نگرش نسبت به کودکان لکنتی و ﻏﻴﺮﻟﻜﻨﺘﻲ کودکستان و مهد کودک: مقایسه با استفاده از یک نمونه اولیه ابزار استاندارد شده

Purpose This study investigated attitudes of nonstuttering preschool and kindergarten children toward peers who stutter in order to identify differences by age groups and better understand the genesis of stuttering attitudes. The study also examined the use of a new stuttering attitudes instrument designed for use with young children. Method The newly developed Public Opinion Survey on Human Attributes–Stuttering/Child was verbally administered to 27 preschool and 24 kindergarten children who do not stutter in the mid-Atlantic region of the USA. Results Overall, preschoolers held more negative stuttering attitudes than kindergarteners, but results were not uniformly in that direction. In both groups, the attribute of stuttering was viewed more negatively than individuals who stutter. Children viewed the potential of peers who stutter as quite positive, whereas their knowledge about and experience with stuttering were generally limited and some of their beliefs quite negative. Conclusions Negative or uninformed stuttering attitudes among nonstuttering children begin as early as the preschool years. This study provides empirical evidence for the need to educate young children about the nature of stuttering and how to respond appropriately to peers who stutter. Educational objectives: Readers should be able to: (a) describe attitudinal differences between kindergarteners and preschoolers toward peers who stutter; (b) describe the parameters of the POSHA–S/Child; (c) describe the nature of stuttering attitudes in young children relative to their beliefs and self reactions; and (d) describe the implications and future direction of stuttering attitude research in young children.

Over the past several decades, there has been a gradual but definite shift in recognizing stuttering not only as a physiological disorder, but also as social disability (Yaruss & Quesal, 2004). An expansive and growing literature base has sought to examine the experiences of people who stutter from the perspective of their social milieu, i.e., attitudes toward stuttering of those with whom they interact or the public. In the ubiquitous stuttering literature, the term public attitudes 1 refer to the inaccurate, insensitive, or otherwise unhelpful beliefs, reactions, perceptions, opinions, values, and related constructs that have been documented in various populations including: educators ( Abdalla and St Louis, 2012, Crowe and Walton, 1981 and Ruscello et al., 1994), speech-language pathologists ( Cooper and Cooper, 1996 and Lass et al., 1989), college students ( Betz et al., 2008, Dorsey and Guenther, 2000, Hughes, 2008, Hughes et al., 2015 and St Louis and Lass, 1981), employers ( Gabel et al., 2004, Gabel et al., 2008, Hurst and Cooper, 1983a, Hurst and Cooper, 1983b and Irani et al., 2009), and family units ( Özdemir, St. Louis, & Topbaş, 2011b). This body of work has consistently confirmed the existence of a negative “stuttering stereotype” ( Woods & Williams, 1976), which pervades cultures and populations worldwide. To date, a majority of the research evaluating public attitudes toward stuttering has been conducted in adults, wherein the etiology of such attitudes remains uncertain due to myriad environmental influences from years of diverse experiences. However, there is growing evidence that awareness of and negative attitudes toward stuttering may begin at a young age (Clark et al., 2012, Langevin, in press and Vanryckeghem et al., 2005). In order to more clearly elucidate the origin and development of negative stuttering attitudes, young children are of particular interest in continued epidemiological investigations. 1.1. Children's awareness of stuttering and speech difficulty At an early age, children who stutter and children who do not stutter begin to construct self-perceptions relative to their speaking ability. An expansive literature has consistently shown that the communication attitudes of children who stutter are significantly worse than children who do not stutter in evaluating their own speaking difficulties, with little apparent effect of children's sex or culture (e.g., Bajaj et al., 2005, Bernardini et al., 2009, De Nil and Brutten, 1991, Gačnik and Vanryckeghem, 2014, Kawai et al., 2012 and Vanryckeghem and Brutten, 1997). In fact, such attitudinal differences have been shown to occur in children as early as the preschool years (Clark et al., 2012 and Vanryckeghem et al., 2005). Using the Communication Attitude Test for Preschool and Kindergarten Children who Stutter (KiddyCAT) ( Vanryckeghem & Brutten, 2007), Clark et al. (2012) showed that stuttering children reported greater speech difficulty when compared to nonstuttering children. In