Abstract
Stuttering is a puzzling disorder which involves voluntary repetition, prolongation along with blocking and other interruptions to the flow of speech. Stuttering impacts on quality of life of individuals with difficulties in overall social behavior and performance. The present study focuses on perception of stuttering by individual with stuttering and their experiences toward their stuttering among family and society. The present study was carried out in two phases. Phase 1 included the development of questionnaire and phase 2 incorporated the administration of questionnaire and analysis of the results. Total of 20 participants (16 males and 4 females) between the age ranges of 15–50 years (SD = 8.33) were included in the study. The results of present study consisted of perception of the individual with stuttering, their family members and other people regarding the probable cause, effects and treatment of stuttering. The causes were than categorized into psychological, superstitious, genetic, physiological and unknown. Likewise the treatment was categorized into speech therapy, medical treatment, self management strategies, superstitious beliefs and unknown. Many of the participants, their family members and other people had inappropriate, irrational and superstitious believes about the cause and treatment of stuttering due to which they faced many difficulties in their life. Hence from this study we conclude that there is requirement of awareness regarding the etiologies of stuttering and its consequences in hazarding the quality of life. It was also observed the urgent need of awareness regarding the speech therapy and its beneficial outcome in enhancing the fluency of individuals with stuttering, therefore, avoiding the consequence of the condition in their life.
Keywords: Stuttering, Individual perceptions
Introduction
Stuttering is a mystifying disorder which involves voluntary repetition, prolongation along with blocking and other interruptions to the flow of speech [1]. The prevalence of stuttering has been reported approximately 1% of the world’s population and males being four times more likely affected than females [2, 3]. Regardless of plentiful literatures, none has ever reported the specific etiological condition [4]. Therefore it’s generally believed to have multifactorial etiologic condition [5, 6] that may vary across each individuals [7] resulting in variation in the characterizing features and degree of stuttering.
Along with the physical manifestations, the condition gets worsen with the presence of secondary behaviors (such as eye blinking, head jerking, foot stamping, and avoidance) and an emotional reaction to oneself as being a person who stutters [8]. These emotional reactions can be intense and significantly impact on the quality of life of individuals with stuttering [8]. The disruptions in speech fluency that these individuals experience are often accompanied by adverse affective, cognitive, and behavioral reaction that stem from these disruptions [9] resulting difficulties in academics [10], social participations [11, 12] and employment [13, 14]. Moreover, the anticipation of negative reaction from listeners toward stuttering causes these reactions to occur [15–17] resulting in stereotyped quite, shy, guarded, anxious, and nervous individuals who are nevertheless friendly, intelligent and cooperative [17].
Immense literatures (e.g. [18–22]) have been documented regarding the pervasive negative or stuttering attitudes among non-stuttering adults across widely variable populations and cultures, and reported that the general public often have misconceptions about the causes of the stuttering and may subsequently perceive an individual with stuttering as being anxious, shy, nervous, unintelligent and incompetent [17]. Few of the studies have reported regarding the perceived impact of stuttering on quality of life in individuals with difficulties in overall social behavior and performance [8, 16, 23]. Psychological processes of individuals with stuttering are complexly related to their speech production behavior including report of challenge, triumph, and heartache [24, 25]. However, none of the earlier studies have ever reported the experience of individuals with stuttering on their own. Hence observing the dearth of studies in understanding these conditions in individuals with stuttering, the present study focuses on perception of stuttering by individual with stuttering and their experiences toward their stuttering among family and society.
Method
The present study was carried out in two phases. Phase 1 included the development of questionnaire and phase 2 incorporated the administration of questionnaire and analysis of the results.
Phase 1: Development of Questionnaire
Prior questionnaires related to stuttering were studied [26–29] for better understanding of the factors to be included in the questionnaire in the present study. Hence, the questionnaire for stuttering individuals was developed in native Gujarati language and translated in English for further analysis. Different questions regarding the individual perception of stuttering, personal experience and opinion among family and society to cure stuttering were included in the questionnaire. The questionnaire was divided into two sections where the first section consisted of the questions regarding the demographic details of an individual with stuttering. The second section consisted of sixteen open set questions about stuttering, personal experience and opinion among family and society to cure stuttering. Therefore, the questionnaire was distributed among 10 related professionals such as speech language pathologists, audiologists, psychologists and otorhinolaryngologists to review and validate the questions. Later, the questionnaire was revised based on the suggestions provided and was utilized for the study.
