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This is to certify that the

thesis entitled

The Relationship of Attitudes and
Intentions to Behave to the Acquisition of Fluent
Speech Behavior by Stammerers

presented by

Trudy Mildon Stewart

has been accepted towards fulfillment

 

of the requirements for
M.A. College of

degree in
Commmication Arts and Sciences

LB.

Major professor

Date August 12, 1931

0-7639

 

 

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THE RELATIONSHIP OF ATTITUDES
AND INTENTIONS TO BEHAVE

TO THE ACQUISITION OF FLUENT

SPEECH BEHAVIOUR BY STAMMERERS

By

Trudy Mildon Stewart

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF ARTS

Department of Audiology and Speech Sciences

1981

ABSTRACT

THE RELATIONSHIP OF ATTITUDES AND INTENTIONS TO BEHAVE
TO THE ACQUISITION OF FLUENT SPEECH BEHAVIOUR
BY STAMMERERS

By
Trudy Mildon Stewart

This study applied the Fishbein and Ajzen model of attitude,
intention and behaviour to stammerers' evaluations and use of their
disfluent speech and a fluency controlling speech pattern. Subjects
were eight adult stammerers who participated in an eight week group
therapy programme. The model advocated a positive relationship
between subjects' attitudes and intention to use their own disfluent
Speech and a fluency controlling technique. A positive relationship
was also hypothesized between their intentions to use disfluent speech
and their intentions to use the fluency controlling technique and their
fluency gains measured after the completion of the therapy programme.
The results supported the relationships proposed by the model and
confirmed its value in predicting fluency gains on the basis of

pre-therapy attitude and intention scores.

Dedicated to Ewan, especially, and to my parents in appreciation
of their love and support. Also dedicated to my colleague
Jackie Turnbull and the stammering groups at Leeds General

Infirmary 1977-1980, who stimulated my interest in this area.

ii

ACKNOWLEDGEMENTS

The author wishes to express her appreciation to all who
have contributed to the development and completion of this
study.

Special acknowledgment is due to my committee chairman,

Dr. Paul Cooke, who gave considerable amounts of his time on behalf
of the study, and to the other members of my committee, Dr. Michael
Burgoon and Dr. Leo Deal. To Mr. Jim Dillard, who assisted in

the analysis of the data, much thanks is expressed.

Warm recognition is also extended to the eight stammering
subjects and to the student clinicians who assisted in the
administration of the therapy programme.

Finally, to Rotary International, gratitude is expressed

for the financial assistance which made the research possible.

iii

TABLE OF CONTENTS

Page
LIST OF TABLES ......................... vi
INTRODUCTION .......................... 1
Purpose and Hypotheses .................. 10
PROCEDURES ........................... 12
Subjects ......................... 12
Therapy .......................... 12
Data Collection and Reduction ............... 16
Fluency Evaluation .................. 16
Stammerers' Communication Attitudes .......... 17

Stimuli Used to Evaluate Attitudes and Intentions. . . 17
Procedure for the Evaluation of the Subjects'

Attitudes to Fluent and Non-fluent Speech ...... 18
Procedure for the Evaluation of the Subjects'

Intention to use Fluent and Non-fluent Speech. . . . 19

RESULTS ............................ 21
Reliability and Validity of the Model ........... 21

Reliability of the Attitude and Intention Scales . . . 21
Stability of the Attitude and Intention Scales . . . . 23

Validity of the Model ................ 23
Summary of the Scores of the Variables .......... 24
Fluency Evaluation .................. 26
"Communication Attitudes" $24 ............. 26
Attitude Evaluation .................. 27
Intention Evaluation ................. 27
Correlations Between Fluency Behaviours and Attitude and
intention Scales ..................... 28
Attitude, Intention and Fluency Gains ......... 29

Attitude, Intention and Stammering Severity (S.S.I.) . 29

iv

Page
Attitude, Intention and "Communication Attitudes" ($24). 31

Multiple Regression ................... 31
DISCUSSION ........................... 34
The Model .......................... 34
"Communication Attitudes" ($24) ............... 38
Therapy ........................... 38
Implications for Further Research .............. 39
Summary and Conclusions ................... 40

