رسیدگی به هزینه های مالی شخصی در ارتباط با لکنت زبان

Stuttering has been found to deteriorate quality of life in psychological, emotional and social functioning domains. It is reasonable to assume then that stuttering would also be associated with economic consequences that may also challenge quality of life. Remarkably, the personal financial costs associated with stuttering in adults has rarely if ever been explored or investigated in the fluency disorders field. This study involved an assessment of the personal costs of stuttering and an investigation into determinants that may influence spending. Two hundred adults who stutter participated in this study. Findings indicated that the average total cost was around $5,500 (median cost $4,165) in 2007/08 Australian dollars over a 5-year period. Major financial items included costs of direct and indirect treatments for stuttering, self-help, stuttering related conferences, and technology. Financial costs were not significantly influenced by the sex of the person, annual income, or by how severe the person stuttered. However, those individuals younger than 60 years old spent significantly more on treatment related costs, while those with elevated levels of social anxiety spent significantly less than those with lower levels of social anxiety. Quality of life implications associated with stuttering are discussed. Educational objectives: The reader will be able to: (a) describe the method for assessing the direct financial costs of stuttering over a 5-year period; (b) describe the financial personal cost of stuttering for adults who stutter; (c) describe the relationship between factors like sex, age, severity of stuttering and financial costs; and (d) describe the relationship between social anxiety and the financial cost of stuttering.

Stuttering is a chronic neurological condition (Namasivayam & van Lieshout, 2008) that has been found to have a negative impact on quality of life (Craig, Blumgart, & Tran, 2009). Stuttering was found to increase risks of reduced vitality (that is, increased levels of fatigue), as well as reduced social, emotional and mental health functioning, and the negative impact of stuttering in these four domains was equivalent to the impact in these same domains from chronic disorders such as spinal cord injury, diabetes and heart disease (Craig et al., 2009). The ability to work is an important indicator of quality of life (QOL), and stuttering has also been found to reduce capacity to function satisfactorily in the work context (Klein & Hood, 2004). Clearly, the negative impact in these areas has the potential to create an economic burden and impose personal financial costs, which arguably can further negatively impact a person's QOL (Allard and Williams, 2008 and Schnittker, 2005). Surprisingly, the economic cost of stuttering has received very little attention in the field of fluency disorders, even though it is known that other chronic diseases such as cardiovascular disease, diabetes and asthma can exact a significant economic burden (Hogan et al., 2003, Pelletier et al., 2006 and Trogdon et al., 2007). It is not at all surprising that stuttering could result in significant financial costs. For instance, communication effectiveness is crucial for the maintenance of social engagement (Taylor, Peplau, & Sears, 1994), and more often than not stuttering will disrupt communication effectiveness (Craig, Hancock, Tran, Craig, & Peters, 2003). Furthermore, even after treatment, stuttering can be physically and emotionally exhausting because for many individuals it requires constant monitoring to control severity (Kalinowski and Dayalu, 2002 and O’Brien et al., 2003). Even when speaking fluently, people who stutter may place more importance on monitoring for signs of negative reactions in the listener and how they themselves (the person who stutters) are speaking, rather than listening to what is being said (Petrunik & Shearing, 1988). According to the National Stuttering Association (1999) and recent research (Allard and Williams, 2008 and Craig et al., 2003b), negative stereotypes about stuttering exist. Common stereotypical beliefs assume that people who stutter are nervous, incompetent, and shy (Craig et al., 2003b, Leahy, 1994, Linn and Caruso, 1998 and Iverach et al., 2009a). Furthermore, people who stutter are often evaluated negatively by people known to them such as teachers and employers (Cooper and Cooper, 1996, Craig and Calver, 1991 and Crichton-Smith, 2002), by the general public (Doody, Kalinowski, Armson, & Stuart, 1993), by those who do not stutter (Craig et al., 2003b and MacKinnon et al., 2007), and negative attitudes toward the work competence of people who stutter have been reported (Klassen, 2001). Research has now also confirmed that stuttering elevates state, trait and social anxiety (Blumgart et al., 2010, Craig and Tran, 2006, Craig et al., 2003a, Ezrati-Vinacour and Levin, 2004, Iverach et al., 2009a, Menzies et al., 2008, Messenger et al., 2004 and Mulcahy et al., 2008). For example, in a group of 34 adults who stutter, Messenger et al. (2004) showed that the people who stuttered had significantly