values of a group of
people who are brought together by commonalities (Johnson 1996 p 270)
Operational Definition
In this research a culture refers to a group of people either of the same ethnic group
same language group or same hometown
Attitude
Conceptual Definition
The Merriam-Webter Online Dictionary (2014) defines attitude as the way you think
and feel about someone or something or a feeling or way of thinking that affects a persons
behaviour Attitude is also defined as a psychological tendency that is expressed by
evaluating a particular entity with some degree of favor or disfavour (as cited in Schwarz amp
Bohner 2001 p2)
Operational Definition
In this research attitude refers to the way individuals understand think about and react
to speech disorders and individuals with speech disorders
Ethnicity
Conceptual Definition
Ethnic group or ethnicity is defined as a group of people whose heritage and group
membership are based on race origin characteristics and institutions An ethnic group
mayor may not consist of individuals of the same race (Johnson 1996 p 270)
6
Operational Definition
In this research ethnic group refers to individuals of similar biological and physical
characteristics
Language group
Conceptual Definition
Language group is defined as a group of languages related by descent from a common
ancestor called the proto-language of that family (Language group 2011)
Operational Definition
In this research language group refers to a group of people categorized by the same
first language they speak
Hometown
Conceptual Definition
Hometown is defined as the town of ones birth or early life or present fixed
residence (H~me town 2014) or the city or town where one was born or grew up
(Hometown 2014)
Operational Definition
In this research hometown refers to the region in Malaysia for West Malaysia and
Sarawak - Northern Central or Southern and for Sabah - Northern or Southern where
participants of the study were born and raised
Summary
In a multicultural country like Malaysia it is vital to study cultural influences on
attitudes toward speech disorders especially because this area has not been probed yet This
study aims to see if different cultures in Malaysia have different attitudes toward speech
disorders The findings from this research would provide key information for the treatment of
these disorders The next chapter discusses literature related to this research
7
CHAPTER TWO LITERATURE REVIEW
Speech Disorders
Communication comprises of voice speech language hearing and cognition Thus
communication disorders refer to a broad area encompassing conditions in an individual that
impairs the individuals communication These conditions can either completely impede or
merely weaken the persons ability to communicate (Melfi amp Garrison 2013) Speech and
language are two major factors involved in the classification of communication disorders
Consequently there are two major types of communication disorders speech disorders and
language disorders (Carter amp Musher 2013)
However speech disorders itself is another wide branch that is further divided into
articulation disorders fluency disorders and voice disorders According to Musher and Carter
(2013) articulation disorders are speech conditions involving substitutions omissions
additions or distortions of speech sounds that interfere with intelligibility Fluency disorder is
present when an individuals speech flow is disrupted by an atypical rate rhythm and
repetitions in sounds syllables words and phrases These may also include excessive
tension struggle behaviour and secondary mannerisms Finally voice disorder refers to
abnormal production of vocal quality pitch loudness resonance andor duration that is
inappropriate for the childs age and sex
While speech disorders and language disorders are often viewed together it is
important to understand that the two are distinct from each other and the occurrence of one
does not necessarily correspond with the occurrence of the other The American Speechshy
Language-Hearing Association (ASHA) makes it clear that an individual with speech
disorders is incapable of constructing speech sounds properly or smoothly using his or her
voice On the other hand language disorders impairs ones ability to understand others
(receptive language) or to share thoughts ideas and feelings completely (expressive
8
language) (ASHA 2014) Speech disorders affect an individuals phonetics skills These
individuals may be able to construct a grammatically correct sentence but they fail to
artioulate it On the other hand language disorder affects the pragmatics skills of an
individual These individuals may be capable of articulating meaningful sounds but lack the
intellectual ability to produce grammatically correct sentences (Lewis et aI 2007)
Another important point to note about speech disorders is that it is distinct from speech
delays (NICHCY 2011) Speech delay refers to speech and language development that
occurs slowly but in the correct sequence of development Speech delay is very common
among children but does not have a lasting effect on the child as the child eventually
develops the necessary speech and language skills (Daines 2014) On the contrary speech
disorder refers to abnormal language [speech] progress (Cas 2011 para 11) According to
Daines (2014) speech disorder is language [speech] development which is not only severely
delayed but also atypical and uneven (para 6) He also mentions that unresolved speech
delay can result in speech disorder This significantly affects an individuals co~munication
abilities if proper intervention is not applied In other words speech disorder is not eventually
resolved by itself instead it impedes an individuals speech permanently (Daines 2014)
Although speech delays and speech disorders are different from each other Daines (2014)
states that it is rather difficult to differentiate one from the other in the beginning of a childs
language acquisition Hence a certified speech-language pathologist is the most reliable to
differentiate between the two (NICHCY 2011)
In this research the focus is only on three speech disorders (AOS dysarthria and
stuttering) out of the many speech disorders that exist This is because there has been no
similar study done on AOS and dysarthria At the same time although similar studies have
been done on stuttering it has never been done in a Malaysian context ASHA classifies the
selected disorders as follows
9
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
Pusat Khidmat MakJumat Akademi~ VNiVERSm MALAYS[A S RAWAi
TABLE OF CONTENTS
LIST OF TABLES v
LIST OF FIGURES vi
ABSTRACT vii
CHAPTER ONE INTRODUCTION 1
CHAPTER TWO LITERATURE REVIEW 8
CHAPTER THREE METHOD 18
CHAPTER FOUR FINDINGS 24
CHAPTER FIVE DISCUSSIONS RECOMMENDATIONS AND CONCLUSION 36
REFERENCES 41
APPENDIX 44
IV
1
2
3
4
5
6
7
8
9
10
LIST OF TABLES
Table Cronbachs Alpha Reliability Test Result 21
Table Summary of Demographic Distribution of Respondents 24
Table Assumption Testing for One-Way ANOVA 29
Table Test for Homogeneity of Variances for Ethnic Groups 30
Table ANOVA Test Based on Ethnic Groups 31
Table Test for Homogeneity of Variances for Language Groups 31
Table ANOV A Test Based on Language Groups 32
Table Test for Homogeneity of Variances for Hometowns 32
Table ANOV A Test Based on Hometowns 33
Table Summary of Overall Findings 34
v
1
2
3
4
5
6
7
LIST OF FIGURES
Figure Conceptual framework 4
Figure Research procedure 18
Figure Pie chart according to gender 25
Figure Pie chart according to faculty 26
Figure Pie chart according to ethnicity 26
Figure Pie chart according to language 27
Figure Pie chart according to hometown 28
VI
ABSTRACT In a multicultural country like Malaysia culture is an important element that has great
influences on the peoples attitudes and behavior significantly Therefore a multicultural
population in which the prevalence of speech disorders is on the rise may have various
attitudes toward these disorders and the individuals with these disorders Consequently this
study was conducted among UNIMAS students with Malaysian citizenship to see if there
were any differences in attitudes toward three speech disorders namely AOS dysarthria and
stuttering based on their various cultural groups Data was collected via questionnaires that
measured the attitudes of respondents based on a 5 point Likert scale One-Way Analysis of
Variance (ANOVA) in SPSS was used to analyze the data in order to determine if differences
did exist Findings showed that attitudes toward speech disorders did not vary according to
culture in this subpopulation In addition data analysis indicated that respondents generally
have positive attitudes toward speech disorders Improvements like expanding the population
under study and using qualitative measures to measure attitudes should be employed in future
research to obtain more accurate and representative findings To conclude different cultures
do not affect Malaysian university students attitudes toward speech disorders
Keywords cultural influences attitudes toward speech disorders ethnicity language groups
hometowns AOS dysarthria stuttering
Vll
ABSTRAK Malaysia merupakan sebuah negara yang berbilang kaum dan budaya merupakan satu
elemen yang penting dalam sikap dan pandangan masyarakat negara ini Tambahan pula
individu yang mengalami masalah pertuturan semakin meningkat dalam masyarakat ini Oleh
itu pandangan dan sikap mereka terhadap masalah ini mungkin berbeza mengikut budaya
Justeru kajian ini telah dijalankan dalam kalangan pelajar UNIMAS yang berwarganegara
Malaysia untuk menentukan kewujudan perbezaan sikap terhadap tiga masalah pertuturan
iaitu AOS Dysarthria dan kegagapan berdasarkan budaya Data telah dikumpulkan melalui
borang soal selidik yang mengukur sikap responden berdasarkan skala Likert 5 mata One-
Way ANOVA dalam SPSS telah digunakan untuk menganalisis data bagi menentukan sarna
ada perbezaan itu wujud Dapatan kajian telah menunjukkan bahawa tiada perbezaan sikap
terhadap masalah pertuturan berdasarkan budaya dalam subpopulasi ini Di samping itu
analisis data ini menunjukkan bahawa responden secara umurnnya mempunyai sikap yang
positif terhadap masalah pertuturan Penarnbahbaikan seperti memperluaskan populasi yang
dikaji dan menggunakan kaedah kualitatif untuk mengukur sikap harus digunakan dalam
kajian akan datang untuk mendapatkan hasil yang lebih tepat Kesimpulannya budaya yang
berbeza tidak memberi kesan kepada sikap pelajar universiti Malaysia terhadap masalah
pertuturan
Kala kunci pengaruh budaya sikap terhadap masalah pertuturan etnik bahasa tempat asal
AOS dysarthria kegagapan
Vlll
I
CHAPTER ONE INTRODUCTION
Background of Study
Speech disorders are becoming increasingly prevalent among Malaysians these days At
the same time Malaysia is a country consisting of diverse cultures and ways of life Since
culture significantly shapes how one views the world and everything in it (Jandt 2015) it is
important to study if culture plays an important role in Malaysians attitudes toward speech
disorders
Initially many researches have focused on analysing societyS general awareness of
and perceptions toward speech disorders and its treatment However as the field of speech
disorders continued to develop new areas were probed in this aspect One of those areas
being cultural influences on the perceptions and attitudes toward this issue However all
these studies were done in countries other than Malaysia Thus far only South Americans
North Americans Kenyans Africans Indians and Chinese have been studied
Consequently the purpose of this research is to study the effects of different cultures on
Malaysians attitudes toward speech disorders namely apraxia of speech (AOS) dysarthria
and stuttering This research which is a quantitative study was conducted among UNIMAS
students representing the diverse cultures in Malaysia
Problem Statement
The prevalence of speech disorders among Malaysian children is quite alanning
Research extrapolates (based on the prevalence rate of speech disorders in the USA) that
around 235224 Malaysians could be suffering from speech disorders (Statistics by Country
for Speech Impainnent 2014) This makes 078 of the population of Malaysia which is
30073353 as of July 2014 (Malaysia Demographics Profile 2014 2014) However many
Malaysians are still oblivious to this issue In Malaysia it is only the well-educated and those
of high social economic status who are aware of speech disorders and the interventions
1
available Studies have shown that Malaysia is one of the countries in which speech disorders
are taken rather lightly whereby treatment is not sought if the severity of the disorder is not
perceived as high (as cited in Wilkerson amp Bakker 2010) Apart from the varying education
levels and socioeconomic status among Malaysian citizens cultural background is yet
another factor that contributes significantly to the diversity of Malaysians It is a wellshy
established fact that culture shapes ones view of the world and everything in it Crossshy
cultural differences significantly outline individuals perceptions and inter-personal attitudes
A persons reactions and attitudes are greatly affected by their religious beliefs and
demographical differences (Loh amp Ascoli 2011) While some cultures are more open and
receptive towards new findings in medicine and health science some may remain resistant
and less receptive toward these developments According to Wilkerson and Bakker (2010)
cultural beliefs can stand in the way of peoples awareness of speech disorders Culture also
plays an important role in the recognizing of speech disorders and the accepted treatment and
intervention for these conditions
Most studies on awareness and perception of speech disorders focus on general
awareness and perception rather than the factors that influence these elements However
substantial research has been conducted to suggest the existence of a relationship between
culture and the attitudes of individuals toward speech disorders Findings from a study
conducted by Bebout and Arthur (1992) in North America indicate that cultural variations do
affect attitudes toward speech disorders Another studyon the Cross-Cultural Attitudes and
Perception Towards Cleft Lip Palate and Deformities done among the Chinese in Africa and
in India highlighted that cultural and religious beliefs do impact ones perceptions and
attitudes toward cleft palate and its treatment (Loh amp Ascoli 2011) In their study on Cultural
Perspectives in Language and Speech Disorders conducted in Kenya Ndung and Kinyua
2
(2009) found that there is a prominent connection between cultural beliefs and language and
speech disorders
While all these studies provide evidence for a relationship between culture and attitudes
toward speech disorders none of the studies have investigated the connection of cultural
backgrounds with attitudes toward speech disorders like apraxia of speech (AOS) and
dysarthria The multicultural population of Malaysia makes this study unique and necessary
Furthermore no studies have addressed cross-cultural influences on attitudes toward speech
disorders among Malaysians Consequently there is a need to investigate if cultural
backgrounds influence Malaysians attitudes toward speech disorders
Objectives
General Objective The general objective of this research is to study the effects of
different cultural backgrounds on attitudes of Malaysian university students toward speech
disorders
Specific Objectives The specific objectives of this research are as follows
1 To find out if there is any difference in attitudes toward speech disorders based on
ethnicity
2 To find out if there is any difference in attitudes toward speech disorders based on
language groups
3 To find out if there IS any difference in attitudes toward speech disorders based on
hometowns
Hypotheses
Hypothesis 1 There is a significant difference in attitudes toward speech disorders based on
ethnicity
Hypothesis 2 There is a significant difference in attitudes toward speech disorders based on
language groups
3
Hypothesis 3 There is a significant difference in attitudes toward speech disorders based on
hometowns
Conceptual Framework
Independent Variables Dependent Variable
ethnic group bull attitudes toward Speechbull language group disorders bull hometown
Figure 1 Conceptual framework
Significance of Study
This research illustrates how cultural diversity influences an individuals attitude
toward speech disorders Findings from this research will also provide important information
for Malaysian Speech-Language Pathologists (SLPs) as they provide services for a
multicultural population This is because the attitudes of society (patient with a speech
disorder patients family and patients community) as a whole toward speech disorders is
central in the treatment process (Bebout amp Arthur 1992)
Limitations of Study
There are several limitations of this study that have been addressed in terms of the
methodology and the topic Necessary measures have been taken to curb these limitations
For example although this research consists of a selected subpopulation the subpopulation is
selected with great diversity to avoid biased results Besides since the topic of this research
limits the types of disorders explored the disorders to be explored are carefully selected so
that the results are significant
Methodological Limitation The sample of this research consists of a selected
subpopulation The sample of the population under study is chosen based on convenience of
access The respondents consist of an academically advantaged group as they are all
4
Pusat Khidmat MakJumat Akademik VNlVERSm MALAYSIA SARAWltJ(
university students Consequently they might not represent their cultures very accurately and
precisely as education may have an influence on their knowledge and awareness and hence
their attitudes toward speech disorders
The quantitative method employed in this research may lack accuracy Respondents are
required to self-rate their attitudes toward speech disorders based on a five-point Likert scale
Self-rating is often biased due to many reasons Therefore attitudes measured in this research
may not correspond with how the respondents actually behave towards an individual with
speech disorders
Topical Limitation The speech disorders discussed in this study are limited to only
three types of disorders This research only focuses on attitudes of Malaysian university
students toward four specific speech disorders namely AOS Dysarthria and Stuttering
There are other speech disorders that will not be looked into in this study Hence findings
from this study cannot be generalized to attitudes toward all speech disorders
Definition of Terms
Speech disorder
Conceptual Definition
MedicineNetcom (2013) defines speech disorder as
a disorder affecting the ability to produce normal speech Speech disorders may affect articulation (phonetic or phonological disorders) fluency (stuttering or cluttering) andor voice (tone pitch volume or rate) Speech disorders may have their roots in oral-motor difficulties although some involve language processing problems (para 1)
Carter and Musher (2013) state that speech disorder is a type of communication
disorder that refers to an impairment of the articulation of speech sounds fluency
andor voice (para 3)
5
Operational Definition
In this research speech disorder refers to motor speech disorders (apraxia of speech and
dysarthria) and fluency disorders (stuttering)
Culture
Definition
Culture is defined as a term to describe behaviors beliefs and values of a group of
people who are brought together by commonalities (Johnson 1996 p 270)
Operational Definition
In this research a culture refers to a group of people either of the same ethnic group
same language group or same hometown
Attitude
Conceptual Definition
The Merriam-Webter Online Dictionary (2014) defines attitude as the way you think
and feel about someone or something or a feeling or way of thinking that affects a persons
behaviour Attitude is also defined as a psychological tendency that is expressed by
evaluating a particular entity with some degree of favor or disfavour (as cited in Schwarz amp
Bohner 2001 p2)
Operational Definition
In this research attitude refers to the way individuals understand think about and react
to speech disorders and individuals with speech disorders
Ethnicity
Conceptual Definition
Ethnic group or ethnicity is defined as a group of people whose heritage and group
membership are based on race origin characteristics and institutions An ethnic group
mayor may not consist of individuals of the same race (Johnson 1996 p 270)
6
Operational Definition
In this research ethnic group refers to individuals of similar biological and physical
characteristics
Language group
Conceptual Definition
Language group is defined as a group of languages related by descent from a common
ancestor called the proto-language of that family (Language group 2011)
Operational Definition
In this research language group refers to a group of people categorized by the same
first language they speak
Hometown
Conceptual Definition
Hometown is defined as the town of ones birth or early life or present fixed
residence (H~me town 2014) or the city or town where one was born or grew up
(Hometown 2014)
Operational Definition
In this research hometown refers to the region in Malaysia for West Malaysia and
Sarawak - Northern Central or Southern and for Sabah - Northern or Southern where
participants of the study were born and raised
Summary
In a multicultural country like Malaysia it is vital to study cultural influences on
attitudes toward speech disorders especially because this area has not been probed yet This
study aims to see if different cultures in Malaysia have different attitudes toward speech
disorders The findings from this research would provide key information for the treatment of
these disorders The next chapter discusses literature related to this research
7
CHAPTER TWO LITERATURE REVIEW
Speech Disorders
Communication comprises of voice speech language hearing and cognition Thus
communication disorders refer to a broad area encompassing conditions in an individual that
impairs the individuals communication These conditions can either completely impede or
merely weaken the persons ability to communicate (Melfi amp Garrison 2013) Speech and
language are two major factors involved in the classification of communication disorders
Consequently there are two major types of communication disorders speech disorders and
language disorders (Carter amp Musher 2013)
However speech disorders itself is another wide branch that is further divided into
articulation disorders fluency disorders and voice disorders According to Musher and Carter
(2013) articulation disorders are speech conditions involving substitutions omissions
additions or distortions of speech sounds that interfere with intelligibility Fluency disorder is
present when an individuals speech flow is disrupted by an atypical rate rhythm and
repetitions in sounds syllables words and phrases These may also include excessive