LIST OF REFERENCES ........................ 42
APPENDICES ............................ 46
A. Contract ........................ 47

B. Therapy and Transfer Objectives ............. 49

C. Stuttering Severity Instrument ............. 55

D. 524 ........................... 57

E. Attitude Rating Scale and Questionnaire ......... 59

F. Intention to Behave Rating Scale and Questionnaire . . . 62

Table

LIST OF TABLES

Summary of the attitude and intention internal
reliability alpha coefficients obtained at the
pre test and post test evaluations ...........

Summary of the correlation coefficients obtained
at the pre and post test evaluations for intention
and fluency gains ...................

Summary of the raw data for the eight subjects'
fluency, attitude and intention evaluations
(pre and post test) ...... . ...........

Comparison of fluency evaluations in subjects with
high and low attitudes and intentions to behave . . . .

Summary of multiple regression analysis using
subjects' pre test scores to predict fluency gains. . .

vi

Page

22

24

25

3O

33

INTRODUCTION

Previous generations of researchers in the field of stammering
have concerned themselves with analysing the nature of stammering, its
physiological and motor components, psychological and social implications
and linguistic features. More recently the focus has been on extending
stammering theories into the realms of therapy, and emphasis has been
placed on designing therapy programmes which yield fluency perceived
as normal by stammerers and listeners alike. In recent years two
major therapeutical approaches have been delineated. The "stutter more
fluently approach" is the first of these general approaches and
essentially involves desenSitizationlrfthe person to his stammering.
Increased monitoring of disfluencies, followed by modification, is
systematically taught and avoidance behaviour is subsequently reduced.
Williams (1979) attributes the success of this approach in facilitating
behaviour change to two factors:

1) it requires that the stutterer practice

staying in the time framework of the

present and 2) it offers the stutterer the

opportunity to test and resolve the fears

associated with stuttering.
In the second approach, "speak more fluently", the major concern is
with replacing stammering, usually by counter-conditioning, with fluent
speech. The goal of fluent speech is achieved by teaching the stammerer

to use a particular technique. Subsequently, the speech pattern is

then shaped so that it approximates, as far as possible, normal

1

sounding speech. Williams (1979) attributes the success of this
approach to the following factors:

1) when stutterers utilize the special techniques

they must attend to the special way they are talk-

ing, and when they do this they are staying in

the present, and 2) the approach utilizes strict

and consistent contingencies for responses in

massed practice situations.
Of the two approaches, the "speak more fluently" approach appears
to be gaining increasing support among clinicians. One of the latest
therapy programmes can be viewed as a further advancement of this
general mode. The Shames and Florance (1980) regime applies specific
behavioural principles which develop the stammerer's responsibility
for carrying out his or her own therapy. Their goals are stated as
the establishment of "stutter free" speech and an accompanying self-
image that is compatible with this new speaking behaviour.

Regardless of the therapeutic methodology employed for changing
the stammerers' behaviour, the main difficulty facing speech clinicians
today is that of the transfer of fluency attained in clinic. Improving
fluency, by whatever method or technique, is the least problematic task
encountered in a typical speech therapy programme.

Having the stammerer extend his or her new-found fluency and
transfering it to "real life" settings has met with numerous setbacks
and failures. As observed by Hanna and Owen (1977):

The present state of stuttering therapy programs
enables the clinician to render many stutterers
virtually stutter-free in the clinic. A major
clinical problem, however, is the transfer of

fluency to non—clinical situations and its maintenance
over time.

The stammerer-patient is, thereby, faced with the frustrating situation
of achieving a good fluent speech pattern in clinic with the therapist
but failing in his or her attempts to extend this speech pattern into
a natural environment. Over the years various methods have been
applied to the transfer stage in an attempt to improve the degree of
success, but as Boberg et al. (1979) comment:
...the dearth of published studies providing accurate
information is an indication of how well fluency is
maintained in the post treatment environment.
Typical problems have been chronicled by Perkins (1979). He groups

stamerers who have difficulties at this therapeutic stage into four

sections:

1. People who have tried hard but failed to master
the skills.

People who understand the procedures perfectly
yet cannot make them work.