elevated fears of negative evaluation in social situations. For these reasons, the work environment can be threatening both emotionally and financially to people who stutter (Hurst and Cooper, 1983 and Rice and Kroll, 1994). Klein and Hood (2004) reported that 70% of people who stutter agreed that their stuttering had decreased their chances of obtaining employment or being promoted and more than 33% felt that stuttering interfered with job performance. Of this cohort, 20% reported that they had been turned down for a job, or a promotion, because of their stuttering. In addition, negative attitudes towards stuttering are common in terms of career opportunities and in the workplace in general (Craig and Calver, 1991 and Gabel et al., 2004Leahy, 1994 and Silverman and Paynter, 1990). Findings also show that people who stutter often work in positions below their potential (Craig & Calver, 1991), or that they often do not choose the career they actually want (Peters & Starkweather, 1989). From an economic perspective, the insecurity related to employment status can be significant burden for people who stutter. The direct personal cost of treatment is a possible economic burden for people with disease and disability (Drummond, O’Brien, Stoddart, & Torrance, 1998). Stuttering is no exception. For instance, intensive forms of treatment are known to be efficacious (Bloodstein & Bernstein-Ratner, 2008), however, intensive treatment is likely to be expensive. Furthermore, owing to the chronic nature of stuttering and the potential for relapse, people who stutter may need to return frequently to be re-treated (Craig, 1998). This imposes an additional economic burden. Furthermore, because direct stuttering therapies may not always be effective, many will inevitably seek other forms of treatment, for example, to manage their social fears associated with their stuttering (Menzies et al., 2008). Examples of indirect treatments for stuttering include cognitive behavior therapy (say for anxiety), acupuncture, hypnotherapy, pharmacotherapy, as well as individual counseling or self-help support groups (Ramig, 1993 and Yaruss et al., 2002). Additional direct costs may also include “out-of-pocket” expenses such as transportation costs to clinics, self-help costs (e.g. maintenance of fluency costs), technology costs (e.g. audio-tape recorders; delayed feedback devices), and in the ongoing quest for new knowledge regarding the causes and latest treatment of stuttering, many may attend national and international seminars, conventions and conferences. Clearly, the direct costs associated with stuttering may impose a substantial financial burden. Although methodologies for estimating costs in chronic conditions have been successfully employed in QOL and disability research (Bean et al., 2004 and Gold et al., 1996), to date, only a few QOL studies in the stuttering field have been conducted. For instance, one study employed the use of preference-based economic measures of QOL assessment in which the opinion of people who did not stutter was sought about their choices associated with speech and disfluency (Bramlett, Bothe, & Franic, 2006), while Yaruss and Quesal (2006) have developed a self-report scale to measure the impact of stuttering on QOL. QOL research can also take the form of assessing the financial impact of a disease on the community (Berger-Schmitt and Jankowitsch, 1999, Cummins, 1995, Fayers and Bjordal, 2001, Gold et al., 1996, Judge and Watanabe, 1993 and Schnittker, 2005). Importantly, neither community nor personal cost research has been conducted in the field of stuttering. An aim of the present research was to rectify this situation by using conventional methods of cost estimation (Patrick & Erickson, 1993), where direct personal costs were retrospectively calculated in monetary terms. Direct cost considerations can have an immediate impact on one's lifestyle (Grabowski & Hansen, 1996) and it is possible that these costs might be substantial enough to impact QOL in people who stutter. Furthermore, the findings of such a cost study may assist in the improvement of treatment procedures, reduce relapse rates and develop broader estimates of cost savings (Wyrwich & Wolinsky, 2000). In the Australian context, allied professional services are only partially covered by government based health rebates (e.g. Medicare), and a disorder such as stuttering, that can have a considerable allied professional expenditure component, can adversely impact lower income families, who may have difficulties affording private health insurance or otherwise paying for the treatment. This paper presents results of a study designed to determine the direct personal cost of stuttering in Australian dollars. This study did not estimate the costs to the community. The primary aim of the investigation was to determine the financial costs of stuttering that the individual incurred over a 5-year retrospective period across a range of potential cost areas, such as treatment and treatment related expenses. A second aim was to determine whether factors such as age, sex, stuttering severity, health status and social anxiety influence these costs.