tension struggle behaviour and secondary mannerisms Finally voice disorder refers to
abnormal production of vocal quality pitch loudness resonance andor duration that is
inappropriate for the childs age and sex
While speech disorders and language disorders are often viewed together it is
important to understand that the two are distinct from each other and the occurrence of one
does not necessarily correspond with the occurrence of the other The American Speechshy
Language-Hearing Association (ASHA) makes it clear that an individual with speech
disorders is incapable of constructing speech sounds properly or smoothly using his or her
voice On the other hand language disorders impairs ones ability to understand others
(receptive language) or to share thoughts ideas and feelings completely (expressive
8
language) (ASHA 2014) Speech disorders affect an individuals phonetics skills These
individuals may be able to construct a grammatically correct sentence but they fail to
artioulate it On the other hand language disorder affects the pragmatics skills of an
individual These individuals may be capable of articulating meaningful sounds but lack the
intellectual ability to produce grammatically correct sentences (Lewis et aI 2007)
Another important point to note about speech disorders is that it is distinct from speech
delays (NICHCY 2011) Speech delay refers to speech and language development that
occurs slowly but in the correct sequence of development Speech delay is very common
among children but does not have a lasting effect on the child as the child eventually
develops the necessary speech and language skills (Daines 2014) On the contrary speech
disorder refers to abnormal language [speech] progress (Cas 2011 para 11) According to
Daines (2014) speech disorder is language [speech] development which is not only severely
delayed but also atypical and uneven (para 6) He also mentions that unresolved speech
delay can result in speech disorder This significantly affects an individuals co~munication
abilities if proper intervention is not applied In other words speech disorder is not eventually
resolved by itself instead it impedes an individuals speech permanently (Daines 2014)
Although speech delays and speech disorders are different from each other Daines (2014)
states that it is rather difficult to differentiate one from the other in the beginning of a childs
language acquisition Hence a certified speech-language pathologist is the most reliable to
differentiate between the two (NICHCY 2011)
In this research the focus is only on three speech disorders (AOS dysarthria and
stuttering) out of the many speech disorders that exist This is because there has been no
similar study done on AOS and dysarthria At the same time although similar studies have
been done on stuttering it has never been done in a Malaysian context ASHA classifies the
selected disorders as follows
9
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
1
2
3
4
5
6
7
8
9
10
LIST OF TABLES
Table Cronbachs Alpha Reliability Test Result 21
Table Summary of Demographic Distribution of Respondents 24
Table Assumption Testing for One-Way ANOVA 29
Table Test for Homogeneity of Variances for Ethnic Groups 30
Table ANOVA Test Based on Ethnic Groups 31
Table Test for Homogeneity of Variances for Language Groups 31
Table ANOV A Test Based on Language Groups 32
Table Test for Homogeneity of Variances for Hometowns 32
Table ANOV A Test Based on Hometowns 33
Table Summary of Overall Findings 34
v
1
2
3
4
5
6
7
LIST OF FIGURES
Figure Conceptual framework 4
Figure Research procedure 18
Figure Pie chart according to gender 25
Figure Pie chart according to faculty 26
Figure Pie chart according to ethnicity 26
Figure Pie chart according to language 27
Figure Pie chart according to hometown 28
VI
ABSTRACT In a multicultural country like Malaysia culture is an important element that has great
influences on the peoples attitudes and behavior significantly Therefore a multicultural
population in which the prevalence of speech disorders is on the rise may have various
attitudes toward these disorders and the individuals with these disorders Consequently this
study was conducted among UNIMAS students with Malaysian citizenship to see if there
were any differences in attitudes toward three speech disorders namely AOS dysarthria and
stuttering based on their various cultural groups Data was collected via questionnaires that
measured the attitudes of respondents based on a 5 point Likert scale One-Way Analysis of
Variance (ANOVA) in SPSS was used to analyze the data in order to determine if differences
did exist Findings showed that attitudes toward speech disorders did not vary according to
culture in this subpopulation In addition data analysis indicated that respondents generally
have positive attitudes toward speech disorders Improvements like expanding the population
under study and using qualitative measures to measure attitudes should be employed in future
research to obtain more accurate and representative findings To conclude different cultures
do not affect Malaysian university students attitudes toward speech disorders
Keywords cultural influences attitudes toward speech disorders ethnicity language groups
hometowns AOS dysarthria stuttering
Vll
ABSTRAK Malaysia merupakan sebuah negara yang berbilang kaum dan budaya merupakan satu
elemen yang penting dalam sikap dan pandangan masyarakat negara ini Tambahan pula
individu yang mengalami masalah pertuturan semakin meningkat dalam masyarakat ini Oleh
itu pandangan dan sikap mereka terhadap masalah ini mungkin berbeza mengikut budaya
Justeru kajian ini telah dijalankan dalam kalangan pelajar UNIMAS yang berwarganegara
Malaysia untuk menentukan kewujudan perbezaan sikap terhadap tiga masalah pertuturan
iaitu AOS Dysarthria dan kegagapan berdasarkan budaya Data telah dikumpulkan melalui
borang soal selidik yang mengukur sikap responden berdasarkan skala Likert 5 mata One-
Way ANOVA dalam SPSS telah digunakan untuk menganalisis data bagi menentukan sarna
ada perbezaan itu wujud Dapatan kajian telah menunjukkan bahawa tiada perbezaan sikap
terhadap masalah pertuturan berdasarkan budaya dalam subpopulasi ini Di samping itu
analisis data ini menunjukkan bahawa responden secara umurnnya mempunyai sikap yang
positif terhadap masalah pertuturan Penarnbahbaikan seperti memperluaskan populasi yang
dikaji dan menggunakan kaedah kualitatif untuk mengukur sikap harus digunakan dalam
kajian akan datang untuk mendapatkan hasil yang lebih tepat Kesimpulannya budaya yang
berbeza tidak memberi kesan kepada sikap pelajar universiti Malaysia terhadap masalah
pertuturan
Kala kunci pengaruh budaya sikap terhadap masalah pertuturan etnik bahasa tempat asal
AOS dysarthria kegagapan
Vlll
I
CHAPTER ONE INTRODUCTION
Background of Study
Speech disorders are becoming increasingly prevalent among Malaysians these days At
the same time Malaysia is a country consisting of diverse cultures and ways of life Since
culture significantly shapes how one views the world and everything in it (Jandt 2015) it is
important to study if culture plays an important role in Malaysians attitudes toward speech
disorders
Initially many researches have focused on analysing societyS general awareness of
and perceptions toward speech disorders and its treatment However as the field of speech
disorders continued to develop new areas were probed in this aspect One of those areas
being cultural influences on the perceptions and attitudes toward this issue However all
these studies were done in countries other than Malaysia Thus far only South Americans
North Americans Kenyans Africans Indians and Chinese have been studied
Consequently the purpose of this research is to study the effects of different cultures on
Malaysians attitudes toward speech disorders namely apraxia of speech (AOS) dysarthria
and stuttering This research which is a quantitative study was conducted among UNIMAS
students representing the diverse cultures in Malaysia
Problem Statement
The prevalence of speech disorders among Malaysian children is quite alanning
Research extrapolates (based on the prevalence rate of speech disorders in the USA) that
around 235224 Malaysians could be suffering from speech disorders (Statistics by Country
for Speech Impainnent 2014) This makes 078 of the population of Malaysia which is
30073353 as of July 2014 (Malaysia Demographics Profile 2014 2014) However many
Malaysians are still oblivious to this issue In Malaysia it is only the well-educated and those
of high social economic status who are aware of speech disorders and the interventions
1
available Studies have shown that Malaysia is one of the countries in which speech disorders
are taken rather lightly whereby treatment is not sought if the severity of the disorder is not
perceived as high (as cited in Wilkerson amp Bakker 2010) Apart from the varying education
levels and socioeconomic status among Malaysian citizens cultural background is yet
another factor that contributes significantly to the diversity of Malaysians It is a wellshy
established fact that culture shapes ones view of the world and everything in it Crossshy
cultural differences significantly outline individuals perceptions and inter-personal attitudes
A persons reactions and attitudes are greatly affected by their religious beliefs and
demographical differences (Loh amp Ascoli 2011) While some cultures are more open and
receptive towards new findings in medicine and health science some may remain resistant
and less receptive toward these developments According to Wilkerson and Bakker (2010)
cultural beliefs can stand in the way of peoples awareness of speech disorders Culture also
plays an important role in the recognizing of speech disorders and the accepted treatment and
intervention for these conditions
Most studies on awareness and perception of speech disorders focus on general
awareness and perception rather than the factors that influence these elements However
substantial research has been conducted to suggest the existence of a relationship between
culture and the attitudes of individuals toward speech disorders Findings from a study
conducted by Bebout and Arthur (1992) in North America indicate that cultural variations do
affect attitudes toward speech disorders Another studyon the Cross-Cultural Attitudes and
Perception Towards Cleft Lip Palate and Deformities done among the Chinese in Africa and
in India highlighted that cultural and religious beliefs do impact ones perceptions and
attitudes toward cleft palate and its treatment (Loh amp Ascoli 2011) In their study on Cultural
Perspectives in Language and Speech Disorders conducted in Kenya Ndung and Kinyua
2
(2009) found that there is a prominent connection between cultural beliefs and language and
speech disorders
While all these studies provide evidence for a relationship between culture and attitudes
toward speech disorders none of the studies have investigated the connection of cultural
backgrounds with attitudes toward speech disorders like apraxia of speech (AOS) and
dysarthria The multicultural population of Malaysia makes this study unique and necessary
Furthermore no studies have addressed cross-cultural influences on attitudes toward speech
disorders among Malaysians Consequently there is a need to investigate if cultural
backgrounds influence Malaysians attitudes toward speech disorders
Objectives
General Objective The general objective of this research is to study the effects of
different cultural backgrounds on attitudes of Malaysian university students toward speech
disorders
Specific Objectives The specific objectives of this research are as follows
1 To find out if there is any difference in attitudes toward speech disorders based on
ethnicity
2 To find out if there is any difference in attitudes toward speech disorders based on
language groups
3 To find out if there IS any difference in attitudes toward speech disorders based on
hometowns
Hypotheses
Hypothesis 1 There is a significant difference in attitudes toward speech disorders based on
ethnicity
Hypothesis 2 There is a significant difference in attitudes toward speech disorders based on
language groups
3
Hypothesis 3 There is a significant difference in attitudes toward speech disorders based on
hometowns
Conceptual Framework
Independent Variables Dependent Variable
ethnic group bull attitudes toward Speechbull language group disorders bull hometown
Figure 1 Conceptual framework
Significance of Study
This research illustrates how cultural diversity influences an individuals attitude
toward speech disorders Findings from this research will also provide important information
for Malaysian Speech-Language Pathologists (SLPs) as they provide services for a
multicultural population This is because the attitudes of society (patient with a speech
disorder patients family and patients community) as a whole toward speech disorders is
central in the treatment process (Bebout amp Arthur 1992)
Limitations of Study
There are several limitations of this study that have been addressed in terms of the
methodology and the topic Necessary measures have been taken to curb these limitations
For example although this research consists of a selected subpopulation the subpopulation is
selected with great diversity to avoid biased results Besides since the topic of this research
limits the types of disorders explored the disorders to be explored are carefully selected so
that the results are significant
Methodological Limitation The sample of this research consists of a selected
subpopulation The sample of the population under study is chosen based on convenience of
access The respondents consist of an academically advantaged group as they are all
4
Pusat Khidmat MakJumat Akademik VNlVERSm MALAYSIA SARAWltJ(
university students Consequently they might not represent their cultures very accurately and
precisely as education may have an influence on their knowledge and awareness and hence
their attitudes toward speech disorders
The quantitative method employed in this research may lack accuracy Respondents are
required to self-rate their attitudes toward speech disorders based on a five-point Likert scale
Self-rating is often biased due to many reasons Therefore attitudes measured in this research
may not correspond with how the respondents actually behave towards an individual with
speech disorders
Topical Limitation The speech disorders discussed in this study are limited to only
three types of disorders This research only focuses on attitudes of Malaysian university
students toward four specific speech disorders namely AOS Dysarthria and Stuttering
There are other speech disorders that will not be looked into in this study Hence findings
from this study cannot be generalized to attitudes toward all speech disorders
Definition of Terms
Speech disorder
Conceptual Definition
MedicineNetcom (2013) defines speech disorder as
a disorder affecting the ability to produce normal speech Speech disorders may affect articulation (phonetic or phonological disorders) fluency (stuttering or cluttering) andor voice (tone pitch volume or rate) Speech disorders may have their roots in oral-motor difficulties although some involve language processing problems (para 1)
Carter and Musher (2013) state that speech disorder is a type of communication
disorder that refers to an impairment of the articulation of speech sounds fluency
andor voice (para 3)
5
Operational Definition
In this research speech disorder refers to motor speech disorders (apraxia of speech and
dysarthria) and fluency disorders (stuttering)
Culture
Definition
Culture is defined as a term to describe behaviors beliefs and values of a group of
people who are brought together by commonalities (Johnson 1996 p 270)
Operational Definition
In this research a culture refers to a group of people either of the same ethnic group
same language group or same hometown
Attitude
Conceptual Definition
The Merriam-Webter Online Dictionary (2014) defines attitude as the way you think
and feel about someone or something or a feeling or way of thinking that affects a persons
behaviour Attitude is also defined as a psychological tendency that is expressed by
evaluating a particular entity with some degree of favor or disfavour (as cited in Schwarz amp
Bohner 2001 p2)
Operational Definition
In this research attitude refers to the way individuals understand think about and react
to speech disorders and individuals with speech disorders
Ethnicity
Conceptual Definition
Ethnic group or ethnicity is defined as a group of people whose heritage and group
membership are based on race origin characteristics and institutions An ethnic group
mayor may not consist of individuals of the same race (Johnson 1996 p 270)
6
Operational Definition
In this research ethnic group refers to individuals of similar biological and physical
characteristics
Language group
Conceptual Definition
Language group is defined as a group of languages related by descent from a common
ancestor called the proto-language of that family (Language group 2011)
Operational Definition
In this research language group refers to a group of people categorized by the same
first language they speak
Hometown
Conceptual Definition
Hometown is defined as the town of ones birth or early life or present fixed
residence (H~me town 2014) or the city or town where one was born or grew up
(Hometown 2014)
Operational Definition
In this research hometown refers to the region in Malaysia for West Malaysia and
Sarawak - Northern Central or Southern and for Sabah - Northern or Southern where
participants of the study were born and raised
Summary
In a multicultural country like Malaysia it is vital to study cultural influences on
attitudes toward speech disorders especially because this area has not been probed yet This
study aims to see if different cultures in Malaysia have different attitudes toward speech
disorders The findings from this research would provide key information for the treatment of
these disorders The next chapter discusses literature related to this research
7
CHAPTER TWO LITERATURE REVIEW
Speech Disorders
Communication comprises of voice speech language hearing and cognition Thus
communication disorders refer to a broad area encompassing conditions in an individual that
impairs the individuals communication These conditions can either completely impede or
merely weaken the persons ability to communicate (Melfi amp Garrison 2013) Speech and
language are two major factors involved in the classification of communication disorders
Consequently there are two major types of communication disorders speech disorders and
language disorders (Carter amp Musher 2013)
However speech disorders itself is another wide branch that is further divided into
articulation disorders fluency disorders and voice disorders According to Musher and Carter
(2013) articulation disorders are speech conditions involving substitutions omissions
additions or distortions of speech sounds that interfere with intelligibility Fluency disorder is
present when an individuals speech flow is disrupted by an atypical rate rhythm and
repetitions in sounds syllables words and phrases These may also include excessive
tension struggle behaviour and secondary mannerisms Finally voice disorder refers to
abnormal production of vocal quality pitch loudness resonance andor duration that is
inappropriate for the childs age and sex
While speech disorders and language disorders are often viewed together it is
important to understand that the two are distinct from each other and the occurrence of one
does not necessarily correspond with the occurrence of the other The American Speechshy
Language-Hearing Association (ASHA) makes it clear that an individual with speech
disorders is incapable of constructing speech sounds properly or smoothly using his or her
voice On the other hand language disorders impairs ones ability to understand others
(receptive language) or to share thoughts ideas and feelings completely (expressive
8
language) (ASHA 2014) Speech disorders affect an individuals phonetics skills These
individuals may be able to construct a grammatically correct sentence but they fail to
artioulate it On the other hand language disorder affects the pragmatics skills of an
individual These individuals may be capable of articulating meaningful sounds but lack the
intellectual ability to produce grammatically correct sentences (Lewis et aI 2007)
Another important point to note about speech disorders is that it is distinct from speech
delays (NICHCY 2011) Speech delay refers to speech and language development that
occurs slowly but in the correct sequence of development Speech delay is very common
among children but does not have a lasting effect on the child as the child eventually
develops the necessary speech and language skills (Daines 2014) On the contrary speech
disorder refers to abnormal language [speech] progress (Cas 2011 para 11) According to
Daines (2014) speech disorder is language [speech] development which is not only severely
delayed but also atypical and uneven (para 6) He also mentions that unresolved speech
delay can result in speech disorder This significantly affects an individuals co~munication
abilities if proper intervention is not applied In other words speech disorder is not eventually
resolved by itself instead it impedes an individuals speech permanently (Daines 2014)
Although speech delays and speech disorders are different from each other Daines (2014)
states that it is rather difficult to differentiate one from the other in the beginning of a childs
language acquisition Hence a certified speech-language pathologist is the most reliable to
differentiate between the two (NICHCY 2011)
In this research the focus is only on three speech disorders (AOS dysarthria and
stuttering) out of the many speech disorders that exist This is because there has been no
similar study done on AOS and dysarthria At the same time although similar studies have
been done on stuttering it has never been done in a Malaysian context ASHA classifies the
selected disorders as follows
9
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
1
2
3
4
5
6
7
LIST OF FIGURES
Figure Conceptual framework 4
Figure Research procedure 18
Figure Pie chart according to gender 25
Figure Pie chart according to faculty 26
Figure Pie chart according to ethnicity 26
Figure Pie chart according to language 27
Figure Pie chart according to hometown 28
VI
ABSTRACT In a multicultural country like Malaysia culture is an important element that has great
influences on the peoples attitudes and behavior significantly Therefore a multicultural
population in which the prevalence of speech disorders is on the rise may have various
attitudes toward these disorders and the individuals with these disorders Consequently this
study was conducted among UNIMAS students with Malaysian citizenship to see if there
were any differences in attitudes toward three speech disorders namely AOS dysarthria and