Phase 2: Administration of Questionnaire and Analysis of Results
Participants
Total of 20 participants (16 males and 4 females) between the age ranges of 15–50 years (SD = 8.33) were included in the study. All the participants were native Gujarati speakers with moderate to severe stuttering using SSI and SPI at Department of Audiology and Speech Therapy, C. U. Shah Medical College and Hospital, Gujarat, India.
Procedure
Questionnaire was provided to each of the participants and was instructed to be honest with their answer as possible. Formal informed consent was taken from each of the participants regarding the confidentiality of information collected would be maintained.
Statistical Analysis
The collected data was analyzed descriptively to determine the frequency and percentage of the participants by using software SPSS 14.0 version.
Result
Twenty individuals with stuttering who participated in the study were of different professional backgrounds with 35% students, 15% housewives, 10% medical doctors and cashiers each and remaining 5% mess boy, peon, sales manager, photographer, database operator and chef each. All these individuals were asked 16 open ended questions regarding the possible etiology behind the stuttering which they felt the most as well as by their family members and other individuals. Therefore the detail of their answers were attempted to be put together in terms of psychological, cultural, superstitions or hereditary factors as mentioned by them.
Possible Cause of Stuttering
Psychological
From the responses obtained, it was found that 45%, 40% and 45% of the individuals with stuttering, their family members and other people respectively reported that the etiology of stuttering could be psychological in nature that might be fear, imitation, low confidence, frustration, wrong model of speech in early childhood etc. in these individuals.
Superstitious Belief
Different superstitious beliefs such as punishment given by the god for the bad deeds, common problem occurring to every child in their childhood etc. were reported in the study by the individuals with stuttering (10%), their family members (15%) and other people (5%).
Genetic and Hereditary
Also, few of the individuals with stuttering (25%), their family members (15%) believed that the cause for stuttering could be due to the hereditary in nature, transferring from one to next generation.
Physiological
Some individuals having stuttering reported that according to them (10%), their family member (5%) and other people (15%), the possible cause of the problem was some physiological abnormality such as breathing difficulty, tongue abnormality and developmental deficiency.
Idiopathic
However, a large number of individuals with stuttering (15%), their family members (30%) and other people (35%) reported that they are unaware of the etiology of the problem.
The detail of the responses of all the individuals with stuttering, their family members and other individuals are listed in Table 1.
Table 1.
Probable cause of stuttering reported by individual with stuttering as per them, their family members and other people
| Frequency | Percentage (%) | |
|---|---|---|
| Possible cause of stuttering as per individual having stuttering | ||
| Fear | 4 | 20 |
| Hereditary | 4 | 20 |
| Wrong speaking habits in childhood | 2 | 10 |
| Abnormality in tongue | 2 | 10 |
| Imitation of friends who has stuttering | 1 | 5 |
| Genetic | 1 | 5 |
| Sucking of water through straw in childhood | 1 | 5 |
| Lack of self confidence | 1 | 5 |
| Punishment of god for my bad deeds | 1 | 5 |
| Unpleasant incident happened at home | 1 | 5 |
| Unknown cause | 3 | 15 |
| Possible cause of stuttering by Family members | ||
| Fear | 5 | 25 |
| Hereditary | 3 | 15 |
| Punishment of god for my bad deeds | 2 | 10 |
| Unpleasant incident at home | 1 | 5 |
| Low will power | 1 | 5 |
| Wrong speaking habits in childhood | 1 | 5 |
| Happens to every child in their childhood | 1 | 5 |
| Breathing difficulties | 1 | 5 |
| Unknown cause | 6 | 30 |
| Possible cause of stuttering by Family members | ||
| Fear | 5 | 25 |
| Wrong speaking habits in childhood | 3 | 15 |
| Abnormality in tongue | 2 | 10 |
| Developmental deficiency | 1 | 5 |
| Punishment of god for my bad deeds | 1 | 5 |
| Frustration | 1 | 5 |
| Unknown cause | 7 | 35 |
Effect of Stuttering on Individual’s Life
In the present study, individuals were also asked regarding the effect of stuttering on their life. Hence, the various aspects such as communication, academic performance, career opportunities, relationship maintenance and daily routine work were reported disturbed. There were few individuals who reported to have no effect of stuttering on their life. Hence, the detail of their answers were attempted to be put together as mentioned by them.
Communication
In the present study, 50% of the individuals with stuttering reported the difficulty in communication with other people. Also, 55% of these individuals stated inability to express the needs, thoughts and knowledge. 25% reported shamefulness while and 15% stated low confidence and anticipatory fear while speaking resulting in affected fluency of speech.