People who profess great desire to sound normal
yet loose control of their speech in daily life.
People who have used the new skills successfully
yet prefer to continue stuttering.

h o: N
o o o

Boberg and Sawyer (1977) introduce two additional categories, namely
those persons who dropped out because the activities at this stage

were too threatening and those who no longer viewed therapy as necessary
because of their increase in fluency.

For several decades researchers have considered a variety of
explanations for the difficulties associated with the acquisition and
transfer of fluency. One major issue has been that of attitude change,
and there have been frequent attempts to relate the speech behaviour
change with an associated change in affect. Early studies by Johnson

(1932, 1934a, 1934b) and Kimmell (1938) investigated stammerers'

attitudes towards stammering and found attitude to have widespread
effects upon social life, home and school behaviour. Also in the
thirties, researchers at the University of Iowa were involved in
changing stammerers' attitudes about stammering by reducing fears and
avoidances and preparing the client for later modifications of
disfluencies. This attitude orientation approach was further developed
by Gregory (1959), Williams (1971), and Sheehan (1975). Following

the emergence of behaviour modification programmes in the sixties,

there has been a renewed interest in stammerers' attitudes and attitude
change in therapy. This has led some researchers to suggest a
relationship between attitude and attitude change and the efficacy of
therapeutic practise. Guitar (1976), for example, found that "stutterers'
attitudes may be related to long term improvement." His study found
that those stammerers with more negative attitudes as measured just prior
to treatment were most likely to have high levels of stammering a year
later, even though all subjects left therapy entirely fluent. Guitar
and Bass (1978) also found that stammerers who did not show a normaliza-
tion of communication attitude during treatment had poorer long term
gains in percentage of stamered syllables than subjects who did show
such normalization. Despite these indications of the importance of a
person's attitude to long term therapeutic success, researchers have

not yet defined those aspects of attitude which are crucial to the
acquisition and maintenance of fluent behaviours. This is emphasized

by Ryan's (1979) statement:

We need to adopt or develop an attitude
measure that will be valid and reliable
and will have a predictive function for
determining the outcome of therapy.

In other areas theorists have attempted to define the states of
mind which are precursors to behaviour. In the field of psychology
focus has been placed on attitudinal concepts in relation to behaviour
and behaviour change. Fishbein and Ajzen (1975) proposed a conceptual
framework which regards attitude as a significant predictor of behaviour.
The foundations for the model lie in the distinction between beliefs,
attitudes, intentions and behaviours, which are defined by Fishbein
and Ajzen (1975) in the following way. Belief refers to "a person's
favourable or unfavourable evaluation of an object". This is measured
on a dimension of subjective probability which relates an object to
an attitude. People may differ in their perception of the likelihood
that the object has the attribute in question, and this is referred
to as "belief strength“. Beliefs form the informational base that
determines the person's attitudes, intentions and behaviours. Their
acquisition may be based upon observation initially, and further
acquisition progresses sequentially on the basis of beliefs already
held.

Attitude is defined as "the amount of affect for or against
some object .... measured by a procedure which locates the subject
on a bipolar affective or evaluative dimension.“ (Fishbein and Ajzen
1975). Thus, beliefs represent the information available about the
object, whereas attitudes refer to an evaluation of an object.

Attitude towards a particular object or person is based on salient

beliefs about that object and will carry with it the positive or
negative belief evaluations. The Fishbein framework goes further and
suggests that a specific attitude is related to a set of beliefs-
rather than to any specific belief (i.e., a many: one relationship).

Behavioural intention refers to "a person's intention to
perform various behaviours." (Fishbein and Ajzen 1975). As with
beliefs, strength of intention is indicated by the person's subjective
probability that he will carry out the specific behaviour. It also
has a similar relationship to attitudes as the attitude toward an
object will usually be related to a whole set of intentions (a one:
many relationship).