stuttering based on their various cultural groups Data was collected via questionnaires that
measured the attitudes of respondents based on a 5 point Likert scale One-Way Analysis of
Variance (ANOVA) in SPSS was used to analyze the data in order to determine if differences
did exist Findings showed that attitudes toward speech disorders did not vary according to
culture in this subpopulation In addition data analysis indicated that respondents generally
have positive attitudes toward speech disorders Improvements like expanding the population
under study and using qualitative measures to measure attitudes should be employed in future
research to obtain more accurate and representative findings To conclude different cultures
do not affect Malaysian university students attitudes toward speech disorders
Keywords cultural influences attitudes toward speech disorders ethnicity language groups
hometowns AOS dysarthria stuttering
Vll
ABSTRAK Malaysia merupakan sebuah negara yang berbilang kaum dan budaya merupakan satu
elemen yang penting dalam sikap dan pandangan masyarakat negara ini Tambahan pula
individu yang mengalami masalah pertuturan semakin meningkat dalam masyarakat ini Oleh
itu pandangan dan sikap mereka terhadap masalah ini mungkin berbeza mengikut budaya
Justeru kajian ini telah dijalankan dalam kalangan pelajar UNIMAS yang berwarganegara
Malaysia untuk menentukan kewujudan perbezaan sikap terhadap tiga masalah pertuturan
iaitu AOS Dysarthria dan kegagapan berdasarkan budaya Data telah dikumpulkan melalui
borang soal selidik yang mengukur sikap responden berdasarkan skala Likert 5 mata One-
Way ANOVA dalam SPSS telah digunakan untuk menganalisis data bagi menentukan sarna
ada perbezaan itu wujud Dapatan kajian telah menunjukkan bahawa tiada perbezaan sikap
terhadap masalah pertuturan berdasarkan budaya dalam subpopulasi ini Di samping itu
analisis data ini menunjukkan bahawa responden secara umurnnya mempunyai sikap yang
positif terhadap masalah pertuturan Penarnbahbaikan seperti memperluaskan populasi yang
dikaji dan menggunakan kaedah kualitatif untuk mengukur sikap harus digunakan dalam
kajian akan datang untuk mendapatkan hasil yang lebih tepat Kesimpulannya budaya yang
berbeza tidak memberi kesan kepada sikap pelajar universiti Malaysia terhadap masalah
pertuturan
Kala kunci pengaruh budaya sikap terhadap masalah pertuturan etnik bahasa tempat asal
AOS dysarthria kegagapan
Vlll
I
CHAPTER ONE INTRODUCTION
Background of Study
Speech disorders are becoming increasingly prevalent among Malaysians these days At
the same time Malaysia is a country consisting of diverse cultures and ways of life Since
culture significantly shapes how one views the world and everything in it (Jandt 2015) it is
important to study if culture plays an important role in Malaysians attitudes toward speech
disorders
Initially many researches have focused on analysing societyS general awareness of
and perceptions toward speech disorders and its treatment However as the field of speech
disorders continued to develop new areas were probed in this aspect One of those areas
being cultural influences on the perceptions and attitudes toward this issue However all
these studies were done in countries other than Malaysia Thus far only South Americans
North Americans Kenyans Africans Indians and Chinese have been studied
Consequently the purpose of this research is to study the effects of different cultures on
Malaysians attitudes toward speech disorders namely apraxia of speech (AOS) dysarthria
and stuttering This research which is a quantitative study was conducted among UNIMAS
students representing the diverse cultures in Malaysia
Problem Statement
The prevalence of speech disorders among Malaysian children is quite alanning
Research extrapolates (based on the prevalence rate of speech disorders in the USA) that
around 235224 Malaysians could be suffering from speech disorders (Statistics by Country
for Speech Impainnent 2014) This makes 078 of the population of Malaysia which is
30073353 as of July 2014 (Malaysia Demographics Profile 2014 2014) However many
Malaysians are still oblivious to this issue In Malaysia it is only the well-educated and those
of high social economic status who are aware of speech disorders and the interventions
1
available Studies have shown that Malaysia is one of the countries in which speech disorders
are taken rather lightly whereby treatment is not sought if the severity of the disorder is not
perceived as high (as cited in Wilkerson amp Bakker 2010) Apart from the varying education
levels and socioeconomic status among Malaysian citizens cultural background is yet
another factor that contributes significantly to the diversity of Malaysians It is a wellshy
established fact that culture shapes ones view of the world and everything in it Crossshy
cultural differences significantly outline individuals perceptions and inter-personal attitudes
A persons reactions and attitudes are greatly affected by their religious beliefs and
demographical differences (Loh amp Ascoli 2011) While some cultures are more open and
receptive towards new findings in medicine and health science some may remain resistant
and less receptive toward these developments According to Wilkerson and Bakker (2010)
cultural beliefs can stand in the way of peoples awareness of speech disorders Culture also
plays an important role in the recognizing of speech disorders and the accepted treatment and
intervention for these conditions
Most studies on awareness and perception of speech disorders focus on general
awareness and perception rather than the factors that influence these elements However
substantial research has been conducted to suggest the existence of a relationship between
culture and the attitudes of individuals toward speech disorders Findings from a study
conducted by Bebout and Arthur (1992) in North America indicate that cultural variations do
affect attitudes toward speech disorders Another studyon the Cross-Cultural Attitudes and
Perception Towards Cleft Lip Palate and Deformities done among the Chinese in Africa and
in India highlighted that cultural and religious beliefs do impact ones perceptions and
attitudes toward cleft palate and its treatment (Loh amp Ascoli 2011) In their study on Cultural
Perspectives in Language and Speech Disorders conducted in Kenya Ndung and Kinyua
2
(2009) found that there is a prominent connection between cultural beliefs and language and
speech disorders
While all these studies provide evidence for a relationship between culture and attitudes
toward speech disorders none of the studies have investigated the connection of cultural
backgrounds with attitudes toward speech disorders like apraxia of speech (AOS) and
dysarthria The multicultural population of Malaysia makes this study unique and necessary
Furthermore no studies have addressed cross-cultural influences on attitudes toward speech
disorders among Malaysians Consequently there is a need to investigate if cultural
backgrounds influence Malaysians attitudes toward speech disorders
Objectives
General Objective The general objective of this research is to study the effects of
different cultural backgrounds on attitudes of Malaysian university students toward speech
disorders
Specific Objectives The specific objectives of this research are as follows
1 To find out if there is any difference in attitudes toward speech disorders based on
ethnicity
2 To find out if there is any difference in attitudes toward speech disorders based on
language groups
3 To find out if there IS any difference in attitudes toward speech disorders based on
hometowns
Hypotheses
Hypothesis 1 There is a significant difference in attitudes toward speech disorders based on
ethnicity
Hypothesis 2 There is a significant difference in attitudes toward speech disorders based on
language groups
3
Hypothesis 3 There is a significant difference in attitudes toward speech disorders based on
hometowns
Conceptual Framework
Independent Variables Dependent Variable
ethnic group bull attitudes toward Speechbull language group disorders bull hometown
Figure 1 Conceptual framework
Significance of Study
This research illustrates how cultural diversity influences an individuals attitude
toward speech disorders Findings from this research will also provide important information
for Malaysian Speech-Language Pathologists (SLPs) as they provide services for a
multicultural population This is because the attitudes of society (patient with a speech
disorder patients family and patients community) as a whole toward speech disorders is
central in the treatment process (Bebout amp Arthur 1992)
Limitations of Study
There are several limitations of this study that have been addressed in terms of the
methodology and the topic Necessary measures have been taken to curb these limitations
For example although this research consists of a selected subpopulation the subpopulation is
selected with great diversity to avoid biased results Besides since the topic of this research
limits the types of disorders explored the disorders to be explored are carefully selected so
that the results are significant
Methodological Limitation The sample of this research consists of a selected
subpopulation The sample of the population under study is chosen based on convenience of
access The respondents consist of an academically advantaged group as they are all
4
Pusat Khidmat MakJumat Akademik VNlVERSm MALAYSIA SARAWltJ(
university students Consequently they might not represent their cultures very accurately and
precisely as education may have an influence on their knowledge and awareness and hence
their attitudes toward speech disorders
The quantitative method employed in this research may lack accuracy Respondents are
required to self-rate their attitudes toward speech disorders based on a five-point Likert scale
Self-rating is often biased due to many reasons Therefore attitudes measured in this research
may not correspond with how the respondents actually behave towards an individual with
speech disorders
Topical Limitation The speech disorders discussed in this study are limited to only
three types of disorders This research only focuses on attitudes of Malaysian university
students toward four specific speech disorders namely AOS Dysarthria and Stuttering
There are other speech disorders that will not be looked into in this study Hence findings
from this study cannot be generalized to attitudes toward all speech disorders
Definition of Terms
Speech disorder
Conceptual Definition
MedicineNetcom (2013) defines speech disorder as
a disorder affecting the ability to produce normal speech Speech disorders may affect articulation (phonetic or phonological disorders) fluency (stuttering or cluttering) andor voice (tone pitch volume or rate) Speech disorders may have their roots in oral-motor difficulties although some involve language processing problems (para 1)
Carter and Musher (2013) state that speech disorder is a type of communication
disorder that refers to an impairment of the articulation of speech sounds fluency
andor voice (para 3)
5
Operational Definition
In this research speech disorder refers to motor speech disorders (apraxia of speech and
dysarthria) and fluency disorders (stuttering)
Culture
Definition
Culture is defined as a term to describe behaviors beliefs and values of a group of
people who are brought together by commonalities (Johnson 1996 p 270)
Operational Definition
In this research a culture refers to a group of people either of the same ethnic group
same language group or same hometown
Attitude
Conceptual Definition
The Merriam-Webter Online Dictionary (2014) defines attitude as the way you think
and feel about someone or something or a feeling or way of thinking that affects a persons
behaviour Attitude is also defined as a psychological tendency that is expressed by
evaluating a particular entity with some degree of favor or disfavour (as cited in Schwarz amp
Bohner 2001 p2)
Operational Definition
In this research attitude refers to the way individuals understand think about and react
to speech disorders and individuals with speech disorders
Ethnicity
Conceptual Definition
Ethnic group or ethnicity is defined as a group of people whose heritage and group
membership are based on race origin characteristics and institutions An ethnic group
mayor may not consist of individuals of the same race (Johnson 1996 p 270)
6
Operational Definition
In this research ethnic group refers to individuals of similar biological and physical
characteristics
Language group
Conceptual Definition
Language group is defined as a group of languages related by descent from a common
ancestor called the proto-language of that family (Language group 2011)
Operational Definition
In this research language group refers to a group of people categorized by the same
first language they speak
Hometown
Conceptual Definition
Hometown is defined as the town of ones birth or early life or present fixed
residence (H~me town 2014) or the city or town where one was born or grew up
(Hometown 2014)
Operational Definition
In this research hometown refers to the region in Malaysia for West Malaysia and
Sarawak - Northern Central or Southern and for Sabah - Northern or Southern where
participants of the study were born and raised
Summary
In a multicultural country like Malaysia it is vital to study cultural influences on
attitudes toward speech disorders especially because this area has not been probed yet This
study aims to see if different cultures in Malaysia have different attitudes toward speech
disorders The findings from this research would provide key information for the treatment of
these disorders The next chapter discusses literature related to this research
7
CHAPTER TWO LITERATURE REVIEW
Speech Disorders
Communication comprises of voice speech language hearing and cognition Thus
communication disorders refer to a broad area encompassing conditions in an individual that
impairs the individuals communication These conditions can either completely impede or
merely weaken the persons ability to communicate (Melfi amp Garrison 2013) Speech and
language are two major factors involved in the classification of communication disorders
Consequently there are two major types of communication disorders speech disorders and
language disorders (Carter amp Musher 2013)
However speech disorders itself is another wide branch that is further divided into
articulation disorders fluency disorders and voice disorders According to Musher and Carter
(2013) articulation disorders are speech conditions involving substitutions omissions
additions or distortions of speech sounds that interfere with intelligibility Fluency disorder is
present when an individuals speech flow is disrupted by an atypical rate rhythm and
repetitions in sounds syllables words and phrases These may also include excessive
tension struggle behaviour and secondary mannerisms Finally voice disorder refers to
abnormal production of vocal quality pitch loudness resonance andor duration that is
inappropriate for the childs age and sex
While speech disorders and language disorders are often viewed together it is
important to understand that the two are distinct from each other and the occurrence of one
does not necessarily correspond with the occurrence of the other The American Speechshy
Language-Hearing Association (ASHA) makes it clear that an individual with speech
disorders is incapable of constructing speech sounds properly or smoothly using his or her
voice On the other hand language disorders impairs ones ability to understand others
(receptive language) or to share thoughts ideas and feelings completely (expressive
8
language) (ASHA 2014) Speech disorders affect an individuals phonetics skills These
individuals may be able to construct a grammatically correct sentence but they fail to
artioulate it On the other hand language disorder affects the pragmatics skills of an
individual These individuals may be capable of articulating meaningful sounds but lack the
intellectual ability to produce grammatically correct sentences (Lewis et aI 2007)
Another important point to note about speech disorders is that it is distinct from speech
delays (NICHCY 2011) Speech delay refers to speech and language development that
occurs slowly but in the correct sequence of development Speech delay is very common
among children but does not have a lasting effect on the child as the child eventually
develops the necessary speech and language skills (Daines 2014) On the contrary speech
disorder refers to abnormal language [speech] progress (Cas 2011 para 11) According to
Daines (2014) speech disorder is language [speech] development which is not only severely
delayed but also atypical and uneven (para 6) He also mentions that unresolved speech
delay can result in speech disorder This significantly affects an individuals co~munication
abilities if proper intervention is not applied In other words speech disorder is not eventually
resolved by itself instead it impedes an individuals speech permanently (Daines 2014)
Although speech delays and speech disorders are different from each other Daines (2014)
states that it is rather difficult to differentiate one from the other in the beginning of a childs
language acquisition Hence a certified speech-language pathologist is the most reliable to
differentiate between the two (NICHCY 2011)
In this research the focus is only on three speech disorders (AOS dysarthria and
stuttering) out of the many speech disorders that exist This is because there has been no
similar study done on AOS and dysarthria At the same time although similar studies have
been done on stuttering it has never been done in a Malaysian context ASHA classifies the
selected disorders as follows
9
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
ABSTRACT In a multicultural country like Malaysia culture is an important element that has great
influences on the peoples attitudes and behavior significantly Therefore a multicultural
population in which the prevalence of speech disorders is on the rise may have various
attitudes toward these disorders and the individuals with these disorders Consequently this
study was conducted among UNIMAS students with Malaysian citizenship to see if there
were any differences in attitudes toward three speech disorders namely AOS dysarthria and
stuttering based on their various cultural groups Data was collected via questionnaires that
measured the attitudes of respondents based on a 5 point Likert scale One-Way Analysis of
Variance (ANOVA) in SPSS was used to analyze the data in order to determine if differences
did exist Findings showed that attitudes toward speech disorders did not vary according to
culture in this subpopulation In addition data analysis indicated that respondents generally
have positive attitudes toward speech disorders Improvements like expanding the population
under study and using qualitative measures to measure attitudes should be employed in future
research to obtain more accurate and representative findings To conclude different cultures
do not affect Malaysian university students attitudes toward speech disorders
Keywords cultural influences attitudes toward speech disorders ethnicity language groups
hometowns AOS dysarthria stuttering
Vll
ABSTRAK Malaysia merupakan sebuah negara yang berbilang kaum dan budaya merupakan satu
elemen yang penting dalam sikap dan pandangan masyarakat negara ini Tambahan pula
individu yang mengalami masalah pertuturan semakin meningkat dalam masyarakat ini Oleh
itu pandangan dan sikap mereka terhadap masalah ini mungkin berbeza mengikut budaya
Justeru kajian ini telah dijalankan dalam kalangan pelajar UNIMAS yang berwarganegara
Malaysia untuk menentukan kewujudan perbezaan sikap terhadap tiga masalah pertuturan
iaitu AOS Dysarthria dan kegagapan berdasarkan budaya Data telah dikumpulkan melalui
borang soal selidik yang mengukur sikap responden berdasarkan skala Likert 5 mata One-
Way ANOVA dalam SPSS telah digunakan untuk menganalisis data bagi menentukan sarna
ada perbezaan itu wujud Dapatan kajian telah menunjukkan bahawa tiada perbezaan sikap
terhadap masalah pertuturan berdasarkan budaya dalam subpopulasi ini Di samping itu
analisis data ini menunjukkan bahawa responden secara umurnnya mempunyai sikap yang
positif terhadap masalah pertuturan Penarnbahbaikan seperti memperluaskan populasi yang
dikaji dan menggunakan kaedah kualitatif untuk mengukur sikap harus digunakan dalam
kajian akan datang untuk mendapatkan hasil yang lebih tepat Kesimpulannya budaya yang
berbeza tidak memberi kesan kepada sikap pelajar universiti Malaysia terhadap masalah
pertuturan
Kala kunci pengaruh budaya sikap terhadap masalah pertuturan etnik bahasa tempat asal
AOS dysarthria kegagapan
Vlll
I
CHAPTER ONE INTRODUCTION
Background of Study
Speech disorders are becoming increasingly prevalent among Malaysians these days At
the same time Malaysia is a country consisting of diverse cultures and ways of life Since
culture significantly shapes how one views the world and everything in it (Jandt 2015) it is
important to study if culture plays an important role in Malaysians attitudes toward speech
disorders
Initially many researches have focused on analysing societyS general awareness of
and perceptions toward speech disorders and its treatment However as the field of speech
disorders continued to develop new areas were probed in this aspect One of those areas
being cultural influences on the perceptions and attitudes toward this issue However all
these studies were done in countries other than Malaysia Thus far only South Americans
North Americans Kenyans Africans Indians and Chinese have been studied
Consequently the purpose of this research is to study the effects of different cultures on
Malaysians attitudes toward speech disorders namely apraxia of speech (AOS) dysarthria
and stuttering This research which is a quantitative study was conducted among UNIMAS
students representing the diverse cultures in Malaysia
Problem Statement
The prevalence of speech disorders among Malaysian children is quite alanning
Research extrapolates (based on the prevalence rate of speech disorders in the USA) that
around 235224 Malaysians could be suffering from speech disorders (Statistics by Country
for Speech Impainnent 2014) This makes 078 of the population of Malaysia which is
30073353 as of July 2014 (Malaysia Demographics Profile 2014 2014) However many
Malaysians are still oblivious to this issue In Malaysia it is only the well-educated and those
of high social economic status who are aware of speech disorders and the interventions
1
available Studies have shown that Malaysia is one of the countries in which speech disorders
are taken rather lightly whereby treatment is not sought if the severity of the disorder is not
perceived as high (as cited in Wilkerson amp Bakker 2010) Apart from the varying education
levels and socioeconomic status among Malaysian citizens cultural background is yet
another factor that contributes significantly to the diversity of Malaysians It is a wellshy