Academic Performance and Career Development
In case of academic performance, 15% of the individuals reported inability to answer the question in classroom. Similarly, 15% of them stated to have been unable in paper presentation while 10% of them reported poor performance in practical viva examination even after having the knowledge of the questions being asked. Also, 45% of the individuals reported difficulty in debate competition and meeting and 15% of them in on-stage performance. 30% of them reported to have difficulty in facing interview resulting in poor career performance.
Relationship
Building and maintaining relationships with different individuals were reported to have affected immensely by around 50% of the time in individuals with stuttering. Moreover 25% of them reported unable to express themselves to their loved ones and 15% reported being rejected for marriage due to the problem. Also, 10% of the individuals reported the helplessness to maintain their relationship and friendship due to the problem.
Routine Activities
The individuals with stuttering also stated difficulty in carrying out routine activities where 15% of them informed to have difficulty in doing outdoor works while 5% reported to have delayed performance due to organizational issue. Also, 5% of them reported to be dependent on others for their own work.
The detail of the responses of all the individuals with stuttering regarding the effect of problem in their living are listed in Table 2.
Table 2.
Consequences of stuttering on individual’s life
| Effect of stuttering on individual’s life | Frequency | Percentage (%) |
|---|---|---|
| Difficulties in communication with other people | 10 | 50 |
| Inability to put my word in debate competition and meeting | 9 | 45 |
| Inability to express the needs, thoughts and knowledge | 8 | 40 |
| Poor academic performance | 7 | 35 |
| Difficulties in facing interview and getting job | 6 | 30 |
| Inability to maintain relationship and friendship | 5 | 25 |
| Guilty and feeling shameful while talking to others | 5 | 25 |
| Lack of self confidence and fear of stuttering while speaking | 3 | 15 |
| Difficulties in speaking/anchoring on stage | 3 | 15 |
| Inability to do the paper presentation | 3 | 15 |
| Difficulties in doing outdoor works | 3 | 15 |
| Inability to express appropriate word | 3 | 15 |
| Difficulties in marriage | 3 | 15 |
| Inability to answer the question in classroom | 3 | 15 |
| Difficulty to face practical viva examination | 2 | 10 |
| Inability to propose a girl whom I loved | 2 | 10 |
| Inability to do the work in limited (fixed) time duration | 1 | 5 |
| Always being dependent on other | 1 | 5 |
| No effects | 10 | 50 |
Possible Treatment of Stuttering
In the questionnaire, questions regarding the possible treatment for stuttering as per individual with stuttering, their family members and other people were also included to have a sight at the understanding of the problem in general public. Most of the individuals gave more than one answers for each questions which could be divided into five categories as (1) Speech therapy, (2) medical treatment (ayurvedic and allopathic), (3) self management technique, (4) irrational and (5) unknown which are listed in Table 3.
Table 3.
Possible treatment reported by individual with stuttering as per them, their family member and other people
| Possible treatment for stuttering reported by individuals with stuttering | ||
|---|---|---|
| Frequency | Percentage (%) | |
| As per individuals | ||
| Speech therapy | 7 | 35 |
| Slow speaking | 3 | 15 |
| Speaking with self-confidence | 2 | 10 |
| Allopathic Medicine | 2 | 10 |
| Eating almonds and cow’s ghee | 1 | 5 |
| Spontaneous Recovery | 1 | 5 |
| God’s prayer | 1 | 5 |
| Not Curable | 1 | 5 |
| Not known | 2 | 10 |
| As per family members | ||
| Slow speaking | 5 | 25 |
| Speech therapy | 5 | 25 |
| Eating almonds and cow’s ghee | 2 | 10 |
| Allopathic Medicine | 2 | 10 |
| God’s prayer | 2 | 10 |
| Speaking with strangers | 1 | 5 |
| Ayurvedic medicine | 1 | 5 |
| Reading loudly | 1 | 5 |
| Not known | 1 | 5 |
| As per other people | ||
| Speaking in front of mirror | 3 | 15 |
| Speech therapy | 3 | 15 |
| Holding eatable thing in mouth while speaking | 2 | 10 |
| Allopathic Medicine | 2 | 10 |
| Eating green chilly | 2 | 10 |
| Slow speaking | 1 | 5 |
| Fearless speaking | 1 | 5 |
| Curing tongue abnormality | 1 | 5 |
| Marrying and having child | 1 | 5 |
| Not known | 4 | 20 |
Speech Therapy
There were 35% of the participants who thought stuttering could be cured with regular speech therapy. Similarly, 25% of the family members suggested speech therapy as the treatment option for the condition. However, only 15% was advised by other people to treat stuttering.
