نگرش ارتباطات کودکان دبستانی ژاپنی که لکنت زبان دارند

Past research with the Communication Attitude Test (CAT) has shown it to be a valid and reliable instrument for assessing speech-associated attitude of children who stutter (CWS). However, in Japan, the CAT has not been used extensively to examine the communication attitude of CWS. The purpose of this study was to determine if a Japanese version of the CAT could differentiate between the communication attitude of Japanese elementary school CWS and children who do not stutter (CWNS). A Japanese translation of the 1991 version of the Communication Attitude Test-Revised (CAT-R) was used in this study. Eighty Japanese CWS and 80 gender- and grade level-matched CWNS participated in the study. The results showed that CWS had a significantly more negative communication attitude than CWNS. Both CWS and CWNS in 1st grade showed significantly more positive communication attitudes than children in 2nd, 3rd, 4th, 5th, and 6th grades. Furthermore, a link between stuttering severity and CWS’ communication attitude was found. Additional research is needed to confirm the results of the current study, which indicate that the communication attitude of Japanese CWS becomes more negative as they get older. Learning outcomes: The reader will be able to: (1) Describe the process that was used to develop a Japanese version of the Communication Attitude Test (CAT-J). (2) Discuss attitude differences between Japanese children who stutter and those who do not and how grade level impacts a negative attitude toward communication. (3) Explain the link between stuttering severity and attitudes of Japanese children who stutter.

There is strong empirical evidence that a negative communication attitude among children who stutter (CWS) is closely linked to their fluency disorder (Andrews and Culter, 1974, Brutten and Vanryckeghem, 2007, De Nil and Brutten, 1991, Guitar, 2005, Van Riper, 1982, Vanryckeghem and Brutten, 1992 and Vanryckeghem and Brutten, 1997). Over the past two decades, several studies completed by Brutten and his colleagues have examined CWS’ communication attitude using different forms of a communication attitude test originally developed by Brutten (1984). One is the Communication Attitude Test© (CAT) (Brutten, 1984 and Brutten and Dunham, 1989) which consisted of 35 statements and another is the Communication Attitude Test-Revised (CAT-R) (De Nil & Brutten, 1991), which consisted of 32 statements. The current version of the CAT includes 33 statements because, repeatedly, two of the original 35 items did not correlate significantly with the CAT's overall score (Brutten and Vanryckeghem, 2003 and Brutten and Vanryckeghem, 2007). The CAT has been translated and researched in several countries around the world to investigate the speech-associated attitude of CWS. These countries include Argentina, Belgium, Brazil, Canada, Croatia, Germany, Iran, Israel, Italy, Malta, the Netherlands, Norway, Pakistan, Slovenia, Spain, Sweden, and the United States. Research has repeatedly shown that, across languages and cultures, CWS demonstrate a communicative attitude that is significantly more negative than that of children who do not stutter (CWNS) (Bernardini et al., 2009, Brutten and Vanryckeghem, 2003, Brutten and Vanryckeghem, 2007, De Nil and Brutten, 1991, Jaksic-Jelcic and Brestovci, 2000, Johannisson et al., 2009, Vanryckeghem and Brutten, 1992, Vanryckeghem and Brutten, 1996, Vanryckeghem and Brutten, 1997, Vanryckeghem and Brutten, 2007, Vanryckeghem et al., 2001, Vanryckeghem and Mukati, 2003 and Vanryckeghem and Mukati, 2006). Several of these investigations have indicated that a negative speech-associated attitude among CWS is already present as early as six years of age when comparing CWS and CWNS’ CAT scores (Brutten and Vanryckeghem, 2003, Brutten and Vanryckeghem, 2007, De Nil and Brutten, 1991 and Vanryckeghem and Brutten, 1997). In addition, several studies found that a negative attitude toward speech tends to increase with age for CWS but it decreases significantly for CWNS (e.g., Brutten and Vanryckeghem, 2003, De Nil and Brutten, 1991 and Vanryckeghem and Brutten, 1997). However, there are a few studies that did not find any significant increase or decrease in negative attitudes toward speech as CWS's age increased (e.g., Bernardini et al., 2009). Given the widespread use of the CAT around the world, it is interesting that there are limited numbers of published studies on the CAT in Asian countries. In 1986, Gokami, Nagasawa, and Ohishi created an informal questionnaire consisting of 20 questions about attitudes toward stuttering and communication. The questionnaire was administered to 358 children who were enrolled in 4–6th grades. Before giving them the questionnaire, the investigators asked the children to report if they felt their speech matched one of several samples of stuttering imitated by one of the