established fact that culture shapes ones view of the world and everything in it Crossshy
cultural differences significantly outline individuals perceptions and inter-personal attitudes
A persons reactions and attitudes are greatly affected by their religious beliefs and
demographical differences (Loh amp Ascoli 2011) While some cultures are more open and
receptive towards new findings in medicine and health science some may remain resistant
and less receptive toward these developments According to Wilkerson and Bakker (2010)
cultural beliefs can stand in the way of peoples awareness of speech disorders Culture also
plays an important role in the recognizing of speech disorders and the accepted treatment and
intervention for these conditions
Most studies on awareness and perception of speech disorders focus on general
awareness and perception rather than the factors that influence these elements However
substantial research has been conducted to suggest the existence of a relationship between
culture and the attitudes of individuals toward speech disorders Findings from a study
conducted by Bebout and Arthur (1992) in North America indicate that cultural variations do
affect attitudes toward speech disorders Another studyon the Cross-Cultural Attitudes and
Perception Towards Cleft Lip Palate and Deformities done among the Chinese in Africa and
in India highlighted that cultural and religious beliefs do impact ones perceptions and
attitudes toward cleft palate and its treatment (Loh amp Ascoli 2011) In their study on Cultural
Perspectives in Language and Speech Disorders conducted in Kenya Ndung and Kinyua
2
(2009) found that there is a prominent connection between cultural beliefs and language and
speech disorders
While all these studies provide evidence for a relationship between culture and attitudes
toward speech disorders none of the studies have investigated the connection of cultural
backgrounds with attitudes toward speech disorders like apraxia of speech (AOS) and
dysarthria The multicultural population of Malaysia makes this study unique and necessary
Furthermore no studies have addressed cross-cultural influences on attitudes toward speech
disorders among Malaysians Consequently there is a need to investigate if cultural
backgrounds influence Malaysians attitudes toward speech disorders
Objectives
General Objective The general objective of this research is to study the effects of
different cultural backgrounds on attitudes of Malaysian university students toward speech
disorders
Specific Objectives The specific objectives of this research are as follows
1 To find out if there is any difference in attitudes toward speech disorders based on
ethnicity
2 To find out if there is any difference in attitudes toward speech disorders based on
language groups
3 To find out if there IS any difference in attitudes toward speech disorders based on
hometowns
Hypotheses
Hypothesis 1 There is a significant difference in attitudes toward speech disorders based on
ethnicity
Hypothesis 2 There is a significant difference in attitudes toward speech disorders based on
language groups
3
Hypothesis 3 There is a significant difference in attitudes toward speech disorders based on
hometowns
Conceptual Framework
Independent Variables Dependent Variable
ethnic group bull attitudes toward Speechbull language group disorders bull hometown
Figure 1 Conceptual framework
Significance of Study
This research illustrates how cultural diversity influences an individuals attitude
toward speech disorders Findings from this research will also provide important information
for Malaysian Speech-Language Pathologists (SLPs) as they provide services for a
multicultural population This is because the attitudes of society (patient with a speech
disorder patients family and patients community) as a whole toward speech disorders is
central in the treatment process (Bebout amp Arthur 1992)
Limitations of Study
There are several limitations of this study that have been addressed in terms of the
methodology and the topic Necessary measures have been taken to curb these limitations
For example although this research consists of a selected subpopulation the subpopulation is
selected with great diversity to avoid biased results Besides since the topic of this research
limits the types of disorders explored the disorders to be explored are carefully selected so
that the results are significant
Methodological Limitation The sample of this research consists of a selected
subpopulation The sample of the population under study is chosen based on convenience of
access The respondents consist of an academically advantaged group as they are all
4
Pusat Khidmat MakJumat Akademik VNlVERSm MALAYSIA SARAWltJ(
university students Consequently they might not represent their cultures very accurately and
precisely as education may have an influence on their knowledge and awareness and hence
their attitudes toward speech disorders
The quantitative method employed in this research may lack accuracy Respondents are
required to self-rate their attitudes toward speech disorders based on a five-point Likert scale
Self-rating is often biased due to many reasons Therefore attitudes measured in this research
may not correspond with how the respondents actually behave towards an individual with
speech disorders
Topical Limitation The speech disorders discussed in this study are limited to only
three types of disorders This research only focuses on attitudes of Malaysian university
students toward four specific speech disorders namely AOS Dysarthria and Stuttering
There are other speech disorders that will not be looked into in this study Hence findings
from this study cannot be generalized to attitudes toward all speech disorders
Definition of Terms
Speech disorder
Conceptual Definition
MedicineNetcom (2013) defines speech disorder as
a disorder affecting the ability to produce normal speech Speech disorders may affect articulation (phonetic or phonological disorders) fluency (stuttering or cluttering) andor voice (tone pitch volume or rate) Speech disorders may have their roots in oral-motor difficulties although some involve language processing problems (para 1)
Carter and Musher (2013) state that speech disorder is a type of communication
disorder that refers to an impairment of the articulation of speech sounds fluency
andor voice (para 3)
5
Operational Definition
In this research speech disorder refers to motor speech disorders (apraxia of speech and
dysarthria) and fluency disorders (stuttering)
Culture
Definition
Culture is defined as a term to describe behaviors beliefs and values of a group of
people who are brought together by commonalities (Johnson 1996 p 270)
Operational Definition
In this research a culture refers to a group of people either of the same ethnic group
same language group or same hometown
Attitude
Conceptual Definition
The Merriam-Webter Online Dictionary (2014) defines attitude as the way you think
and feel about someone or something or a feeling or way of thinking that affects a persons
behaviour Attitude is also defined as a psychological tendency that is expressed by
evaluating a particular entity with some degree of favor or disfavour (as cited in Schwarz amp
Bohner 2001 p2)
Operational Definition
In this research attitude refers to the way individuals understand think about and react
to speech disorders and individuals with speech disorders
Ethnicity
Conceptual Definition
Ethnic group or ethnicity is defined as a group of people whose heritage and group
membership are based on race origin characteristics and institutions An ethnic group
mayor may not consist of individuals of the same race (Johnson 1996 p 270)
6
Operational Definition
In this research ethnic group refers to individuals of similar biological and physical
characteristics
Language group
Conceptual Definition
Language group is defined as a group of languages related by descent from a common
ancestor called the proto-language of that family (Language group 2011)
Operational Definition
In this research language group refers to a group of people categorized by the same
first language they speak
Hometown
Conceptual Definition
Hometown is defined as the town of ones birth or early life or present fixed
residence (H~me town 2014) or the city or town where one was born or grew up
(Hometown 2014)
Operational Definition
In this research hometown refers to the region in Malaysia for West Malaysia and
Sarawak - Northern Central or Southern and for Sabah - Northern or Southern where
participants of the study were born and raised
Summary
In a multicultural country like Malaysia it is vital to study cultural influences on
attitudes toward speech disorders especially because this area has not been probed yet This
study aims to see if different cultures in Malaysia have different attitudes toward speech
disorders The findings from this research would provide key information for the treatment of
these disorders The next chapter discusses literature related to this research
7
CHAPTER TWO LITERATURE REVIEW
Speech Disorders
Communication comprises of voice speech language hearing and cognition Thus
communication disorders refer to a broad area encompassing conditions in an individual that
impairs the individuals communication These conditions can either completely impede or
merely weaken the persons ability to communicate (Melfi amp Garrison 2013) Speech and
language are two major factors involved in the classification of communication disorders
Consequently there are two major types of communication disorders speech disorders and
language disorders (Carter amp Musher 2013)
However speech disorders itself is another wide branch that is further divided into
articulation disorders fluency disorders and voice disorders According to Musher and Carter
(2013) articulation disorders are speech conditions involving substitutions omissions
additions or distortions of speech sounds that interfere with intelligibility Fluency disorder is
present when an individuals speech flow is disrupted by an atypical rate rhythm and
repetitions in sounds syllables words and phrases These may also include excessive
tension struggle behaviour and secondary mannerisms Finally voice disorder refers to
abnormal production of vocal quality pitch loudness resonance andor duration that is
inappropriate for the childs age and sex
While speech disorders and language disorders are often viewed together it is
important to understand that the two are distinct from each other and the occurrence of one
does not necessarily correspond with the occurrence of the other The American Speechshy
Language-Hearing Association (ASHA) makes it clear that an individual with speech
disorders is incapable of constructing speech sounds properly or smoothly using his or her
voice On the other hand language disorders impairs ones ability to understand others
(receptive language) or to share thoughts ideas and feelings completely (expressive
8
language) (ASHA 2014) Speech disorders affect an individuals phonetics skills These
individuals may be able to construct a grammatically correct sentence but they fail to
artioulate it On the other hand language disorder affects the pragmatics skills of an
individual These individuals may be capable of articulating meaningful sounds but lack the
intellectual ability to produce grammatically correct sentences (Lewis et aI 2007)
Another important point to note about speech disorders is that it is distinct from speech
delays (NICHCY 2011) Speech delay refers to speech and language development that
occurs slowly but in the correct sequence of development Speech delay is very common
among children but does not have a lasting effect on the child as the child eventually
develops the necessary speech and language skills (Daines 2014) On the contrary speech
disorder refers to abnormal language [speech] progress (Cas 2011 para 11) According to
Daines (2014) speech disorder is language [speech] development which is not only severely
delayed but also atypical and uneven (para 6) He also mentions that unresolved speech
delay can result in speech disorder This significantly affects an individuals co~munication
abilities if proper intervention is not applied In other words speech disorder is not eventually
resolved by itself instead it impedes an individuals speech permanently (Daines 2014)
Although speech delays and speech disorders are different from each other Daines (2014)
states that it is rather difficult to differentiate one from the other in the beginning of a childs
language acquisition Hence a certified speech-language pathologist is the most reliable to
differentiate between the two (NICHCY 2011)
In this research the focus is only on three speech disorders (AOS dysarthria and
stuttering) out of the many speech disorders that exist This is because there has been no
similar study done on AOS and dysarthria At the same time although similar studies have
been done on stuttering it has never been done in a Malaysian context ASHA classifies the
selected disorders as follows
9
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
ABSTRAK Malaysia merupakan sebuah negara yang berbilang kaum dan budaya merupakan satu
elemen yang penting dalam sikap dan pandangan masyarakat negara ini Tambahan pula
individu yang mengalami masalah pertuturan semakin meningkat dalam masyarakat ini Oleh
itu pandangan dan sikap mereka terhadap masalah ini mungkin berbeza mengikut budaya
Justeru kajian ini telah dijalankan dalam kalangan pelajar UNIMAS yang berwarganegara
Malaysia untuk menentukan kewujudan perbezaan sikap terhadap tiga masalah pertuturan
iaitu AOS Dysarthria dan kegagapan berdasarkan budaya Data telah dikumpulkan melalui
borang soal selidik yang mengukur sikap responden berdasarkan skala Likert 5 mata One-
Way ANOVA dalam SPSS telah digunakan untuk menganalisis data bagi menentukan sarna
ada perbezaan itu wujud Dapatan kajian telah menunjukkan bahawa tiada perbezaan sikap
terhadap masalah pertuturan berdasarkan budaya dalam subpopulasi ini Di samping itu
analisis data ini menunjukkan bahawa responden secara umurnnya mempunyai sikap yang
positif terhadap masalah pertuturan Penarnbahbaikan seperti memperluaskan populasi yang
dikaji dan menggunakan kaedah kualitatif untuk mengukur sikap harus digunakan dalam
kajian akan datang untuk mendapatkan hasil yang lebih tepat Kesimpulannya budaya yang
berbeza tidak memberi kesan kepada sikap pelajar universiti Malaysia terhadap masalah
pertuturan
Kala kunci pengaruh budaya sikap terhadap masalah pertuturan etnik bahasa tempat asal
AOS dysarthria kegagapan
Vlll
I
CHAPTER ONE INTRODUCTION
Background of Study
Speech disorders are becoming increasingly prevalent among Malaysians these days At
the same time Malaysia is a country consisting of diverse cultures and ways of life Since
culture significantly shapes how one views the world and everything in it (Jandt 2015) it is
important to study if culture plays an important role in Malaysians attitudes toward speech
disorders
Initially many researches have focused on analysing societyS general awareness of
and perceptions toward speech disorders and its treatment However as the field of speech
disorders continued to develop new areas were probed in this aspect One of those areas
being cultural influences on the perceptions and attitudes toward this issue However all
these studies were done in countries other than Malaysia Thus far only South Americans
North Americans Kenyans Africans Indians and Chinese have been studied
Consequently the purpose of this research is to study the effects of different cultures on
Malaysians attitudes toward speech disorders namely apraxia of speech (AOS) dysarthria
and stuttering This research which is a quantitative study was conducted among UNIMAS
students representing the diverse cultures in Malaysia
Problem Statement
The prevalence of speech disorders among Malaysian children is quite alanning
Research extrapolates (based on the prevalence rate of speech disorders in the USA) that
around 235224 Malaysians could be suffering from speech disorders (Statistics by Country
for Speech Impainnent 2014) This makes 078 of the population of Malaysia which is
30073353 as of July 2014 (Malaysia Demographics Profile 2014 2014) However many
Malaysians are still oblivious to this issue In Malaysia it is only the well-educated and those
of high social economic status who are aware of speech disorders and the interventions
1
available Studies have shown that Malaysia is one of the countries in which speech disorders
are taken rather lightly whereby treatment is not sought if the severity of the disorder is not
perceived as high (as cited in Wilkerson amp Bakker 2010) Apart from the varying education
levels and socioeconomic status among Malaysian citizens cultural background is yet
another factor that contributes significantly to the diversity of Malaysians It is a wellshy
established fact that culture shapes ones view of the world and everything in it Crossshy
cultural differences significantly outline individuals perceptions and inter-personal attitudes
A persons reactions and attitudes are greatly affected by their religious beliefs and
demographical differences (Loh amp Ascoli 2011) While some cultures are more open and
receptive towards new findings in medicine and health science some may remain resistant
and less receptive toward these developments According to Wilkerson and Bakker (2010)
cultural beliefs can stand in the way of peoples awareness of speech disorders Culture also
plays an important role in the recognizing of speech disorders and the accepted treatment and
intervention for these conditions
Most studies on awareness and perception of speech disorders focus on general
awareness and perception rather than the factors that influence these elements However
substantial research has been conducted to suggest the existence of a relationship between
culture and the attitudes of individuals toward speech disorders Findings from a study
conducted by Bebout and Arthur (1992) in North America indicate that cultural variations do
affect attitudes toward speech disorders Another studyon the Cross-Cultural Attitudes and
Perception Towards Cleft Lip Palate and Deformities done among the Chinese in Africa and
in India highlighted that cultural and religious beliefs do impact ones perceptions and
attitudes toward cleft palate and its treatment (Loh amp Ascoli 2011) In their study on Cultural
Perspectives in Language and Speech Disorders conducted in Kenya Ndung and Kinyua
2
(2009) found that there is a prominent connection between cultural beliefs and language and
speech disorders
While all these studies provide evidence for a relationship between culture and attitudes
toward speech disorders none of the studies have investigated the connection of cultural
backgrounds with attitudes toward speech disorders like apraxia of speech (AOS) and
dysarthria The multicultural population of Malaysia makes this study unique and necessary
Furthermore no studies have addressed cross-cultural influences on attitudes toward speech
disorders among Malaysians Consequently there is a need to investigate if cultural
backgrounds influence Malaysians attitudes toward speech disorders
Objectives
General Objective The general objective of this research is to study the effects of
different cultural backgrounds on attitudes of Malaysian university students toward speech
disorders
Specific Objectives The specific objectives of this research are as follows
1 To find out if there is any difference in attitudes toward speech disorders based on
ethnicity
2 To find out if there is any difference in attitudes toward speech disorders based on
language groups
3 To find out if there IS any difference in attitudes toward speech disorders based on
hometowns
Hypotheses
Hypothesis 1 There is a significant difference in attitudes toward speech disorders based on
ethnicity
Hypothesis 2 There is a significant difference in attitudes toward speech disorders based on
language groups
3
Hypothesis 3 There is a significant difference in attitudes toward speech disorders based on
hometowns
Conceptual Framework
Independent Variables Dependent Variable
ethnic group bull attitudes toward Speechbull language group disorders bull hometown
Figure 1 Conceptual framework
Significance of Study
This research illustrates how cultural diversity influences an individuals attitude
toward speech disorders Findings from this research will also provide important information
for Malaysian Speech-Language Pathologists (SLPs) as they provide services for a
multicultural population This is because the attitudes of society (patient with a speech
disorder patients family and patients community) as a whole toward speech disorders is
central in the treatment process (Bebout amp Arthur 1992)
Limitations of Study
There are several limitations of this study that have been addressed in terms of the
methodology and the topic Necessary measures have been taken to curb these limitations
For example although this research consists of a selected subpopulation the subpopulation is
selected with great diversity to avoid biased results Besides since the topic of this research
limits the types of disorders explored the disorders to be explored are carefully selected so
that the results are significant
Methodological Limitation The sample of this research consists of a selected
subpopulation The sample of the population under study is chosen based on convenience of
access The respondents consist of an academically advantaged group as they are all
4
Pusat Khidmat MakJumat Akademik VNlVERSm MALAYSIA SARAWltJ(
university students Consequently they might not represent their cultures very accurately and
precisely as education may have an influence on their knowledge and awareness and hence
their attitudes toward speech disorders
The quantitative method employed in this research may lack accuracy Respondents are
required to self-rate their attitudes toward speech disorders based on a five-point Likert scale
Self-rating is often biased due to many reasons Therefore attitudes measured in this research
may not correspond with how the respondents actually behave towards an individual with
speech disorders
Topical Limitation The speech disorders discussed in this study are limited to only
three types of disorders This research only focuses on attitudes of Malaysian university
students toward four specific speech disorders namely AOS Dysarthria and Stuttering
There are other speech disorders that will not be looked into in this study Hence findings
from this study cannot be generalized to attitudes toward all speech disorders
Definition of Terms
Speech disorder
Conceptual Definition
MedicineNetcom (2013) defines speech disorder as
a disorder affecting the ability to produce normal speech Speech disorders may affect articulation (phonetic or phonological disorders) fluency (stuttering or cluttering) andor voice (tone pitch volume or rate) Speech disorders may have their roots in oral-motor difficulties although some involve language processing problems (para 1)
