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The purpose of this factorial study was to establish normative data for the Italian version of the Communication Attitude Test (CAT) in order to determine whether or not the speech-associated attitude reported by Italian children who stutter (CWS) differs significantly from that of their nonstuttering peers (CWNS). Toward this end, the Italian CAT was administered to 149 CWS and 148 CWNS between the ages of 6 and 14. The results showed that the mean CAT score of the CWS sampled is higher, to a statistically significant extent, than that of their nonstuttering peers. Moreover, age and gender did not differentially affect this result. Together, these findings and the large between-group effect size suggest that the CAT is a useful clinical aid in evaluating the attitude of Italian children whose fluency is problematic. It can serve well to determine if a child's speech-associated belief system needs to be addressed in therapy and, if so, whether or not the cognitive change tactics employed have been effective.

It has been well established that speech disruption is but one component of the stuttering syndrome (Brutten & Shoemaker, 1967; Cooper, 1979, Williams, 1957 and Wingate, 1964). Indeed, research has shown that the speech-associated attitudinal, emotional and coping reactions of those who stutter need to be assessed to fully highlight the multi-dimensional nature of this disorder. Moreover, clinicians and applied researchers have come to view the attitude of the person who stutters (PWS) as playing an important role in both the instatement and maintenance of fluency (Guitar, 1976 and Guitar, 2006; Peters & Guitar, 1991). In this regard, there is evidence that a PWS’ negative attitude toward speech increases the likelihood of relapse (Andrews & Cutler, 1974) while a positive belief about one's verbal ability tends to aide long-term maintenance of improvement (Guitar, 1976 and Guitar, 2006; Guitar & Bass, 1978). The therapeutic importance of improving the attitude of PWS has been echoed by Ryan, 1974 and Ryan, 1979, Cooper (1979), Perkins (1979), Boberg (1981), among others. The therapeutic value of improving attitude has been supported by a survey of members of the National Stuttering Association (McClure & Yaruss, 2003). They rated therapy that incorporated attitude change as resulting in a ‘very successful’ outcome, compared to stuttering modification (30% very successful) and fluency shaping (19% very successful). Self-report test procedures have long been used to measure the attitude toward speech of adults who stutter (Andrews & Cutler, 1974; Erickson, 1969; Johnson, Darley, & Spriestersbach, 1952; Lanyon, 1967 and Shumak, 1955). However, it was not until a couple of decades later that inventories of this type were fully developed so that the speech-related belief of children who stutter could be adequately measured. The delay appears, in part, to have resulted from the concern that directly asking children about their attitude might draw attention to their speech and worsen their condition (Johnson, 1961; Johnson, Brown, Curtis, Edney, & Keaster, 1967). Grims (1978) and Guitar and Grims (1979) were the first to propose a scale that directly assessed the attitude of children about their speech through their response to 19 speech-specific statements. The A-19 scale did not prove to significantly differentiate the attitude of children who stuttered from those who did not. Some years later, Brutten (1984) re-opened the issue of whether or not the speech-associated attitude of grade-school children who stutter differs from that of their peers who do not. Toward this end he designed the Communication Attitude Test (CAT), a self-report test containing 35 statements that children are to answer with true or false depending upon whether or not they reflect the way they think about their speech. The first investigation that employed the Communication Attitude Test involved 518 nonstuttering grade-school children (Brutten & Dunham, 1989). The results indicated both that nonstutterers display very little in the way of a negative attitude toward speech and that the CAT provided considerable room for measuring the attitude of children whose belief system might be more negative. Since its development, the CAT has been translated into various languages and has been subject to extensive international use by clinicians and applied researchers. Moreover, the results of a series of investigations have shown that the CAT is an internally reliable instrument (Brutten & Dunham, 1989; Brutten and Vanryckeghem, 2003 and Brutten and Vanryckeghem, 2007; De Nil & Brutten, 1991) that has good test–retest reliability (Vanryckeghem and Brutten, 1992a and Vanryckeghem and Brutten, 1992b), and is sensitive to behavior change (Johannisen & Wennerfeldt, 2000; Vanryckeghem and Brutten, 1992a and Vanryckeghem and Brutten, 1992b). In addition, the CAT has been shown to have content, criterion and construct validity (Brutten and Vanryckeghem, 2003 and Brutten and Vanryckeghem, 2007; DeKort, 1997). Between-group studies of the CAT have also shown that it is helpful in differentiating normally fluent children (CWNS) from those who stutter (CWS). As a group, youngsters who stutter report a significantly more negative speech-associated attitude than their peers who do not stutter (Boutsen & Brutten, 1990; Brutten and Vanryckeghem, 2003 and Brutten and Vanryckeghem, 2007; De Nil & Brutten, 1991; De Nil, Brutten, & Claeys, 1985; Jaksic Jelcic & Brestovci, 2000; Vanryckeghem & Brutten, 1992a). Still more, within-group comparisons have shown that, cross-culturally, the mean CAT scores of the CWS studied fall well within 1 standard deviation of each other. This is also true for the CWNS sampled. The clinical utility of the CAT as a supplementary means of differentiating children who stutter from those who do not also serves to highlight the speech-specific attitude change needed by a CWS. This test procedure also makes it possible to determine if the therapy tactics employed have served to improve a child's speech-associated belief system. With regard to these and similar matters, it is noteworthy that Italian clinicians have become increasingly concerned in recent years with the measurement of the speech-associated attitude of CWS as it relates to the cognitive aspect of the stuttering syndrome. It is this which has led to the present normative investigation whose purpose is to determine if the communicative attitude of Italian CWS and CWNS differs significantly, and if this difference, should it be observed, is affected by age and gender.