investigators. If so, the child was classified as a CWS. Fourteen of the 358 (4%) participants considered themselves CWS and the remaining 344 reported that they were CWNS. Comparing the attitude between the two groups of children, the researchers concluded that CWS demonstrated a more negative attitude toward speech than CWNS. One problem with the Gokami et al. study was the method used to assess stuttering. A standardized test was not used to determine if the children stuttered or not. Instead, they relied on the children's self-reports. Another limitation of this study was the selection of participants in that they only chose children from 4th to 6th grades. These methodological shortcomings raise concerns about the validity of Gokami et al.’s findings. In order to assess the attitude of Japanese CWS with a more standardized questionnaire than the one used in the Gokami et al. (1986) study, Kawai (1995) translated the CAT-R (De Nil & Brutten, 1991) into Japanese. This instrument was called the CAT-J and included the same 32 items as the CAT-R. Using the CAT-J, Kawai conducted a pilot study of the speech-associated attitude difference between 32 CWS and 70 CWNS who were in the 4–6th grades of elementary school. Kawai (1995) found a significant difference in speech-related attitude between CWS and CWNS. However, it was observed that Japanese CWNS demonstrated a more negative attitude toward speech compared to CWNS in the United States and European countries (Kawai, 1995 and Kawai, 1997). Unfortunately, Kawai's (1995) study is an unpublished manuscript. There is only one published study using the CAT with Japanese CWS. Nagasawa and Kawai (1998) used the CAT-J to investigate attitude change of Japanese CWS to measure the efficacy of the cognitive component of stuttering therapy. They administered the CAT-J to 64 CWS four times with an interval of three months. Thirty-five out of sixty-four CWS received stuttering modification therapy and the rest of the CWS received fluency shaping therapy. Nagasawa and Kawai found that the CWS who received stuttering modification therapy showed significantly positive communication attitude as therapy went on, but those who received fluency shaping therapy did not show significant attitude change in nine months. Although the between-group difference results of Kawai's (1995) pilot study were similar to those of past research with the CAT (Brutten and Vanryckeghem, 2003, Brutten and Vanryckeghem, 2007 and De Nil and Brutten, 1991), the study was limited in a similar way as the Gokami et al. study (1986) because the data were only collected from children in grades 4 through 6. Additionally, the restricted age range prevented Kawai from determining any difference in the CAT-J scores across a wide range of ages, as had been done in other studies (Bernardini et al., 2009, Brutten and Vanryckeghem, 2003, Brutten and Vanryckeghem, 2007, De Nil and Brutten, 1991, Johannisson et al., 2009 and Vanryckeghem and Brutten, 1997). A few studies have found that a negative attitude toward speech tends to increase with age for CWS but it decreases for CWNS (e.g., Brutten and Vanryckeghem, 2003, Brutten and Vanryckeghem, 2007, De Nil and Brutten, 1991 and Vanryckeghem and Brutten, 1997). However, there is at least one study that did not show this age effect (e.g., Bernardini et al., 2009). These differences in findings might be due to cultural variations among the countries where the CAT was administered. Therefore, it will be important to investigate whether Japanese CWS show increased negative attitudes as they get older (i.e., matriculate through elementary grades 1–6). Another important factor that may affect CWS’ communication attitude is stuttering severity. Vanryckeghem (1997) along with Vanryckeghem and Brutten (1996) found that Belgian CWS’ negative communication attitude increased as their severity of stuttering increased. Their findings supported the earlier findings of Miller and Watson (1992) that negative communication attitude of American CWS became increasingly negative as self-ratings of stuttering became more severe. However, no studies have determined if stuttering severity influences Japanese CWS’ attitude toward communication. Therefore, in order to gain a more comprehensive understanding of the speech-associated attitude of Japanese CWS, the purpose of the present study was to compare the CAT-J scores of CWS, from 1st through 6th grade (i.e., an age range of 6–12), with those of CWNS. In addition, the differences between communication attitude and stuttering severity were examined. Three experimental questions were developed: (1) Does the communication attitude of Japanese CWS and CWNS, as measured by the CAT-J, differ significantly? (2) Do the CAT-J scores of CWS increase as they matriculate through grades 1–6? and (3) Does the communication attitude differ for Japanese CWS who show mild, moderately severe, and severe stuttering?