Medical Treatment (Ayurvedic and Allopathic)
In this category, 10% of the individuals with stuttering thought their problem to be cured by allopathic medicine while 15% of the family members thought stuttering to be cured by allopathic and ayurvedic medicine. Allopathic medicine and surgical treatment were suggested by 15% of others people as they perceived the problem was due to the abnormality of tongue or orofacial anomalies.
Self Management Strategy
Many individuals with stuttering, their family members and others believed stuttering to be reduced with self management strategy. 25% of these individuals thought stuttering to be cured with self management skills like slow speech and speaking with confidence. 35% of the family members reported strategy such as slow speech, practice speaking with strangers and reading loudly while 25% self management advice by other peoples were to speak infront of mirror, slow speech and fearless speech to reduce stuttering.
Superstitious Believes
Many of the individuals with stuttering reported superstitious beliefs and irrational thoughts in treating the problem. 5% of them reported the stuttering to be cured with eating almonds and cow’s ghee while other 5% reported it be cured by praying the god. 20% of the family members believed to be cured by eating almond and cow’s ghee and praying to god. Also, 25% irrational advices given to these individuals by other people include holding eatable thing in mouth while speaking, eating green chillies and by marrying and having child.
Idiopathic
There were few individuals with stuttering who were not known about the treatment of stuttering, neither were their family members and other people. 10% of these individuals reported to be not unknown regarding any treatment of stuttering while 5% of them reported it to be not curable. Also, 5% of the family members were unknown about stuttering treatment and 20% of the response by other people was regarding the treatment to be unknown.
Perception of Stuttering in Multimedia
In the present study, individuals with stuttering were asked regarding the rationality of the projection of stuttering in various multimedia content. Around 65% of the individuals in the study reported the presence of the character of stuttering individuals in various T.V serials and cinemas irrespective of the languages. 50% of these individuals reported the content to be appropriate and useful in awareness regarding the problem. However, other 50% of the individuals believed inappropriate replication of stuttering in the multimedia by trying to create humor in the programme with projecting disorder than creating awareness.
Individual’s Curiosity to Know About Stuttering
The present study tried to understand the queries present in individuals with stuttering regarding the problem where 40% of them had the common query about the etiology of the problem. Other 35% enquired regarding the possible treatment and its onset of the problem. 20% of the individuals had queried about the curability of the problem and 5% wanted to know if the problem was due to any of their superstitious beliefs.
Perception of Other People About Intelligence of Individuals Who Have Stuttering
In this part of the study, individuals with stuttering were asked about their opinion regarding the perception of their intelligence by other people in the society. 70% of them believed to be treated equally in terms of intelligence. However, 25% of them reported the presence of discrimination in terms of intelligence due to the stuttering. 5% of them did not have any issue regarding the intelligence.
Message by Individuals to Other individuals with stuttering
In this part of the study, these individuals were asked if they wanted to convey any message to other individuals with stuttering. Various answers were reported by these individuals regarding the issue, possible rehabilitative measure and their beliefs which are depicted in Table 4.
Table 4.
Possible treatment reported by individual with stuttering as per them, their family member and other people
| Message conveyed by individuals having stuttering | Frequency | Percentage (%) |
|---|---|---|
| Speaking without fear and hesitation and be confidant while speaking | 7 | 35 |
| Take speech therapy | 5 | 25 |
| Face the situation, again and again in which you find most difficulty while speaking | 3 | 15 |
| Speak clearly | 3 | 15 |
| Stuttering is curable | 2 | 10 |
| Not to think them self inferior to other people | 2 | 10 |
| Creating awareness about stuttering and speech therapy so, can cure most of the people and they can get advantage | 1 | 5 |
| Shouldn’t make fun of individual with stuttering as it can happen to anyone | 1 | 5 |
| accept this problem as god’s will | 1 | 5 |
| Didn’t have any message to convey | 1 | 5 |
Discussion
The present study was based on open ended questions. These questions were based on perception of individuals with stuttering, their family members and other people about the cause, effect of stuttering on individuals’ life, possible treatment felt by them and the effect of multimedia in projecting the disorder.