addition, there is substantial evidence that young children who do and do not stutter also demonstrate the ability to discriminate between fluent and stuttered speech in others ( Ambrose and Yairi, 1994, Ezrati-Vinacour et al., 2001 and Griffin and Leahy, 2007). Ambrose and Yairi (1994) followed 20, 2–6 year-old children who stuttered and 20 age-matched children who did not over the course of two years. In three different visits, children watched a video depicting a fluent puppet and stuttering puppet and were asked to select which puppet talked the way they do. Only few preschool children who stuttered demonstrated awareness of the similarity between the puppet's stuttering and their own stuttered speech, but by 5–6 years of age, their ability to identify a similar-speaking puppet became consistent. Ezrati-Vinacour et al. (2001) conducted a similar study in children ages 3–7. Results indicated that 25% of typically fluent 3 year-olds were able to differentiate stuttered and fluent speech, and this skill was consistent in most children by 5 years of age and older. These findings parallel psychological and developmental research that has shown children's awareness of differences in themselves and others emerge during the preschool years and continue to increase with age ( Derman-Sparks, 1989, Hazzard, 1983 and Rochat, 2003). However, it remains unclear if a child's ability to discriminate differences in human attributes (i.e., stuttering) is a product of factors such as one's maturation or one's experiences. 1.2. Children's attitudes toward stuttering Awareness of differences in others naturally gives way to the development of attitudes toward persons who possess those differences, involving beliefs about and reactions to various human attributes. McDonald and Messinger (2011) reviewed the literature on the development of empathy in young children and posited that both emotional and cognitive components undergo identifiable changes from shortly after birth to adulthood. While it is clear that young stuttering children may hold negative self-attitudes toward their own stuttering, we are interested in whether or not nonstuttering children hold similar perceptions toward them. As children become aware of differences, they begin to develop a belief system of attributes considered to be desirable and those that are not, and these contain both emotional and cognitive aspects. Psychologist Frances Aboud (1988) proposed a “social-cognitive developmental theory” to describe the interaction of children's maturational development and their understanding of the world and those around them. According to her theory, emergence of prejudice in children is influenced by rapid changes in their cognition and development. As a result, prejudice does not develop in a linear fashion; rather, it emerges quickly between 4 to 6 years of age and begins to decline around age 7. Aboud's social-cognitive theory of prejudice draws from the seminal cognitive development work of Piaget which posits children younger than age 7 have rigid classification systems and do not have the cognitive ability to think flexibility ( Piaget & Cook, 1952). Therefore, they lack the capacity to classify persons according to multiple traits or attributes (Killen & Rutland, 2011). Another psychologist, Derman-Sparks (1989), coined the term pre-prejudice to describe children's initial feelings of discomfort, fear, social rejection, and similar feelings in response toward people with differences. Children's pre-prejudicial attitudes can either be mitigated by adults or strengthened by the typical environment into more firmly rooted prejudices ( Derman-Sparks, 1989). Applying this conceptualization to previous research bearing on stuttering, Ezrati-Vinacour et al. (2001), for example, observed pre-prejudicial preferences in almost all of their 4 year-old nonstuttering children who identified stuttering as being “not good” and expressed preference for friends with fluent opposed to stuttered speech. Similarly, Griffin and Leahy (2007) evaluated the stuttering perceptions of 18, 3–5 year-old nonstuttering children. After watching a short video of a stuttering puppet and fluent puppet, they were asked questions about the puppets’ communication skills and each child's behavioral intentions toward the puppet such as, “Would you be friends with this puppet?” Forty-five percent of the children showed overt negative reactions in response to the stuttering puppet such as laughing or looking at the examiner, with the older children (i.e., 5 year-olds) demonstrating more frequent negative reactions than the younger children (i.e., 3 year-olds). 