Carter and Musher (2013) state that speech disorder is a type of communication
disorder that refers to an impairment of the articulation of speech sounds fluency
andor voice (para 3)
5
Operational Definition
In this research speech disorder refers to motor speech disorders (apraxia of speech and
dysarthria) and fluency disorders (stuttering)
Culture
Definition
Culture is defined as a term to describe behaviors beliefs and values of a group of
people who are brought together by commonalities (Johnson 1996 p 270)
Operational Definition
In this research a culture refers to a group of people either of the same ethnic group
same language group or same hometown
Attitude
Conceptual Definition
The Merriam-Webter Online Dictionary (2014) defines attitude as the way you think
and feel about someone or something or a feeling or way of thinking that affects a persons
behaviour Attitude is also defined as a psychological tendency that is expressed by
evaluating a particular entity with some degree of favor or disfavour (as cited in Schwarz amp
Bohner 2001 p2)
Operational Definition
In this research attitude refers to the way individuals understand think about and react
to speech disorders and individuals with speech disorders
Ethnicity
Conceptual Definition
Ethnic group or ethnicity is defined as a group of people whose heritage and group
membership are based on race origin characteristics and institutions An ethnic group
mayor may not consist of individuals of the same race (Johnson 1996 p 270)
6
Operational Definition
In this research ethnic group refers to individuals of similar biological and physical
characteristics
Language group
Conceptual Definition
Language group is defined as a group of languages related by descent from a common
ancestor called the proto-language of that family (Language group 2011)
Operational Definition
In this research language group refers to a group of people categorized by the same
first language they speak
Hometown
Conceptual Definition
Hometown is defined as the town of ones birth or early life or present fixed
residence (H~me town 2014) or the city or town where one was born or grew up
(Hometown 2014)
Operational Definition
In this research hometown refers to the region in Malaysia for West Malaysia and
Sarawak - Northern Central or Southern and for Sabah - Northern or Southern where
participants of the study were born and raised
Summary
In a multicultural country like Malaysia it is vital to study cultural influences on
attitudes toward speech disorders especially because this area has not been probed yet This
study aims to see if different cultures in Malaysia have different attitudes toward speech
disorders The findings from this research would provide key information for the treatment of
these disorders The next chapter discusses literature related to this research
7
CHAPTER TWO LITERATURE REVIEW
Speech Disorders
Communication comprises of voice speech language hearing and cognition Thus
communication disorders refer to a broad area encompassing conditions in an individual that
impairs the individuals communication These conditions can either completely impede or
merely weaken the persons ability to communicate (Melfi amp Garrison 2013) Speech and
language are two major factors involved in the classification of communication disorders
Consequently there are two major types of communication disorders speech disorders and
language disorders (Carter amp Musher 2013)
However speech disorders itself is another wide branch that is further divided into
articulation disorders fluency disorders and voice disorders According to Musher and Carter
(2013) articulation disorders are speech conditions involving substitutions omissions
additions or distortions of speech sounds that interfere with intelligibility Fluency disorder is
present when an individuals speech flow is disrupted by an atypical rate rhythm and
repetitions in sounds syllables words and phrases These may also include excessive
tension struggle behaviour and secondary mannerisms Finally voice disorder refers to
abnormal production of vocal quality pitch loudness resonance andor duration that is
inappropriate for the childs age and sex
While speech disorders and language disorders are often viewed together it is
important to understand that the two are distinct from each other and the occurrence of one
does not necessarily correspond with the occurrence of the other The American Speechshy
Language-Hearing Association (ASHA) makes it clear that an individual with speech
disorders is incapable of constructing speech sounds properly or smoothly using his or her
voice On the other hand language disorders impairs ones ability to understand others
(receptive language) or to share thoughts ideas and feelings completely (expressive
8
language) (ASHA 2014) Speech disorders affect an individuals phonetics skills These
individuals may be able to construct a grammatically correct sentence but they fail to
artioulate it On the other hand language disorder affects the pragmatics skills of an
individual These individuals may be capable of articulating meaningful sounds but lack the
intellectual ability to produce grammatically correct sentences (Lewis et aI 2007)
Another important point to note about speech disorders is that it is distinct from speech
delays (NICHCY 2011) Speech delay refers to speech and language development that
occurs slowly but in the correct sequence of development Speech delay is very common
among children but does not have a lasting effect on the child as the child eventually
develops the necessary speech and language skills (Daines 2014) On the contrary speech
disorder refers to abnormal language [speech] progress (Cas 2011 para 11) According to
Daines (2014) speech disorder is language [speech] development which is not only severely
delayed but also atypical and uneven (para 6) He also mentions that unresolved speech
delay can result in speech disorder This significantly affects an individuals co~munication
abilities if proper intervention is not applied In other words speech disorder is not eventually
resolved by itself instead it impedes an individuals speech permanently (Daines 2014)
Although speech delays and speech disorders are different from each other Daines (2014)
states that it is rather difficult to differentiate one from the other in the beginning of a childs
language acquisition Hence a certified speech-language pathologist is the most reliable to
differentiate between the two (NICHCY 2011)
In this research the focus is only on three speech disorders (AOS dysarthria and
stuttering) out of the many speech disorders that exist This is because there has been no
similar study done on AOS and dysarthria At the same time although similar studies have
been done on stuttering it has never been done in a Malaysian context ASHA classifies the
selected disorders as follows
9
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
I
CHAPTER ONE INTRODUCTION
Background of Study
Speech disorders are becoming increasingly prevalent among Malaysians these days At
the same time Malaysia is a country consisting of diverse cultures and ways of life Since
culture significantly shapes how one views the world and everything in it (Jandt 2015) it is
important to study if culture plays an important role in Malaysians attitudes toward speech
disorders
Initially many researches have focused on analysing societyS general awareness of
and perceptions toward speech disorders and its treatment However as the field of speech
disorders continued to develop new areas were probed in this aspect One of those areas
being cultural influences on the perceptions and attitudes toward this issue However all
these studies were done in countries other than Malaysia Thus far only South Americans
North Americans Kenyans Africans Indians and Chinese have been studied
Consequently the purpose of this research is to study the effects of different cultures on
Malaysians attitudes toward speech disorders namely apraxia of speech (AOS) dysarthria
and stuttering This research which is a quantitative study was conducted among UNIMAS
students representing the diverse cultures in Malaysia
Problem Statement
The prevalence of speech disorders among Malaysian children is quite alanning
Research extrapolates (based on the prevalence rate of speech disorders in the USA) that
around 235224 Malaysians could be suffering from speech disorders (Statistics by Country
for Speech Impainnent 2014) This makes 078 of the population of Malaysia which is
30073353 as of July 2014 (Malaysia Demographics Profile 2014 2014) However many
Malaysians are still oblivious to this issue In Malaysia it is only the well-educated and those
of high social economic status who are aware of speech disorders and the interventions
1
available Studies have shown that Malaysia is one of the countries in which speech disorders
are taken rather lightly whereby treatment is not sought if the severity of the disorder is not
perceived as high (as cited in Wilkerson amp Bakker 2010) Apart from the varying education
levels and socioeconomic status among Malaysian citizens cultural background is yet
another factor that contributes significantly to the diversity of Malaysians It is a wellshy
established fact that culture shapes ones view of the world and everything in it Crossshy
cultural differences significantly outline individuals perceptions and inter-personal attitudes
A persons reactions and attitudes are greatly affected by their religious beliefs and
demographical differences (Loh amp Ascoli 2011) While some cultures are more open and
receptive towards new findings in medicine and health science some may remain resistant
and less receptive toward these developments According to Wilkerson and Bakker (2010)
cultural beliefs can stand in the way of peoples awareness of speech disorders Culture also
plays an important role in the recognizing of speech disorders and the accepted treatment and
intervention for these conditions
Most studies on awareness and perception of speech disorders focus on general
awareness and perception rather than the factors that influence these elements However
substantial research has been conducted to suggest the existence of a relationship between
culture and the attitudes of individuals toward speech disorders Findings from a study
conducted by Bebout and Arthur (1992) in North America indicate that cultural variations do
affect attitudes toward speech disorders Another studyon the Cross-Cultural Attitudes and
Perception Towards Cleft Lip Palate and Deformities done among the Chinese in Africa and
in India highlighted that cultural and religious beliefs do impact ones perceptions and
attitudes toward cleft palate and its treatment (Loh amp Ascoli 2011) In their study on Cultural
Perspectives in Language and Speech Disorders conducted in Kenya Ndung and Kinyua
2
(2009) found that there is a prominent connection between cultural beliefs and language and
speech disorders
While all these studies provide evidence for a relationship between culture and attitudes
toward speech disorders none of the studies have investigated the connection of cultural
backgrounds with attitudes toward speech disorders like apraxia of speech (AOS) and
dysarthria The multicultural population of Malaysia makes this study unique and necessary
Furthermore no studies have addressed cross-cultural influences on attitudes toward speech
disorders among Malaysians Consequently there is a need to investigate if cultural
backgrounds influence Malaysians attitudes toward speech disorders
Objectives
General Objective The general objective of this research is to study the effects of
different cultural backgrounds on attitudes of Malaysian university students toward speech
disorders
Specific Objectives The specific objectives of this research are as follows
1 To find out if there is any difference in attitudes toward speech disorders based on
ethnicity
2 To find out if there is any difference in attitudes toward speech disorders based on
language groups
3 To find out if there IS any difference in attitudes toward speech disorders based on
hometowns
Hypotheses
Hypothesis 1 There is a significant difference in attitudes toward speech disorders based on
ethnicity
Hypothesis 2 There is a significant difference in attitudes toward speech disorders based on
language groups
3
Hypothesis 3 There is a significant difference in attitudes toward speech disorders based on
hometowns
Conceptual Framework
Independent Variables Dependent Variable
ethnic group bull attitudes toward Speechbull language group disorders bull hometown
Figure 1 Conceptual framework
Significance of Study
This research illustrates how cultural diversity influences an individuals attitude
toward speech disorders Findings from this research will also provide important information
for Malaysian Speech-Language Pathologists (SLPs) as they provide services for a
multicultural population This is because the attitudes of society (patient with a speech
disorder patients family and patients community) as a whole toward speech disorders is
central in the treatment process (Bebout amp Arthur 1992)
Limitations of Study
There are several limitations of this study that have been addressed in terms of the
methodology and the topic Necessary measures have been taken to curb these limitations
For example although this research consists of a selected subpopulation the subpopulation is
selected with great diversity to avoid biased results Besides since the topic of this research
limits the types of disorders explored the disorders to be explored are carefully selected so
that the results are significant
Methodological Limitation The sample of this research consists of a selected
subpopulation The sample of the population under study is chosen based on convenience of
access The respondents consist of an academically advantaged group as they are all
4
Pusat Khidmat MakJumat Akademik VNlVERSm MALAYSIA SARAWltJ(
university students Consequently they might not represent their cultures very accurately and
precisely as education may have an influence on their knowledge and awareness and hence
their attitudes toward speech disorders
The quantitative method employed in this research may lack accuracy Respondents are
required to self-rate their attitudes toward speech disorders based on a five-point Likert scale
Self-rating is often biased due to many reasons Therefore attitudes measured in this research
may not correspond with how the respondents actually behave towards an individual with
speech disorders
Topical Limitation The speech disorders discussed in this study are limited to only
three types of disorders This research only focuses on attitudes of Malaysian university
students toward four specific speech disorders namely AOS Dysarthria and Stuttering
There are other speech disorders that will not be looked into in this study Hence findings
from this study cannot be generalized to attitudes toward all speech disorders
Definition of Terms
Speech disorder
Conceptual Definition
MedicineNetcom (2013) defines speech disorder as
a disorder affecting the ability to produce normal speech Speech disorders may affect articulation (phonetic or phonological disorders) fluency (stuttering or cluttering) andor voice (tone pitch volume or rate) Speech disorders may have their roots in oral-motor difficulties although some involve language processing problems (para 1)
Carter and Musher (2013) state that speech disorder is a type of communication
disorder that refers to an impairment of the articulation of speech sounds fluency
andor voice (para 3)
5
Operational Definition
In this research speech disorder refers to motor speech disorders (apraxia of speech and
dysarthria) and fluency disorders (stuttering)
Culture
Definition
Culture is defined as a term to describe behaviors beliefs and values of a group of
people who are brought together by commonalities (Johnson 1996 p 270)
Operational Definition
In this research a culture refers to a group of people either of the same ethnic group
same language group or same hometown
Attitude
Conceptual Definition
The Merriam-Webter Online Dictionary (2014) defines attitude as the way you think
and feel about someone or something or a feeling or way of thinking that affects a persons
behaviour Attitude is also defined as a psychological tendency that is expressed by
evaluating a particular entity with some degree of favor or disfavour (as cited in Schwarz amp
Bohner 2001 p2)
Operational Definition
In this research attitude refers to the way individuals understand think about and react
to speech disorders and individuals with speech disorders
Ethnicity
Conceptual Definition
Ethnic group or ethnicity is defined as a group of people whose heritage and group
membership are based on race origin characteristics and institutions An ethnic group
mayor may not consist of individuals of the same race (Johnson 1996 p 270)
6
Operational Definition
In this research ethnic group refers to individuals of similar biological and physical
characteristics
Language group
Conceptual Definition
Language group is defined as a group of languages related by descent from a common
ancestor called the proto-language of that family (Language group 2011)
Operational Definition
In this research language group refers to a group of people categorized by the same
first language they speak
Hometown
Conceptual Definition
Hometown is defined as the town of ones birth or early life or present fixed
residence (H~me town 2014) or the city or town where one was born or grew up
(Hometown 2014)
Operational Definition
In this research hometown refers to the region in Malaysia for West Malaysia and
Sarawak - Northern Central or Southern and for Sabah - Northern or Southern where
participants of the study were born and raised
Summary
In a multicultural country like Malaysia it is vital to study cultural influences on
attitudes toward speech disorders especially because this area has not been probed yet This
study aims to see if different cultures in Malaysia have different attitudes toward speech
disorders The findings from this research would provide key information for the treatment of
these disorders The next chapter discusses literature related to this research
7
CHAPTER TWO LITERATURE REVIEW
Speech Disorders
Communication comprises of voice speech language hearing and cognition Thus
communication disorders refer to a broad area encompassing conditions in an individual that
impairs the individuals communication These conditions can either completely impede or
merely weaken the persons ability to communicate (Melfi amp Garrison 2013) Speech and
language are two major factors involved in the classification of communication disorders
Consequently there are two major types of communication disorders speech disorders and
language disorders (Carter amp Musher 2013)
However speech disorders itself is another wide branch that is further divided into
articulation disorders fluency disorders and voice disorders According to Musher and Carter
(2013) articulation disorders are speech conditions involving substitutions omissions
additions or distortions of speech sounds that interfere with intelligibility Fluency disorder is
present when an individuals speech flow is disrupted by an atypical rate rhythm and
repetitions in sounds syllables words and phrases These may also include excessive
tension struggle behaviour and secondary mannerisms Finally voice disorder refers to
abnormal production of vocal quality pitch loudness resonance andor duration that is
inappropriate for the childs age and sex
While speech disorders and language disorders are often viewed together it is
important to understand that the two are distinct from each other and the occurrence of one
does not necessarily correspond with the occurrence of the other The American Speechshy
Language-Hearing Association (ASHA) makes it clear that an individual with speech
disorders is incapable of constructing speech sounds properly or smoothly using his or her
voice On the other hand language disorders impairs ones ability to understand others
(receptive language) or to share thoughts ideas and feelings completely (expressive
8
language) (ASHA 2014) Speech disorders affect an individuals phonetics skills These
individuals may be able to construct a grammatically correct sentence but they fail to
artioulate it On the other hand language disorder affects the pragmatics skills of an
individual These individuals may be capable of articulating meaningful sounds but lack the
intellectual ability to produce grammatically correct sentences (Lewis et aI 2007)
Another important point to note about speech disorders is that it is distinct from speech
delays (NICHCY 2011) Speech delay refers to speech and language development that
occurs slowly but in the correct sequence of development Speech delay is very common
among children but does not have a lasting effect on the child as the child eventually
develops the necessary speech and language skills (Daines 2014) On the contrary speech
disorder refers to abnormal language [speech] progress (Cas 2011 para 11) According to
Daines (2014) speech disorder is language [speech] development which is not only severely
delayed but also atypical and uneven (para 6) He also mentions that unresolved speech
delay can result in speech disorder This significantly affects an individuals co~munication
abilities if proper intervention is not applied In other words speech disorder is not eventually
resolved by itself instead it impedes an individuals speech permanently (Daines 2014)
Although speech delays and speech disorders are different from each other Daines (2014)
states that it is rather difficult to differentiate one from the other in the beginning of a childs
language acquisition Hence a certified speech-language pathologist is the most reliable to
differentiate between the two (NICHCY 2011)
In this research the focus is only on three speech disorders (AOS dysarthria and
stuttering) out of the many speech disorders that exist This is because there has been no
similar study done on AOS and dysarthria At the same time although similar studies have
been done on stuttering it has never been done in a Malaysian context ASHA classifies the
selected disorders as follows
9
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
available Studies have shown that Malaysia is one of the countries in which speech disorders
are taken rather lightly whereby treatment is not sought if the severity of the disorder is not
perceived as high (as cited in Wilkerson amp Bakker 2010) Apart from the varying education
levels and socioeconomic status among Malaysian citizens cultural background is yet
another factor that contributes significantly to the diversity of Malaysians It is a wellshy
established fact that culture shapes ones view of the world and everything in it Crossshy
cultural differences significantly outline individuals perceptions and inter-personal attitudes