In the present study, the possible etiology behind the stuttering which was felt the most by individuals with stuttering, their family members and other individuals was psychological in nature which included fear, imitation of friend who had stuttering, low confidence, frustration, wrong model of speech in early childhood etc. Similar result was reported by Kollabruner et al. [30] where most of their participants reported fear, frustration, loneliness, desperation, depression, shock and anger to be the cause for stuttering and believed to have adverse effect in their communication. Similarly, many studies have been reported where the psychological factors such as nervousness, frustration and anxiousness have been attributed by the individuals with stuttering as an etiological factor behind their problem and its adverse effect in speech fluency in both child and adult [31, 32]. Also in the present study, few of the individuals with stuttering, their family members and other people were observed to have superstitious and irrational beliefs for the occurrence of stuttering which was found mostly in illiterate individuals that might be due to the lack of awareness of the condition. Similar results were previously reported in the literature [31, 33–36] where these irrational thoughts have been attributed by these individuals with stuttering for the problem. Moreover, few of the individuals reported the possible etiology for stuttering could be hereditary in nature. These are in coherence with the study by [36, 37] where the hereditary and genetics had been attributed for the presence of stuttering. Also, few of the individuals reported their stuttering could be due to the physiological reasons such as abnormalities in tongue, developmental deficiencies etc. Similar understanding about stuttering was found to be present in earlier days [38, 39] due to the lack of thorough understanding of the disorder. By the early 1800s the cause of stuttering was generally accepted as a disruption in the wider speech apparatus, especially the tongue [40]. Also, few of the individuals, their family members and other people reported no probable cause for the condition which was in coherence with earlier reports [26, 41].
Core behaviors in the individuals with stuttering such as fear, anxiety, depression, shame etc. could affect their quality of life [42]. It was coherent in our study where these behaviors were found to have resulted negative effects in individuals’ life affecting communication, academic performance and career development, relationship and routine activities. In the study, these individuals with stuttering reported inability to express the needs, thoughts, and knowledge to other people. Similar results were reported by Kasbi et al. [43] and Tiffani [31] where the individuals embarrassment and disappointment in social communication interactions resulting anxiety and other behavioral deviations such as avoidance and fear from social and communication. In the present study, few of the individuals reported the negative impact of stuttering on their academic performance and career development which could be due to the low self-confidence level. These individuals were reported to have good knowledge of the content being discussed and were still having difficulty in participating in classroom interaction, presentation, interview and viva exams. These results are in coherence with earlier studies [44–47] where the stuttering was found to have adverse affect in academic and professional success. In the present study, some of these individuals reported inability to maintain their relationship as well as friendship which was in coherence with the study by Shears [48], where most of the individuals reported to have difficulties in getting married and other married individuals reported unhappy married life due to the stuttering. There were few individuals in the present study who reported delayed performance of their routine activities and therefore, reliance on others for the completion due to the stuttering. These results were in coherence with the study by Klompass and Ross [26]. However, few of the individuals in our study reported no effect of stuttering on their life. Similar results were earlier reported by Klompass and Ross [26, 43] which could be due to the lesser degree of the problem and the cope mechanism developed by individuals after some period of time.
In the present study, all the individuals with stuttering, their family members and other people expressed their opinion regarding the possible treatment of the disorder. There were some individuals who were aware about their problem and reported speech therapy to be the possible rehabilitative method for the same. Similar reports were suggested by the family members and other people for intervening the condition. This suggests the growing awareness among the individuals regarding fluency disorder and its intervention approach. Also, in the survey by National Stuttering Association [49], it was found that most of the individuals recommended speech therapy as a primary treatment for stuttering. Also, in the present study, few of the individuals with stuttering, their family members and other people reported medical treatment could be possible approach for treating the condition which was similar to the perception of participants in the study of Klompas and Ross [26]. This type of postulation might be due to the lack of understanding of the mechanism of stuttering and therefore, assuming the treatment based on the overt features of the disorder in general public. In the present study, some of the self management strategies like speaking slowly and confidently, speaking with strangers, reading loudly and speaking in front of mirror were used by these individuals to intervene stuttering. Some of which were also suggested by their family members and other people. Moreover, these types of understanding in individuals with stuttering were previously reported [50, 51]. Also, some of them with superstitious beliefs about the etiology of their problem, also believed the same for the treatment in the present study. These beliefs included praying to the god, putting eatable things under the tongue, eating green chili, almonds, cow’s ghee, marrying and having children. Similar studies were previously reported in the literature where these irrational beliefs were attributed to the illiteracy and lack of awareness about the condition and its treatment [26, [52].