1.3. Social ramifications of stuttering in children In a recent article, Boyle (2013) documented the existence of self-stigma in stuttering adults, a term describing their internalization of dominant negative stuttering attitudes. Self-stigma then bears negatively on their self-concept and overall well-being. Similarly, stuttering children have been shown to demonstrate self-stigmatic behaviors toward their stuttering by discontinuing talking and withdrawing from communication exchanges ( Boey et al., 2009). Also, children who stutter have been shown to take longer to initiate communication exchanges in unfamiliar social situations when compared to their fluent peers ( Choi, Conture, Walden, Lambert, & Tumanova, 2013). Negative or uninformed responses toward children who stutter by their nonstuttering peers may have negative social consequences as well. These have been identified as early as preschool by Langevin, Packman, & Onslow (2009). In their study, four 3–4 year-old preschool children who stutter were videotaped at their respective schools during periods of free play with their peers. Results indicated that stuttering negatively impacted the social experiences of the stuttering preschoolers. For example, they were observed to have difficulty leading their peers in play, participating in dramatic play, resolving conflicts, and engaging in discussions related to problem solving. Unfortunately, negative consequences of stuttering on social interactions have been found to persist beyond preschool and into elementary school-age years (Hartford & Leahy, 2007) and adolescence (Evans et al., 2008 and Mooney and Smith, 1995). Consequences may include increased likelihood to (a) receive a low social nomination among their peers (Davis, Howell, & Cooke, 2002), (b) be overlooked as a desired playmate (Hartford & Leahy, 2007), and (c) be teased or bullied (Blood and Blood, 2004, Langevin et al., 1998 and Mooney and Smith, 1995). Although the aforementioned studies provide evidence that young children view stuttering unfavorably, the lack of uniform methodology makes it difficult to compare results across these studies. As with measures of attitudes in adults (e.g., St. Louis, 2011), we submit that a need exists for a standard instrument for use in gathering comparable profiles of stuttering attitudes of children. Doing so will (a) permit valid cross-study comparisons, (b) provide empirical evidence of the nature and genesis of stuttering attitudes, and (c) identify potential areas that could be targeted for improvement. Such a measure has been developed for adults, the Public Opinion Survey on Human Attributes–Stuttering (POSHA–S) ( St Louis, 2011, St Louis, 2012 and St Louis et al., 2008). Particularly relevant for this study, the POSHA–S is capable of measuring attitudes of 6th grade children ( Özdemir, St. Louis, & Topbaş, 2011b) and 9th grade adolescents ( Flynn & St. Louis, 2011). Özdemir et al. (2011b) discovered that while one's own individual family had a limited but measurable effect on stuttering attitudes of 6th grade Turkish students, attitudes of all of the families and neighborhoods were remarkably similar. The 6th graders’ attitudes were nearly identical to those of their parents, grandparents, and neighbors. Flynn and St. Louis (2011) found that high school adolescents’ attitudes were generally more negative than those observed in numerous studies of adults. 1.4. Purpose It is clear that negative social sequelae accrue as a result of awareness of—and attitudes toward—stuttering among young children as early as 3 years of age. For children who stutter, these negative consequences are no doubt heavily influenced by beliefs and reactions of their nonstuttering peers as well as their own beliefs and reactions. Given limited extant research dealing with stuttering attitudes in young nonstuttering children, there is a need to gain more comprehensive understanding of those attitudes and to identify any maturational influences on them. In this paper, attitude refers to children's multidimensional constructs relative to their beliefs about the attribute of stuttering and people who stutter, as well as their self reactions toward people who stutter, parallel to those same constructs describing attitudes of adults ( St. Louis, in press). Gaining such information will be a necessary first step in developing educational programming aimed to improve those attitudes. Two purposes guided this investigation of nonstuttering children's stuttering attitudes using a standard measure, the Public Opinion Survey on Human Attributes–Stuttering/Child (POSHA–S/Child) ( Weidner & St. Louis, 2014). The first was to explore attitudinal differences in two groups of young children who do not stutter (i.e., preschoolers versus slightly older kindergartners). The second purpose was to examine the potential of the first prototype of the POSHA–S/Child as a standard instrument for measuring children's stuttering attitudes.