A persons reactions and attitudes are greatly affected by their religious beliefs and
demographical differences (Loh amp Ascoli 2011) While some cultures are more open and
receptive towards new findings in medicine and health science some may remain resistant
and less receptive toward these developments According to Wilkerson and Bakker (2010)
cultural beliefs can stand in the way of peoples awareness of speech disorders Culture also
plays an important role in the recognizing of speech disorders and the accepted treatment and
intervention for these conditions
Most studies on awareness and perception of speech disorders focus on general
awareness and perception rather than the factors that influence these elements However
substantial research has been conducted to suggest the existence of a relationship between
culture and the attitudes of individuals toward speech disorders Findings from a study
conducted by Bebout and Arthur (1992) in North America indicate that cultural variations do
affect attitudes toward speech disorders Another studyon the Cross-Cultural Attitudes and
Perception Towards Cleft Lip Palate and Deformities done among the Chinese in Africa and
in India highlighted that cultural and religious beliefs do impact ones perceptions and
attitudes toward cleft palate and its treatment (Loh amp Ascoli 2011) In their study on Cultural
Perspectives in Language and Speech Disorders conducted in Kenya Ndung and Kinyua
2
(2009) found that there is a prominent connection between cultural beliefs and language and
speech disorders
While all these studies provide evidence for a relationship between culture and attitudes
toward speech disorders none of the studies have investigated the connection of cultural
backgrounds with attitudes toward speech disorders like apraxia of speech (AOS) and
dysarthria The multicultural population of Malaysia makes this study unique and necessary
Furthermore no studies have addressed cross-cultural influences on attitudes toward speech
disorders among Malaysians Consequently there is a need to investigate if cultural
backgrounds influence Malaysians attitudes toward speech disorders
Objectives
General Objective The general objective of this research is to study the effects of
different cultural backgrounds on attitudes of Malaysian university students toward speech
disorders
Specific Objectives The specific objectives of this research are as follows
1 To find out if there is any difference in attitudes toward speech disorders based on
ethnicity
2 To find out if there is any difference in attitudes toward speech disorders based on
language groups
3 To find out if there IS any difference in attitudes toward speech disorders based on
hometowns
Hypotheses
Hypothesis 1 There is a significant difference in attitudes toward speech disorders based on
ethnicity
Hypothesis 2 There is a significant difference in attitudes toward speech disorders based on
language groups
3
Hypothesis 3 There is a significant difference in attitudes toward speech disorders based on
hometowns
Conceptual Framework
Independent Variables Dependent Variable
ethnic group bull attitudes toward Speechbull language group disorders bull hometown
Figure 1 Conceptual framework
Significance of Study
This research illustrates how cultural diversity influences an individuals attitude
toward speech disorders Findings from this research will also provide important information
for Malaysian Speech-Language Pathologists (SLPs) as they provide services for a
multicultural population This is because the attitudes of society (patient with a speech
disorder patients family and patients community) as a whole toward speech disorders is
central in the treatment process (Bebout amp Arthur 1992)
Limitations of Study
There are several limitations of this study that have been addressed in terms of the
methodology and the topic Necessary measures have been taken to curb these limitations
For example although this research consists of a selected subpopulation the subpopulation is
selected with great diversity to avoid biased results Besides since the topic of this research
limits the types of disorders explored the disorders to be explored are carefully selected so
that the results are significant
Methodological Limitation The sample of this research consists of a selected
subpopulation The sample of the population under study is chosen based on convenience of
access The respondents consist of an academically advantaged group as they are all
4
Pusat Khidmat MakJumat Akademik VNlVERSm MALAYSIA SARAWltJ(
university students Consequently they might not represent their cultures very accurately and
precisely as education may have an influence on their knowledge and awareness and hence
their attitudes toward speech disorders
The quantitative method employed in this research may lack accuracy Respondents are
required to self-rate their attitudes toward speech disorders based on a five-point Likert scale
Self-rating is often biased due to many reasons Therefore attitudes measured in this research
may not correspond with how the respondents actually behave towards an individual with
speech disorders
Topical Limitation The speech disorders discussed in this study are limited to only
three types of disorders This research only focuses on attitudes of Malaysian university
students toward four specific speech disorders namely AOS Dysarthria and Stuttering
There are other speech disorders that will not be looked into in this study Hence findings
from this study cannot be generalized to attitudes toward all speech disorders
Definition of Terms
Speech disorder
Conceptual Definition
MedicineNetcom (2013) defines speech disorder as
a disorder affecting the ability to produce normal speech Speech disorders may affect articulation (phonetic or phonological disorders) fluency (stuttering or cluttering) andor voice (tone pitch volume or rate) Speech disorders may have their roots in oral-motor difficulties although some involve language processing problems (para 1)
Carter and Musher (2013) state that speech disorder is a type of communication
disorder that refers to an impairment of the articulation of speech sounds fluency
andor voice (para 3)
5
Operational Definition
In this research speech disorder refers to motor speech disorders (apraxia of speech and
dysarthria) and fluency disorders (stuttering)
Culture
Definition
Culture is defined as a term to describe behaviors beliefs and values of a group of
people who are brought together by commonalities (Johnson 1996 p 270)
Operational Definition
In this research a culture refers to a group of people either of the same ethnic group
same language group or same hometown
Attitude
Conceptual Definition
The Merriam-Webter Online Dictionary (2014) defines attitude as the way you think
and feel about someone or something or a feeling or way of thinking that affects a persons
behaviour Attitude is also defined as a psychological tendency that is expressed by
evaluating a particular entity with some degree of favor or disfavour (as cited in Schwarz amp
Bohner 2001 p2)
Operational Definition
In this research attitude refers to the way individuals understand think about and react
to speech disorders and individuals with speech disorders
Ethnicity
Conceptual Definition
Ethnic group or ethnicity is defined as a group of people whose heritage and group
membership are based on race origin characteristics and institutions An ethnic group
mayor may not consist of individuals of the same race (Johnson 1996 p 270)
6
Operational Definition
In this research ethnic group refers to individuals of similar biological and physical
characteristics
Language group
Conceptual Definition
Language group is defined as a group of languages related by descent from a common
ancestor called the proto-language of that family (Language group 2011)
Operational Definition
In this research language group refers to a group of people categorized by the same
first language they speak
Hometown
Conceptual Definition
Hometown is defined as the town of ones birth or early life or present fixed
residence (H~me town 2014) or the city or town where one was born or grew up
(Hometown 2014)
Operational Definition
In this research hometown refers to the region in Malaysia for West Malaysia and
Sarawak - Northern Central or Southern and for Sabah - Northern or Southern where
participants of the study were born and raised
Summary
In a multicultural country like Malaysia it is vital to study cultural influences on
attitudes toward speech disorders especially because this area has not been probed yet This
study aims to see if different cultures in Malaysia have different attitudes toward speech
disorders The findings from this research would provide key information for the treatment of
these disorders The next chapter discusses literature related to this research
7
CHAPTER TWO LITERATURE REVIEW
Speech Disorders
Communication comprises of voice speech language hearing and cognition Thus
communication disorders refer to a broad area encompassing conditions in an individual that
impairs the individuals communication These conditions can either completely impede or
merely weaken the persons ability to communicate (Melfi amp Garrison 2013) Speech and
language are two major factors involved in the classification of communication disorders
Consequently there are two major types of communication disorders speech disorders and
language disorders (Carter amp Musher 2013)
However speech disorders itself is another wide branch that is further divided into
articulation disorders fluency disorders and voice disorders According to Musher and Carter
(2013) articulation disorders are speech conditions involving substitutions omissions
additions or distortions of speech sounds that interfere with intelligibility Fluency disorder is
present when an individuals speech flow is disrupted by an atypical rate rhythm and
repetitions in sounds syllables words and phrases These may also include excessive
tension struggle behaviour and secondary mannerisms Finally voice disorder refers to
abnormal production of vocal quality pitch loudness resonance andor duration that is
inappropriate for the childs age and sex
While speech disorders and language disorders are often viewed together it is
important to understand that the two are distinct from each other and the occurrence of one
does not necessarily correspond with the occurrence of the other The American Speechshy
Language-Hearing Association (ASHA) makes it clear that an individual with speech
disorders is incapable of constructing speech sounds properly or smoothly using his or her
voice On the other hand language disorders impairs ones ability to understand others
(receptive language) or to share thoughts ideas and feelings completely (expressive
8
language) (ASHA 2014) Speech disorders affect an individuals phonetics skills These
individuals may be able to construct a grammatically correct sentence but they fail to
artioulate it On the other hand language disorder affects the pragmatics skills of an
individual These individuals may be capable of articulating meaningful sounds but lack the
intellectual ability to produce grammatically correct sentences (Lewis et aI 2007)
Another important point to note about speech disorders is that it is distinct from speech
delays (NICHCY 2011) Speech delay refers to speech and language development that
occurs slowly but in the correct sequence of development Speech delay is very common
among children but does not have a lasting effect on the child as the child eventually
develops the necessary speech and language skills (Daines 2014) On the contrary speech
disorder refers to abnormal language [speech] progress (Cas 2011 para 11) According to
Daines (2014) speech disorder is language [speech] development which is not only severely
delayed but also atypical and uneven (para 6) He also mentions that unresolved speech
delay can result in speech disorder This significantly affects an individuals co~munication
abilities if proper intervention is not applied In other words speech disorder is not eventually
resolved by itself instead it impedes an individuals speech permanently (Daines 2014)
Although speech delays and speech disorders are different from each other Daines (2014)
states that it is rather difficult to differentiate one from the other in the beginning of a childs
language acquisition Hence a certified speech-language pathologist is the most reliable to
differentiate between the two (NICHCY 2011)
In this research the focus is only on three speech disorders (AOS dysarthria and
stuttering) out of the many speech disorders that exist This is because there has been no
similar study done on AOS and dysarthria At the same time although similar studies have
been done on stuttering it has never been done in a Malaysian context ASHA classifies the
selected disorders as follows
9
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
(2009) found that there is a prominent connection between cultural beliefs and language and
speech disorders
While all these studies provide evidence for a relationship between culture and attitudes
toward speech disorders none of the studies have investigated the connection of cultural
backgrounds with attitudes toward speech disorders like apraxia of speech (AOS) and
dysarthria The multicultural population of Malaysia makes this study unique and necessary
Furthermore no studies have addressed cross-cultural influences on attitudes toward speech
disorders among Malaysians Consequently there is a need to investigate if cultural
backgrounds influence Malaysians attitudes toward speech disorders
Objectives
General Objective The general objective of this research is to study the effects of
different cultural backgrounds on attitudes of Malaysian university students toward speech
disorders
Specific Objectives The specific objectives of this research are as follows
1 To find out if there is any difference in attitudes toward speech disorders based on
ethnicity
2 To find out if there is any difference in attitudes toward speech disorders based on
language groups
3 To find out if there IS any difference in attitudes toward speech disorders based on
hometowns
Hypotheses
Hypothesis 1 There is a significant difference in attitudes toward speech disorders based on
ethnicity
Hypothesis 2 There is a significant difference in attitudes toward speech disorders based on
language groups
3
Hypothesis 3 There is a significant difference in attitudes toward speech disorders based on
hometowns
Conceptual Framework
Independent Variables Dependent Variable
ethnic group bull attitudes toward Speechbull language group disorders bull hometown
Figure 1 Conceptual framework
Significance of Study
This research illustrates how cultural diversity influences an individuals attitude
toward speech disorders Findings from this research will also provide important information
for Malaysian Speech-Language Pathologists (SLPs) as they provide services for a
multicultural population This is because the attitudes of society (patient with a speech
disorder patients family and patients community) as a whole toward speech disorders is
central in the treatment process (Bebout amp Arthur 1992)
Limitations of Study
There are several limitations of this study that have been addressed in terms of the
methodology and the topic Necessary measures have been taken to curb these limitations
For example although this research consists of a selected subpopulation the subpopulation is
selected with great diversity to avoid biased results Besides since the topic of this research
limits the types of disorders explored the disorders to be explored are carefully selected so
that the results are significant
Methodological Limitation The sample of this research consists of a selected
subpopulation The sample of the population under study is chosen based on convenience of
access The respondents consist of an academically advantaged group as they are all
4
Pusat Khidmat MakJumat Akademik VNlVERSm MALAYSIA SARAWltJ(
university students Consequently they might not represent their cultures very accurately and
precisely as education may have an influence on their knowledge and awareness and hence
their attitudes toward speech disorders
The quantitative method employed in this research may lack accuracy Respondents are
required to self-rate their attitudes toward speech disorders based on a five-point Likert scale
Self-rating is often biased due to many reasons Therefore attitudes measured in this research
may not correspond with how the respondents actually behave towards an individual with
speech disorders
Topical Limitation The speech disorders discussed in this study are limited to only
three types of disorders This research only focuses on attitudes of Malaysian university
students toward four specific speech disorders namely AOS Dysarthria and Stuttering
There are other speech disorders that will not be looked into in this study Hence findings
from this study cannot be generalized to attitudes toward all speech disorders
Definition of Terms
Speech disorder
Conceptual Definition
MedicineNetcom (2013) defines speech disorder as
a disorder affecting the ability to produce normal speech Speech disorders may affect articulation (phonetic or phonological disorders) fluency (stuttering or cluttering) andor voice (tone pitch volume or rate) Speech disorders may have their roots in oral-motor difficulties although some involve language processing problems (para 1)
Carter and Musher (2013) state that speech disorder is a type of communication
disorder that refers to an impairment of the articulation of speech sounds fluency
andor voice (para 3)
5
Operational Definition
In this research speech disorder refers to motor speech disorders (apraxia of speech and
dysarthria) and fluency disorders (stuttering)
Culture
Definition
Culture is defined as a term to describe behaviors beliefs and values of a group of
people who are brought together by commonalities (Johnson 1996 p 270)
Operational Definition
In this research a culture refers to a group of people either of the same ethnic group
same language group or same hometown
Attitude
Conceptual Definition
The Merriam-Webter Online Dictionary (2014) defines attitude as the way you think
and feel about someone or something or a feeling or way of thinking that affects a persons
behaviour Attitude is also defined as a psychological tendency that is expressed by
evaluating a particular entity with some degree of favor or disfavour (as cited in Schwarz amp
Bohner 2001 p2)
Operational Definition
In this research attitude refers to the way individuals understand think about and react
to speech disorders and individuals with speech disorders
Ethnicity
Conceptual Definition
Ethnic group or ethnicity is defined as a group of people whose heritage and group
membership are based on race origin characteristics and institutions An ethnic group
mayor may not consist of individuals of the same race (Johnson 1996 p 270)
6
Operational Definition
In this research ethnic group refers to individuals of similar biological and physical
characteristics
Language group
Conceptual Definition
Language group is defined as a group of languages related by descent from a common
ancestor called the proto-language of that family (Language group 2011)
Operational Definition
In this research language group refers to a group of people categorized by the same
first language they speak
Hometown
Conceptual Definition
Hometown is defined as the town of ones birth or early life or present fixed
residence (H~me town 2014) or the city or town where one was born or grew up
(Hometown 2014)
Operational Definition
In this research hometown refers to the region in Malaysia for West Malaysia and
Sarawak - Northern Central or Southern and for Sabah - Northern or Southern where
participants of the study were born and raised
Summary
In a multicultural country like Malaysia it is vital to study cultural influences on
attitudes toward speech disorders especially because this area has not been probed yet This
study aims to see if different cultures in Malaysia have different attitudes toward speech
disorders The findings from this research would provide key information for the treatment of
these disorders The next chapter discusses literature related to this research
7
CHAPTER TWO LITERATURE REVIEW
Speech Disorders
Communication comprises of voice speech language hearing and cognition Thus
communication disorders refer to a broad area encompassing conditions in an individual that
impairs the individuals communication These conditions can either completely impede or
merely weaken the persons ability to communicate (Melfi amp Garrison 2013) Speech and
language are two major factors involved in the classification of communication disorders
Consequently there are two major types of communication disorders speech disorders and
language disorders (Carter amp Musher 2013)
However speech disorders itself is another wide branch that is further divided into
articulation disorders fluency disorders and voice disorders According to Musher and Carter
(2013) articulation disorders are speech conditions involving substitutions omissions
additions or distortions of speech sounds that interfere with intelligibility Fluency disorder is
present when an individuals speech flow is disrupted by an atypical rate rhythm and
repetitions in sounds syllables words and phrases These may also include excessive
tension struggle behaviour and secondary mannerisms Finally voice disorder refers to
abnormal production of vocal quality pitch loudness resonance andor duration that is
inappropriate for the childs age and sex
While speech disorders and language disorders are often viewed together it is
important to understand that the two are distinct from each other and the occurrence of one
does not necessarily correspond with the occurrence of the other The American Speechshy
Language-Hearing Association (ASHA) makes it clear that an individual with speech
disorders is incapable of constructing speech sounds properly or smoothly using his or her
voice On the other hand language disorders impairs ones ability to understand others
(receptive language) or to share thoughts ideas and feelings completely (expressive
8
language) (ASHA 2014) Speech disorders affect an individuals phonetics skills These
individuals may be able to construct a grammatically correct sentence but they fail to
artioulate it On the other hand language disorder affects the pragmatics skills of an
individual These individuals may be capable of articulating meaningful sounds but lack the
intellectual ability to produce grammatically correct sentences (Lewis et aI 2007)
Another important point to note about speech disorders is that it is distinct from speech
delays (NICHCY 2011) Speech delay refers to speech and language development that
occurs slowly but in the correct sequence of development Speech delay is very common
among children but does not have a lasting effect on the child as the child eventually