In the present study, we have tried to understand the opinion of individuals with stuttering, their family members and other people regarding the projection of the condition in multimedia. 50% of the individuals with stuttering in this study believed that there is inappropriate replication of stuttering in the multimedia by displaying individuals as introvert or less intelligent. It was found to affect these individuals with humiliation, embarrassment and frustration resulting in the isolation from the society. Similar studies were reported earlier [53, 54] where an adverse impact in the quality of life of these individuals was found.
Conclusion
In the present study, many individuals with stuttering, their family members and other people had inappropriate, irrational and superstitious beliefs about the cause, consequences and treatment of stuttering. It was found to have adverse effect in individuals’ life with underestimation of their ability, consideration as less intelligent individuals etc. Scenario was reported to go worst with embarrassment causing multimedia content broadcasting wrong representation of these individuals with stuttering. Hence from this study we conclude that there is requirement of awareness regarding the etiologies of stuttering and its consequences in hazarding the quality of life. It was also observed the urgent need of awareness regarding the speech therapy and its beneficial outcome in enhancing the fluency of individuals with stuttering, therefore, avoiding the consequence of the condition in their life.
Appendix
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References
- 1.Bloodstein O. A handbook on stuttering. 5. San Diego, CA: Singular; 1995. [Google Scholar]
- 2.Carlson N. Physiology of behavior. 11. Boston: Allyn and Bacon; 2013. Human communication; pp. 497–500. [Google Scholar]
- 3.Stuttering facts and information. FAQ. Stuttering foundation. https://www.stutteringhelp.org/faq.
- 4.Packman A. Attanasio J (2004) Theoretical issues in stuttering. New York: Psychology Press; 2004. [Google Scholar]
- 5.Ambrose NG. Theoretical perspectives on the cause of stuttering. Contemporary Issue Commun Sci Disorders. 2004;31:80–91. doi: 10.1044/cicsd_31_S_80. [DOI] [Google Scholar]
- 6.Onslow M. Treatment of stuttering in preschool children. Behav Change. 2004;21(4):201–214. doi: 10.1375/bech.21.4.201.66104. [DOI] [Google Scholar]
- 7.Millard SK, Nicholas A, Cook FE. Is parent-child interaction therapy effective in reducing stuttering? J Speech Lang Hearing Res JSLHR. 2008;51(3):636–650. doi: 10.1044/1092-4388(2008/046). [DOI] [PubMed] [Google Scholar]
- 8.Daniels D, Gabel R. The Impact of Stuttering on Identity Construction. Topics in Language Disorders. 2004;24:200–215. doi: 10.1097/00011363-200407000-00007. [DOI] [Google Scholar]
- 9.Bennett MP, Cecile A (2006) Humor and laughter may influence health. I. History and background”. Evidence-based complementary and alternative medicine: eCAM 3(1): 61–63. [DOI] [PMC free article] [PubMed]
- 10.Dorsey RM, Guenther K. Attitudes of professors and students toward college students who stutter. J Fluency Disorders. 2000;25(1):77–83. doi: 10.1016/S0094-730X(99)00026-1. [DOI] [Google Scholar]
- 11.Boberg MJ, Boberg E. The other side of the block: the stutterer's spouse. J Fluency Disorders. 1990;15:61–75. doi: 10.1016/0094-730X(90)90033-O. [DOI] [Google Scholar]
- 12.Linn GW, Caruso AJ. Perspectives on the effects of stuttering on the formation and maintenance of intimate relationships. J Rehab. 1998;64:12–15. [Google Scholar]
- 13.Gabel R, Blood W, Tellis G, Althouse MT. Measuring role entrapment of people who stutter. J Fluency Disorders. 2004;29:27–49. doi: 10.1016/j.jfludis.2003.09.002. [DOI] [PubMed] [Google Scholar]
- 14.Hurst MI, Cooper EB (1983) Employer attitudes toward stuttering. J Fluency Disordes 8(1):1–12. 10.1016/0094-730X(83)90017-7.
- 15.Sheehan B. Stuttering: A second symposium. Jon Eisenson, New York: Harper & Row; 1975. Conflict theory and avoidance-reduction therapy; pp. 97–189. [Google Scholar]
- 16.Van Riper C. The nature of stuttering. Englewood Cliffs, NJ: Prentice-Hall; 1982. [Google Scholar]
- 17.Woods CL, Williams DE. Traits attributed to stuttering and normally fluent males. J Speech Hear Res. 1976;19(2):267–278. doi: 10.1044/jshr.1902.267. [DOI] [PubMed] [Google Scholar]
- 18.Abdalla FA, St. Louiss KO. Arab school teachers’ knowledge, beliefs and reactions regarding stuttering. J Fluency Disorders. 2012;37:54–69. doi: 10.1016/j.jfludis.2011.11.007. [DOI] [PubMed] [Google Scholar]
- 19.Crowe TA, Walton JH. Teacher attitudes toward stuttering. J Fluency Disorders. 1981;6:163–174. doi: 10.1016/0094-730X(81)90013-9. [DOI] [Google Scholar]
- 20.Hughes S (2015) Attitudes toward stuttering: an annotated bibliography. In: St. Louis KO (ed) Stuttering meets stereotype, stigma, and discrimination: an overview of attitude research, pp 310–350. West Virginia University Press, Morgantown
- 21.Hughes S, Gabel R. Roseman C, Daniels D (2015) An interdisciplinary training program in stuttering: raising awareness and changing attitudes. In: St. Louis KO (ed) Stuttering meets stereotype, stigma, and discrimination: an overview of attitude research, pp 243–252. West Virginia University Press, Morgantown.
- 22.Ruscello DM, Lass NJ, Schmitt JF, Pannbacker MD. Special educators’ perceptions of stutterers. J Fluency Disorders. 1994;19:125–132. doi: 10.1016/0094-730X(94)90018-3. [DOI] [Google Scholar]
- 23.O’Keefe BM. Communication disorders. In: Renwick R, Brown I, Nagler M, editors. Quality of life in health promotion and rehabilitation. London: Sage Publications; 1996. pp. 219–236. [Google Scholar]
- 24.Ginsberg A. Shame, Self-Consciousness, and Locus of Control in People Who Stutter. The Journal of genetic psychology. 2001;161:389–399. doi: 10.1080/00221320009596720. [DOI] [PubMed] [Google Scholar]
- 25.Conture EG. Stuttering: Its nature, diagnosis, and treatment. 3. Boston: Allyn & Bacon; 2001. [Google Scholar]
- 26.Klompas M, Ross E. Life experiences of people who stutter, and the perceived impact of stuttering on quality of life: personal accounts of South African individuals. J Fluency Disord. 2004;29(4):275–305. doi: 10.1016/j.jfludis.2004.10.001. [DOI] [PubMed] [Google Scholar]
- 27.Nang C, Hersh D, Milton K, Lau SR. The impact of stuttering on development of self-identity, relationships, and quality of life in women who stutter. Am J Speech-Language Pathol. 2018;27(2018):1244–1258. doi: 10.1044/2018_AJSLP-ODC11-17-0201. [DOI] [PubMed] [Google Scholar]
- 28.Weidner ME, St. Louis KO, Nakisci E, Ozdemir RS. A comparison of attitudes towards stuttering of non-stuttering preschoolers in the United States and Turkey. South Af J Commun Disord. 2017;64(1):a178. doi: 10.4102/sajcd.v64i1.178. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Smith, Katie Lauren (2018) Listener's perceptions of stuttering (2018) Linguistics Senior Research Projects. 15. http://digitalcommons.cedarville.edu/linguistics_senior_projects/15.
- 30.Kollbrunner J, Wedell SF, Zimmermann A, Seifert E (2014) Stuttering risk: neurophysiological and genetic findings versus psychosocial insights. A proposal for a resolution. J Psychol Clin Psychiatry 1(7):00044. 10.15406/jpcpy.2014.01.00044.
- 31.Tiffani K (2014) Education and changing the perceptions of stuttering. Proc Natl Conf Undergraduate Res, pp 492–499. 10.13140/2.1.2961.3763.
- 32.Ruscello DM, Lass NJ, Brown J. College students' perception of stutterers. NSSLHA J. 1988;16(1988):115–120. doi: 10.1044/nsshla_16_115. [DOI] [Google Scholar]
- 33.Rathu N, Mathew K (2009) Cultural perspectives in language and speech disorders. Disability Stud Quarterly, vol 29. 10.18061/dsq.v29i4.986.