develops the necessary speech and language skills (Daines 2014) On the contrary speech
disorder refers to abnormal language [speech] progress (Cas 2011 para 11) According to
Daines (2014) speech disorder is language [speech] development which is not only severely
delayed but also atypical and uneven (para 6) He also mentions that unresolved speech
delay can result in speech disorder This significantly affects an individuals co~munication
abilities if proper intervention is not applied In other words speech disorder is not eventually
resolved by itself instead it impedes an individuals speech permanently (Daines 2014)
Although speech delays and speech disorders are different from each other Daines (2014)
states that it is rather difficult to differentiate one from the other in the beginning of a childs
language acquisition Hence a certified speech-language pathologist is the most reliable to
differentiate between the two (NICHCY 2011)
In this research the focus is only on three speech disorders (AOS dysarthria and
stuttering) out of the many speech disorders that exist This is because there has been no
similar study done on AOS and dysarthria At the same time although similar studies have
been done on stuttering it has never been done in a Malaysian context ASHA classifies the
selected disorders as follows
9
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
Hypothesis 3 There is a significant difference in attitudes toward speech disorders based on
hometowns
Conceptual Framework
Independent Variables Dependent Variable
ethnic group bull attitudes toward Speechbull language group disorders bull hometown
Figure 1 Conceptual framework
Significance of Study
This research illustrates how cultural diversity influences an individuals attitude
toward speech disorders Findings from this research will also provide important information
for Malaysian Speech-Language Pathologists (SLPs) as they provide services for a
multicultural population This is because the attitudes of society (patient with a speech
disorder patients family and patients community) as a whole toward speech disorders is
central in the treatment process (Bebout amp Arthur 1992)
Limitations of Study
There are several limitations of this study that have been addressed in terms of the
methodology and the topic Necessary measures have been taken to curb these limitations
For example although this research consists of a selected subpopulation the subpopulation is
selected with great diversity to avoid biased results Besides since the topic of this research
limits the types of disorders explored the disorders to be explored are carefully selected so
that the results are significant
Methodological Limitation The sample of this research consists of a selected
subpopulation The sample of the population under study is chosen based on convenience of
access The respondents consist of an academically advantaged group as they are all
4
Pusat Khidmat MakJumat Akademik VNlVERSm MALAYSIA SARAWltJ(
university students Consequently they might not represent their cultures very accurately and
precisely as education may have an influence on their knowledge and awareness and hence
their attitudes toward speech disorders
The quantitative method employed in this research may lack accuracy Respondents are
required to self-rate their attitudes toward speech disorders based on a five-point Likert scale
Self-rating is often biased due to many reasons Therefore attitudes measured in this research
may not correspond with how the respondents actually behave towards an individual with
speech disorders
Topical Limitation The speech disorders discussed in this study are limited to only
three types of disorders This research only focuses on attitudes of Malaysian university
students toward four specific speech disorders namely AOS Dysarthria and Stuttering
There are other speech disorders that will not be looked into in this study Hence findings
from this study cannot be generalized to attitudes toward all speech disorders
Definition of Terms
Speech disorder
Conceptual Definition
MedicineNetcom (2013) defines speech disorder as
a disorder affecting the ability to produce normal speech Speech disorders may affect articulation (phonetic or phonological disorders) fluency (stuttering or cluttering) andor voice (tone pitch volume or rate) Speech disorders may have their roots in oral-motor difficulties although some involve language processing problems (para 1)
Carter and Musher (2013) state that speech disorder is a type of communication
disorder that refers to an impairment of the articulation of speech sounds fluency
andor voice (para 3)
5
Operational Definition
In this research speech disorder refers to motor speech disorders (apraxia of speech and
dysarthria) and fluency disorders (stuttering)
Culture
Definition
Culture is defined as a term to describe behaviors beliefs and values of a group of
people who are brought together by commonalities (Johnson 1996 p 270)
Operational Definition
In this research a culture refers to a group of people either of the same ethnic group
same language group or same hometown
Attitude
Conceptual Definition
The Merriam-Webter Online Dictionary (2014) defines attitude as the way you think
and feel about someone or something or a feeling or way of thinking that affects a persons
behaviour Attitude is also defined as a psychological tendency that is expressed by
evaluating a particular entity with some degree of favor or disfavour (as cited in Schwarz amp
Bohner 2001 p2)
Operational Definition
In this research attitude refers to the way individuals understand think about and react
to speech disorders and individuals with speech disorders
Ethnicity
Conceptual Definition
Ethnic group or ethnicity is defined as a group of people whose heritage and group
membership are based on race origin characteristics and institutions An ethnic group
mayor may not consist of individuals of the same race (Johnson 1996 p 270)
6
Operational Definition
In this research ethnic group refers to individuals of similar biological and physical
characteristics
Language group
Conceptual Definition
Language group is defined as a group of languages related by descent from a common
ancestor called the proto-language of that family (Language group 2011)
Operational Definition
In this research language group refers to a group of people categorized by the same
first language they speak
Hometown
Conceptual Definition
Hometown is defined as the town of ones birth or early life or present fixed
residence (H~me town 2014) or the city or town where one was born or grew up
(Hometown 2014)
Operational Definition
In this research hometown refers to the region in Malaysia for West Malaysia and
Sarawak - Northern Central or Southern and for Sabah - Northern or Southern where
participants of the study were born and raised
Summary
In a multicultural country like Malaysia it is vital to study cultural influences on
attitudes toward speech disorders especially because this area has not been probed yet This
study aims to see if different cultures in Malaysia have different attitudes toward speech
disorders The findings from this research would provide key information for the treatment of
these disorders The next chapter discusses literature related to this research
7
CHAPTER TWO LITERATURE REVIEW
Speech Disorders
Communication comprises of voice speech language hearing and cognition Thus
communication disorders refer to a broad area encompassing conditions in an individual that
impairs the individuals communication These conditions can either completely impede or
merely weaken the persons ability to communicate (Melfi amp Garrison 2013) Speech and
language are two major factors involved in the classification of communication disorders
Consequently there are two major types of communication disorders speech disorders and
language disorders (Carter amp Musher 2013)
However speech disorders itself is another wide branch that is further divided into
articulation disorders fluency disorders and voice disorders According to Musher and Carter
(2013) articulation disorders are speech conditions involving substitutions omissions
additions or distortions of speech sounds that interfere with intelligibility Fluency disorder is
present when an individuals speech flow is disrupted by an atypical rate rhythm and
repetitions in sounds syllables words and phrases These may also include excessive
tension struggle behaviour and secondary mannerisms Finally voice disorder refers to
abnormal production of vocal quality pitch loudness resonance andor duration that is
inappropriate for the childs age and sex
While speech disorders and language disorders are often viewed together it is
important to understand that the two are distinct from each other and the occurrence of one
does not necessarily correspond with the occurrence of the other The American Speechshy
Language-Hearing Association (ASHA) makes it clear that an individual with speech
disorders is incapable of constructing speech sounds properly or smoothly using his or her
voice On the other hand language disorders impairs ones ability to understand others
(receptive language) or to share thoughts ideas and feelings completely (expressive
8
language) (ASHA 2014) Speech disorders affect an individuals phonetics skills These
individuals may be able to construct a grammatically correct sentence but they fail to
artioulate it On the other hand language disorder affects the pragmatics skills of an
individual These individuals may be capable of articulating meaningful sounds but lack the
intellectual ability to produce grammatically correct sentences (Lewis et aI 2007)
Another important point to note about speech disorders is that it is distinct from speech
delays (NICHCY 2011) Speech delay refers to speech and language development that
occurs slowly but in the correct sequence of development Speech delay is very common
among children but does not have a lasting effect on the child as the child eventually
develops the necessary speech and language skills (Daines 2014) On the contrary speech
disorder refers to abnormal language [speech] progress (Cas 2011 para 11) According to
Daines (2014) speech disorder is language [speech] development which is not only severely
delayed but also atypical and uneven (para 6) He also mentions that unresolved speech
delay can result in speech disorder This significantly affects an individuals co~munication
abilities if proper intervention is not applied In other words speech disorder is not eventually
resolved by itself instead it impedes an individuals speech permanently (Daines 2014)
Although speech delays and speech disorders are different from each other Daines (2014)
states that it is rather difficult to differentiate one from the other in the beginning of a childs
language acquisition Hence a certified speech-language pathologist is the most reliable to
differentiate between the two (NICHCY 2011)
In this research the focus is only on three speech disorders (AOS dysarthria and
stuttering) out of the many speech disorders that exist This is because there has been no
similar study done on AOS and dysarthria At the same time although similar studies have
been done on stuttering it has never been done in a Malaysian context ASHA classifies the
selected disorders as follows
9
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
Pusat Khidmat MakJumat Akademik VNlVERSm MALAYSIA SARAWltJ(
university students Consequently they might not represent their cultures very accurately and
precisely as education may have an influence on their knowledge and awareness and hence
their attitudes toward speech disorders
The quantitative method employed in this research may lack accuracy Respondents are
required to self-rate their attitudes toward speech disorders based on a five-point Likert scale
Self-rating is often biased due to many reasons Therefore attitudes measured in this research
may not correspond with how the respondents actually behave towards an individual with
speech disorders
Topical Limitation The speech disorders discussed in this study are limited to only
three types of disorders This research only focuses on attitudes of Malaysian university
students toward four specific speech disorders namely AOS Dysarthria and Stuttering
There are other speech disorders that will not be looked into in this study Hence findings
from this study cannot be generalized to attitudes toward all speech disorders
Definition of Terms
Speech disorder
Conceptual Definition
MedicineNetcom (2013) defines speech disorder as
a disorder affecting the ability to produce normal speech Speech disorders may affect articulation (phonetic or phonological disorders) fluency (stuttering or cluttering) andor voice (tone pitch volume or rate) Speech disorders may have their roots in oral-motor difficulties although some involve language processing problems (para 1)
Carter and Musher (2013) state that speech disorder is a type of communication
disorder that refers to an impairment of the articulation of speech sounds fluency
andor voice (para 3)
5
Operational Definition
In this research speech disorder refers to motor speech disorders (apraxia of speech and
dysarthria) and fluency disorders (stuttering)
Culture
Definition
Culture is defined as a term to describe behaviors beliefs and values of a group of
people who are brought together by commonalities (Johnson 1996 p 270)
Operational Definition
In this research a culture refers to a group of people either of the same ethnic group
same language group or same hometown
Attitude
Conceptual Definition
The Merriam-Webter Online Dictionary (2014) defines attitude as the way you think
and feel about someone or something or a feeling or way of thinking that affects a persons
behaviour Attitude is also defined as a psychological tendency that is expressed by
evaluating a particular entity with some degree of favor or disfavour (as cited in Schwarz amp
Bohner 2001 p2)
Operational Definition
In this research attitude refers to the way individuals understand think about and react
to speech disorders and individuals with speech disorders
Ethnicity
Conceptual Definition
Ethnic group or ethnicity is defined as a group of people whose heritage and group
membership are based on race origin characteristics and institutions An ethnic group
mayor may not consist of individuals of the same race (Johnson 1996 p 270)
6
Operational Definition
In this research ethnic group refers to individuals of similar biological and physical
characteristics
Language group
Conceptual Definition
Language group is defined as a group of languages related by descent from a common
ancestor called the proto-language of that family (Language group 2011)
Operational Definition
In this research language group refers to a group of people categorized by the same
first language they speak
Hometown
Conceptual Definition
Hometown is defined as the town of ones birth or early life or present fixed
residence (H~me town 2014) or the city or town where one was born or grew up
(Hometown 2014)
Operational Definition
In this research hometown refers to the region in Malaysia for West Malaysia and
Sarawak - Northern Central or Southern and for Sabah - Northern or Southern where
participants of the study were born and raised
Summary
In a multicultural country like Malaysia it is vital to study cultural influences on
attitudes toward speech disorders especially because this area has not been probed yet This
study aims to see if different cultures in Malaysia have different attitudes toward speech
disorders The findings from this research would provide key information for the treatment of
these disorders The next chapter discusses literature related to this research
7
CHAPTER TWO LITERATURE REVIEW
Speech Disorders
Communication comprises of voice speech language hearing and cognition Thus
communication disorders refer to a broad area encompassing conditions in an individual that
impairs the individuals communication These conditions can either completely impede or
merely weaken the persons ability to communicate (Melfi amp Garrison 2013) Speech and
language are two major factors involved in the classification of communication disorders
Consequently there are two major types of communication disorders speech disorders and
language disorders (Carter amp Musher 2013)
However speech disorders itself is another wide branch that is further divided into
articulation disorders fluency disorders and voice disorders According to Musher and Carter
(2013) articulation disorders are speech conditions involving substitutions omissions
additions or distortions of speech sounds that interfere with intelligibility Fluency disorder is
present when an individuals speech flow is disrupted by an atypical rate rhythm and
repetitions in sounds syllables words and phrases These may also include excessive
tension struggle behaviour and secondary mannerisms Finally voice disorder refers to
abnormal production of vocal quality pitch loudness resonance andor duration that is
inappropriate for the childs age and sex
While speech disorders and language disorders are often viewed together it is
important to understand that the two are distinct from each other and the occurrence of one
does not necessarily correspond with the occurrence of the other The American Speechshy
Language-Hearing Association (ASHA) makes it clear that an individual with speech
disorders is incapable of constructing speech sounds properly or smoothly using his or her
voice On the other hand language disorders impairs ones ability to understand others
(receptive language) or to share thoughts ideas and feelings completely (expressive
8
language) (ASHA 2014) Speech disorders affect an individuals phonetics skills These
individuals may be able to construct a grammatically correct sentence but they fail to
artioulate it On the other hand language disorder affects the pragmatics skills of an
individual These individuals may be capable of articulating meaningful sounds but lack the
intellectual ability to produce grammatically correct sentences (Lewis et aI 2007)
Another important point to note about speech disorders is that it is distinct from speech
delays (NICHCY 2011) Speech delay refers to speech and language development that
occurs slowly but in the correct sequence of development Speech delay is very common
among children but does not have a lasting effect on the child as the child eventually
develops the necessary speech and language skills (Daines 2014) On the contrary speech
disorder refers to abnormal language [speech] progress (Cas 2011 para 11) According to
Daines (2014) speech disorder is language [speech] development which is not only severely
delayed but also atypical and uneven (para 6) He also mentions that unresolved speech
delay can result in speech disorder This significantly affects an individuals co~munication
abilities if proper intervention is not applied In other words speech disorder is not eventually
resolved by itself instead it impedes an individuals speech permanently (Daines 2014)
Although speech delays and speech disorders are different from each other Daines (2014)
states that it is rather difficult to differentiate one from the other in the beginning of a childs
language acquisition Hence a certified speech-language pathologist is the most reliable to
differentiate between the two (NICHCY 2011)
In this research the focus is only on three speech disorders (AOS dysarthria and
stuttering) out of the many speech disorders that exist This is because there has been no
similar study done on AOS and dysarthria At the same time although similar studies have
been done on stuttering it has never been done in a Malaysian context ASHA classifies the
selected disorders as follows
9
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
Operational Definition
In this research speech disorder refers to motor speech disorders (apraxia of speech and
dysarthria) and fluency disorders (stuttering)
Culture
Definition
Culture is defined as a term to describe behaviors beliefs and values of a group of
people who are brought together by commonalities (Johnson 1996 p 270)
Operational Definition
In this research a culture refers to a group of people either of the same ethnic group
same language group or same hometown
Attitude
Conceptual Definition
The Merriam-Webter Online Dictionary (2014) defines attitude as the way you think
and feel about someone or something or a feeling or way of thinking that affects a persons
behaviour Attitude is also defined as a psychological tendency that is expressed by
evaluating a particular entity with some degree of favor or disfavour (as cited in Schwarz amp
Bohner 2001 p2)
Operational Definition
In this research attitude refers to the way individuals understand think about and react
to speech disorders and individuals with speech disorders
Ethnicity
Conceptual Definition
Ethnic group or ethnicity is defined as a group of people whose heritage and group
membership are based on race origin characteristics and institutions An ethnic group
mayor may not consist of individuals of the same race (Johnson 1996 p 270)
6
Operational Definition
In this research ethnic group refers to individuals of similar biological and physical
characteristics
Language group
Conceptual Definition
Language group is defined as a group of languages related by descent from a common
ancestor called the proto-language of that family (Language group 2011)
Operational Definition
In this research language group refers to a group of people categorized by the same
first language they speak
Hometown
Conceptual Definition
Hometown is defined as the town of ones birth or early life or present fixed
residence (H~me town 2014) or the city or town where one was born or grew up
(Hometown 2014)
Operational Definition
In this research hometown refers to the region in Malaysia for West Malaysia and
Sarawak - Northern Central or Southern and for Sabah - Northern or Southern where
participants of the study were born and raised
Summary
In a multicultural country like Malaysia it is vital to study cultural influences on
attitudes toward speech disorders especially because this area has not been probed yet This
study aims to see if different cultures in Malaysia have different attitudes toward speech
disorders The findings from this research would provide key information for the treatment of
these disorders The next chapter discusses literature related to this research
7
CHAPTER TWO LITERATURE REVIEW
Speech Disorders
Communication comprises of voice speech language hearing and cognition Thus
communication disorders refer to a broad area encompassing conditions in an individual that
impairs the individuals communication These conditions can either completely impede or
merely weaken the persons ability to communicate (Melfi amp Garrison 2013) Speech and
language are two major factors involved in the classification of communication disorders
Consequently there are two major types of communication disorders speech disorders and
language disorders (Carter amp Musher 2013)