- 34.Al-Khaledi M, Lincoln M, McCabe P, Packman A, Alshatti T. The attitudes, knowledge and beliefs of Arab parents in Kuwait about stuttering. J Fluency Disord. 2009;34(1):44–59. doi: 10.1016/j.jfludis.2009.02.003. [DOI] [PubMed] [Google Scholar]
- 35.Erickson JG, Devlieger PJ, Sung JM. Korean-American female perspectives on disability. Am J Speech-Language Pathol. 1999;8(2):99–108. doi: 10.1044/1058-0360.0802.99. [DOI] [Google Scholar]
- 36.Kidd KK (1983) Recent progress on the genetics of stuttering, genetic aspects of speech and language disorders. In: Ludlow CL, Cooper JA (ed) Academic Press, New York.
- 37.Howell P. Signs of developmental stuttering up to age eight and at 12 plus. Clin Psychol Rev. 1999;27(3):287–306. doi: 10.1016/j.cpr.2006.08.005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38.Bloodstein O, Berstein Ratner N (2008) A handbook on stuttering, 6th edn. Delmar, Clifton Park, NY.
- 39.Kraft SJ, Yairi E (2011) Genetic bases of stuttering: the state of the art, 2011” Folia phoniatrica et logopaedica: official organ of the International Association of Logopedics and Phoniatrics (IALP) vol. 64(1): 34–47. 10.1159/000331073. [DOI] [PMC free article] [PubMed]
- 40.Büchel C, Sommer M. What causes stuttering? PLoS Biol. 2004;2(2):E46. doi: 10.1371/journal.pbio.0020046. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 41.Wingate ME (2002) Foundation of stuttering. San Diego: Academic press. J Acoust Soc Am 112:1229. 10.1121/1.1501910.
- 42.Silverman FH. Stuttering and other fluency disorders. 3. Long Grove, IL: Waveland Press; 2004. [Google Scholar]
- 43.Kasbi F, Majid M, Maryam M, Marziye M, Reyhaneh N, Leyla M, Majid MMR (2015) Effects of stuttering on quality of life in adults who stutter. Middle East J Rehabil Health. 2. e25314. 10.17795/mejrh-25314.
- 44.Sanju HK, Choudhury M, Kumar V. Effect of stuttering intervention on depression, stress and anxiety among individuals with stuttering: case study. J Speech Pathol Ther. 2018;3:132. doi: 10.4172/2472-5005.1000132. [DOI] [Google Scholar]
- 45.Sari H, Gökdağ H. An analysis of difficulties of children with stuttering enrolled in Turkish primary inclusive classes who encounter in Academic and social activities: from their perspectives. J Educ Pract. 2018;8:31–43. [Google Scholar]
- 46.ASHA (American Speech-Language-Hearing Association) (1999) Terminology pertaining to fluency and fluency disorders: guidelines. American Speech-Language-Hearing Association.
- 47.Klein FJ, Hood SB. The impact of stuttering on employment opportunities and job performance. J Fluency Disord. 2004;29:255–273. doi: 10.1016/j.jfludis.2004.08.001. [DOI] [PubMed] [Google Scholar]
- 48.Shears ML, Carl JJ. Social acceptability of anomalous persons. Exceptional Child. 1969;36:91–96. doi: 10.1177/001440296903600204. [DOI] [PubMed] [Google Scholar]
- 49.A Survey by the National Stuttering Association (2009) The experience of people who stutter. https://westutter.org/wp-content/uploads/2016/12/NSAsurveyMay09.pdf.
- 50.Eric S Jackson, Jonathan Scott Yaruss, Robert W Quesal, Valerie Terranova, Douglas H. Whalen. Responses of adults who stutter to the anticipation of stuttering. Journal of fluency disorders 45 (2015):38–51. 10.1016/j.jfludis.2015.05.002. [DOI] [PMC free article] [PubMed]
- 51.Milton K (2013) Women who stutter : experiences of developing self-management and quality of life. Retrieved from https://ro.ecu.edu.au/theses_hons/90.
- 52.Tellis G, Tellis C. Multicultural issues in school settings. Semin Speech Lang. 2003;24:21–26. doi: 10.1055/s-2003-37447. [DOI] [PubMed] [Google Scholar]
- 53.Miller T (2015) Stuttering in the Movies: Effects on Adolescents' Perceptions of People who Stutter. WWU Graduate School Collection. 409. https://cedar.wwu.edu/wwuet/409.
- 54.Evans J, Williams R. Stuttering in film media—investigation of a stereotype. Proc Soc Behav Sci. 2015;193:337. doi: 10.1016/j.sbspro.2015.03.310. [DOI] [Google Scholar]