However speech disorders itself is another wide branch that is further divided into
articulation disorders fluency disorders and voice disorders According to Musher and Carter
(2013) articulation disorders are speech conditions involving substitutions omissions
additions or distortions of speech sounds that interfere with intelligibility Fluency disorder is
present when an individuals speech flow is disrupted by an atypical rate rhythm and
repetitions in sounds syllables words and phrases These may also include excessive
tension struggle behaviour and secondary mannerisms Finally voice disorder refers to
abnormal production of vocal quality pitch loudness resonance andor duration that is
inappropriate for the childs age and sex
While speech disorders and language disorders are often viewed together it is
important to understand that the two are distinct from each other and the occurrence of one
does not necessarily correspond with the occurrence of the other The American Speechshy
Language-Hearing Association (ASHA) makes it clear that an individual with speech
disorders is incapable of constructing speech sounds properly or smoothly using his or her
voice On the other hand language disorders impairs ones ability to understand others
(receptive language) or to share thoughts ideas and feelings completely (expressive
8
language) (ASHA 2014) Speech disorders affect an individuals phonetics skills These
individuals may be able to construct a grammatically correct sentence but they fail to
artioulate it On the other hand language disorder affects the pragmatics skills of an
individual These individuals may be capable of articulating meaningful sounds but lack the
intellectual ability to produce grammatically correct sentences (Lewis et aI 2007)
Another important point to note about speech disorders is that it is distinct from speech
delays (NICHCY 2011) Speech delay refers to speech and language development that
occurs slowly but in the correct sequence of development Speech delay is very common
among children but does not have a lasting effect on the child as the child eventually
develops the necessary speech and language skills (Daines 2014) On the contrary speech
disorder refers to abnormal language [speech] progress (Cas 2011 para 11) According to
Daines (2014) speech disorder is language [speech] development which is not only severely
delayed but also atypical and uneven (para 6) He also mentions that unresolved speech
delay can result in speech disorder This significantly affects an individuals co~munication
abilities if proper intervention is not applied In other words speech disorder is not eventually
resolved by itself instead it impedes an individuals speech permanently (Daines 2014)
Although speech delays and speech disorders are different from each other Daines (2014)
states that it is rather difficult to differentiate one from the other in the beginning of a childs
language acquisition Hence a certified speech-language pathologist is the most reliable to
differentiate between the two (NICHCY 2011)
In this research the focus is only on three speech disorders (AOS dysarthria and
stuttering) out of the many speech disorders that exist This is because there has been no
similar study done on AOS and dysarthria At the same time although similar studies have
been done on stuttering it has never been done in a Malaysian context ASHA classifies the
selected disorders as follows
9
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
Operational Definition
In this research ethnic group refers to individuals of similar biological and physical
characteristics
Language group
Conceptual Definition
Language group is defined as a group of languages related by descent from a common
ancestor called the proto-language of that family (Language group 2011)
Operational Definition
In this research language group refers to a group of people categorized by the same
first language they speak
Hometown
Conceptual Definition
Hometown is defined as the town of ones birth or early life or present fixed
residence (H~me town 2014) or the city or town where one was born or grew up
(Hometown 2014)
Operational Definition
In this research hometown refers to the region in Malaysia for West Malaysia and
Sarawak - Northern Central or Southern and for Sabah - Northern or Southern where
participants of the study were born and raised
Summary
In a multicultural country like Malaysia it is vital to study cultural influences on
attitudes toward speech disorders especially because this area has not been probed yet This
study aims to see if different cultures in Malaysia have different attitudes toward speech
disorders The findings from this research would provide key information for the treatment of
these disorders The next chapter discusses literature related to this research
7
CHAPTER TWO LITERATURE REVIEW
Speech Disorders
Communication comprises of voice speech language hearing and cognition Thus
communication disorders refer to a broad area encompassing conditions in an individual that
impairs the individuals communication These conditions can either completely impede or
merely weaken the persons ability to communicate (Melfi amp Garrison 2013) Speech and
language are two major factors involved in the classification of communication disorders
Consequently there are two major types of communication disorders speech disorders and
language disorders (Carter amp Musher 2013)
However speech disorders itself is another wide branch that is further divided into
articulation disorders fluency disorders and voice disorders According to Musher and Carter
(2013) articulation disorders are speech conditions involving substitutions omissions
additions or distortions of speech sounds that interfere with intelligibility Fluency disorder is
present when an individuals speech flow is disrupted by an atypical rate rhythm and
repetitions in sounds syllables words and phrases These may also include excessive
tension struggle behaviour and secondary mannerisms Finally voice disorder refers to
abnormal production of vocal quality pitch loudness resonance andor duration that is
inappropriate for the childs age and sex
While speech disorders and language disorders are often viewed together it is
important to understand that the two are distinct from each other and the occurrence of one
does not necessarily correspond with the occurrence of the other The American Speechshy
Language-Hearing Association (ASHA) makes it clear that an individual with speech
disorders is incapable of constructing speech sounds properly or smoothly using his or her
voice On the other hand language disorders impairs ones ability to understand others
(receptive language) or to share thoughts ideas and feelings completely (expressive
8
language) (ASHA 2014) Speech disorders affect an individuals phonetics skills These
individuals may be able to construct a grammatically correct sentence but they fail to
artioulate it On the other hand language disorder affects the pragmatics skills of an
individual These individuals may be capable of articulating meaningful sounds but lack the
intellectual ability to produce grammatically correct sentences (Lewis et aI 2007)
Another important point to note about speech disorders is that it is distinct from speech
delays (NICHCY 2011) Speech delay refers to speech and language development that
occurs slowly but in the correct sequence of development Speech delay is very common
among children but does not have a lasting effect on the child as the child eventually
develops the necessary speech and language skills (Daines 2014) On the contrary speech
disorder refers to abnormal language [speech] progress (Cas 2011 para 11) According to
Daines (2014) speech disorder is language [speech] development which is not only severely
delayed but also atypical and uneven (para 6) He also mentions that unresolved speech
delay can result in speech disorder This significantly affects an individuals co~munication
abilities if proper intervention is not applied In other words speech disorder is not eventually
resolved by itself instead it impedes an individuals speech permanently (Daines 2014)
Although speech delays and speech disorders are different from each other Daines (2014)
states that it is rather difficult to differentiate one from the other in the beginning of a childs
language acquisition Hence a certified speech-language pathologist is the most reliable to
differentiate between the two (NICHCY 2011)
In this research the focus is only on three speech disorders (AOS dysarthria and
stuttering) out of the many speech disorders that exist This is because there has been no
similar study done on AOS and dysarthria At the same time although similar studies have
been done on stuttering it has never been done in a Malaysian context ASHA classifies the
selected disorders as follows
9
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
CHAPTER TWO LITERATURE REVIEW
Speech Disorders
Communication comprises of voice speech language hearing and cognition Thus
communication disorders refer to a broad area encompassing conditions in an individual that
impairs the individuals communication These conditions can either completely impede or
merely weaken the persons ability to communicate (Melfi amp Garrison 2013) Speech and
language are two major factors involved in the classification of communication disorders
Consequently there are two major types of communication disorders speech disorders and
language disorders (Carter amp Musher 2013)
However speech disorders itself is another wide branch that is further divided into
articulation disorders fluency disorders and voice disorders According to Musher and Carter
(2013) articulation disorders are speech conditions involving substitutions omissions
additions or distortions of speech sounds that interfere with intelligibility Fluency disorder is
present when an individuals speech flow is disrupted by an atypical rate rhythm and
repetitions in sounds syllables words and phrases These may also include excessive
tension struggle behaviour and secondary mannerisms Finally voice disorder refers to
abnormal production of vocal quality pitch loudness resonance andor duration that is
inappropriate for the childs age and sex
While speech disorders and language disorders are often viewed together it is
important to understand that the two are distinct from each other and the occurrence of one
does not necessarily correspond with the occurrence of the other The American Speechshy
Language-Hearing Association (ASHA) makes it clear that an individual with speech
disorders is incapable of constructing speech sounds properly or smoothly using his or her
voice On the other hand language disorders impairs ones ability to understand others
(receptive language) or to share thoughts ideas and feelings completely (expressive
8
language) (ASHA 2014) Speech disorders affect an individuals phonetics skills These
individuals may be able to construct a grammatically correct sentence but they fail to
artioulate it On the other hand language disorder affects the pragmatics skills of an
individual These individuals may be capable of articulating meaningful sounds but lack the
intellectual ability to produce grammatically correct sentences (Lewis et aI 2007)
Another important point to note about speech disorders is that it is distinct from speech
delays (NICHCY 2011) Speech delay refers to speech and language development that
occurs slowly but in the correct sequence of development Speech delay is very common
among children but does not have a lasting effect on the child as the child eventually
develops the necessary speech and language skills (Daines 2014) On the contrary speech
disorder refers to abnormal language [speech] progress (Cas 2011 para 11) According to
Daines (2014) speech disorder is language [speech] development which is not only severely
delayed but also atypical and uneven (para 6) He also mentions that unresolved speech
delay can result in speech disorder This significantly affects an individuals co~munication
abilities if proper intervention is not applied In other words speech disorder is not eventually
resolved by itself instead it impedes an individuals speech permanently (Daines 2014)
Although speech delays and speech disorders are different from each other Daines (2014)
states that it is rather difficult to differentiate one from the other in the beginning of a childs
language acquisition Hence a certified speech-language pathologist is the most reliable to
differentiate between the two (NICHCY 2011)
In this research the focus is only on three speech disorders (AOS dysarthria and
stuttering) out of the many speech disorders that exist This is because there has been no
similar study done on AOS and dysarthria At the same time although similar studies have
been done on stuttering it has never been done in a Malaysian context ASHA classifies the
selected disorders as follows
9
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
language) (ASHA 2014) Speech disorders affect an individuals phonetics skills These
individuals may be able to construct a grammatically correct sentence but they fail to
artioulate it On the other hand language disorder affects the pragmatics skills of an
individual These individuals may be capable of articulating meaningful sounds but lack the
intellectual ability to produce grammatically correct sentences (Lewis et aI 2007)
Another important point to note about speech disorders is that it is distinct from speech
delays (NICHCY 2011) Speech delay refers to speech and language development that
occurs slowly but in the correct sequence of development Speech delay is very common
among children but does not have a lasting effect on the child as the child eventually
develops the necessary speech and language skills (Daines 2014) On the contrary speech
disorder refers to abnormal language [speech] progress (Cas 2011 para 11) According to
Daines (2014) speech disorder is language [speech] development which is not only severely
delayed but also atypical and uneven (para 6) He also mentions that unresolved speech
delay can result in speech disorder This significantly affects an individuals co~munication
abilities if proper intervention is not applied In other words speech disorder is not eventually
resolved by itself instead it impedes an individuals speech permanently (Daines 2014)
Although speech delays and speech disorders are different from each other Daines (2014)
states that it is rather difficult to differentiate one from the other in the beginning of a childs
language acquisition Hence a certified speech-language pathologist is the most reliable to
differentiate between the two (NICHCY 2011)
In this research the focus is only on three speech disorders (AOS dysarthria and
stuttering) out of the many speech disorders that exist This is because there has been no
similar study done on AOS and dysarthria At the same time although similar studies have
been done on stuttering it has never been done in a Malaysian context ASHA classifies the
selected disorders as follows
9
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
Motor Speech Disorders According to Melfi and Garrison (2013) motor speech
disorders refer to speech disorders involving motor coordination of the structures of the
respiratory system larynx pharynx and oral cavity These disorders are categorized as
apraxias and dysarthrias
1 Apraxia of Speech (AOS)
Apraxia is defined as a weakness in ones capacity to program speech musculature to
select plan organize and initiate a motor pattern It is a disorder caused by the failure of the
brain to coordinate the movement of speech muscles for speech production Hence it is
believed to be a neurological disorder (Carter amp Musher 2013) Melfi and Garrison (2013)
classify apraxia into two different types namely oral apraxia and apraxia of speech Oral
apraxia does not involve speech production but is a defect in nonverbal oral movements like
sticking out the tongue and licking the lips On the other hand apraxia of speech (AOS)
refers to an inability to articulate speech and revolves around the intonation rhythm and
stress of speech also known as prosody AOS typically occurs as a result of left frontal
lesions adjacent to the Broca area (Melfi amp Garrison 2013)
As highlighted by (ASHA 2014) childhood apraxia of speech (CAS) is apraxia of
speech that occurs in children with varying signs and symptoms in younger children and
older children Among the various symptoms of CAS include late first words failure to coo
and babble choppy and monotonous speech and appearing to be groping when attempting to
produce sounds A child suffering from CAS is mentally aware of what he or she wants to say
but struggles in coordinating speech muscles to say it (ASHA 2014) Treatment or
intervention for CAS involves training the patient to improve their control over their oral
musculature and teaching them to sequence and program sounds (Melfi amp Garrison 2013)
Intervention that focuses on strengthening the oral musculature will not improve the speech
ofa child with CAS (ASHA 2014)
10
=
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
Hence AOS is a speech disorder that results from the brain being unable to coordinate
the muscles involved in speech production Therefore AOS is classified as a neurological
disorder rather than a muscular disorder
2 Dysarthria
Dysarthria IS defined as a disorder that results from the interference of the
neuromuscular control of speech (Melfi amp Garrison 2013) This is due to the weakening of
mouth face and respiratory system muscles as a consequence of a stroke or brain injury
(ASHA 2014) Melfi and Garrison (2013) categorize dysarthria into nine different types
flaccid spastic ataxic hypokinetic hyperkinetic quick slow tremors and mixed
Dysarthria is generally caused by a disorder of the nervous system that is damage to the
central or peripheral nervous system (Carter amp Musher 2013 Melfi amp Garrison 2013)
ASHA includes stroke head injury cerebral palsy and muscular dystrophy as specific causes
of dysarthria Both children and adults are susceptible to dysarthria as in the case of AOS
However this research focuses on dysarthria in children Children with dysarthria can be
identified as those with weakness slowness or incoordination of speech (Melfi amp Garrison
20l3) These children could also face swallowing problems as the same musculature is
involved in speaking and swallowing (Carter amp Musher 2013) The more precise symptoms
of dysarthria include slurred and soft speech limited tongue lip and jaw movement drooling
or poor control of saliva and slow speech rate (ASHA 2014) While treatment of dysarthria
depends on the cause type and severity of the disorder the main aim of the intervention is to
strengthen speech and swallowing muscles to increase mouth tongue and lip movement to
improve articulation so that speech is more clear and to improve breath support (ASHA
2014) Some intervention may also introduce alternative channels of communication if the
severity of dysarthria is too high
11
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
Hence dysarthria is a speech disorder that results from the weakness of muscles
involved in speech production Therefore it is usually viewed as a disorder resulting from
biologjcal or physiological weakening
Fluency Disorders
1 Stuttering
The Mayo Clinic (2014) defines stuttering as frequent and significant problems that
interrupt the fluency and flow of ones speech Stuttering is also known as stammering It
usually starts in children between the ages of two to five years (Carter amp Musher 2013)
Stuttering is not always a disorder because it is a common phenomenon among children as
they acquire and sharpen language skills This is known as developmental stuttering (Mayo
Clinic 2014) However some children do not outgrow developmental stuttering once their
language skills are fully developed and the condition persists on until adulthood This is when
stuttering is considered a disorder Carter and Musher (2013) explain that causes of stuttering
remain unclear but some studies propose an interaction between genetic and environmental
factors as a possible cause Stuttering is a rather unique disorder compared to the disorders
previously explained This is so because the incidence of stuttering varies in each individual
that is it affects only certain communication of an individual (Carter amp Musher 2013) For
example a person may stutter while talking to a large group of people but not stutter when
talking on the phone Symptoms of stuttering include repetition of words or fragments of
words and prolongations of speech sounds (ASHA 2014) Treatment and intervention for
stutterers focus on reducing the disorders impact on communication rather than trying to
completely eliminate the dysfluency of speech (ASHA 2014)
Hence stuttering is a speech disorder that results from the disruption of an individuals
flow of speech due to either interruptions or gaps in ones speech It usually starts in early
childhood and is only considered a disorder if it persists into adulthood
12
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13
Findings from Previous Studies
In the past several researches have been done to investigate the general attitudes of
individuals toward speech disorders One such study is to explore the Knowledge and
Attitudes of Students from Two Universities in the Western Cape toward Stuttering The
results obtained from this study showed that the population under study generally had
inadequate knowledge about stuttering Despite the lack of knowledge they looked at the
speech disorder (stuttering) itself positively On the other hand this population viewed the
disordered persons (stutterer) negatively (Power 2001)
At the same time there are quite a number of researches that have been done to
investigate the influences of cultural variation on the awareness of and perception toward
speech disorders Wilkerson and Bakker (2010) wrote a paper to speculate the nature of the
interaction ofcultural variation with the awareness of cluttering in North and South American
countries The fact that there is no commonly accepted word for cluttering in this society
drove the researchers to speculate this issue Battle (2010) mentions that culture serves as a
lens for one to view and comprehend the world (cited in Wilkerson amp Bakker 2010 para
11) Hence cultural beliefs can thwart the knowledge and understanding of cluttering and
other speech disorders
Bebout and Arthur (1992) conducted a study to analyse Cross-Cultural Attitudes toward
Speech Disorders among North Americans In this study the researches focused on four
specific disorders cleft palate dysfluency hearing impairment and rnisarticulation This
study was also done on university students who represented English-speaking North
American Chinese Southeast Asian and Hispanic cultures The results from this study gave
evidence to the existence of significant differences among the different cultural groups of the
population in this study
13