Finally, behaviour is defined as "one or more observable actions
performed by the individual and recorded in some way by the investigator."
(Ajzen and Fishbein 1977). This rules out questionnaires and verbal
responses which may be used to infer attitudes, etc. Behaviour is
seen to correspond to each intention. Thus, attitude twoard an object
will again be related to the total behavioural pattern rather than
a specific act. Therefore, according to this model, a specific
behaviour such as fluent speech is determined by the person's intention
to perform that behaviour, and is heavily influrnced by the person's
attitude toward the behaviour. In summary, the theory underlining this
model concerns itself primarily with the prediction of a behavioral
intention, because it is this component which is thought to mediate
overt behaviour.

This framework has been successfully applied in a number of areas.

For example, Thach (1974) examined the use of public health service

facilities and the development of communication campaigns. The
appropriateness of the model was affirmed as it was found that

intentions could be predicted from measurement of attitudes and

normative beliefs. Other reviews of research utilizing the Fishbein
model have appeared in both the social psychology (Ajzen and Fishbein
1973) and the consumer behaviour literature (Ryan and Bonfield 1975).
These reviews also conclude that the model offers satisfactory predictive
value, in terms of predicting behavioural intentions from attitudinal
components and behaviour from behavioural intentions.

Despite these attempts to define attitudes and other interactive
components more precisely, little has been done to specify those
attitudes or predispositional states crucial to the acquisition and
maintenance of fluency. In the field of speech pathology the earliest
attempts to evaluate attitudes used assessments which were not de-
signed specifically for the speech and language disordered population.
With stammerers the Knower Speech Attitude Scale and the Knower Speech
Experience Inventory (Knower 1938) were two such tests.

The Iowa Scale of Attitude Toward Stuttering (Ammons and Johnson
1944) was designed specifically to assess the stammerers' attitudes
toward their own disfluencies, specifically their tolerance or
intolerance of stammering using a Likert-type scale. However no
evidence of validity of the measures has been shown and as Johnson,
Darley and Spriestersbach (1963) note:

The score itself is of limited value, largely
because it is obviously easy for the subject, if
he is so inclined, to make responses that "look

good" -- or that "look bad" -- rather than responses
that reflect his attitude in an honest or valid fashion.

They also reconmend that the test be used as a guide for interviewing
and counsel'ing rather than an assessment tool. Shumak (1955) reported
on a scale used to assess stammerers' reactions to speech situations
in which they were required to rate 1) the tendancy to avoid, 2) the
like or dislike of a situation, 3) the stammering severity in a
situation and 4) the frequency with which the situation was encountered.
Critical appraisal of the scale revealed an attempt to assess not one
specific attitude but a potpourri of variables which include not only
attitude items (e.g., attitude to situations) but also behavioural
evaluations (e.g., severity of stammering and avoidance behaviour).
Similiar problems have emerged in scales devised in recent years.
The Erickson S scale (Erickson 1969) and the shorter version, the
$24 scale (Andrews and Gutler 1974), were devised in an attempt to
provide a measure of communication attitudes which were relatively
free of error and with the interpretation of item responses based
on "empirically demonstrated relationships." (Erickson 1969). Their
aim was to provide an index of the extent to which the stammerers'
attitudes to communication differed from those of normal fluent
speakers. However, the items included seem to reflect many variables.
For example, the item "I am a good mixer" appears to be more indicative
of an attitude to self or self concept, whereas an attitude to
listeners appears to be what is being assessed in the item "People
sometimes seem uncomfortable when I am talking to them."

It would seem reasonable to suggest that the stammerer should

have a positive predispositional state or attitude to fluency before

one would expect him or her to use fluent behaviour consistently, but
the exact nature of such a state has yet to be defined. Fishbein and
Ajzen's model seems a useful framework that could be applied to this
problem. In the case of successful clients, one might hypothesize

that the stammerers present themselves for therapy with inconsistancies
in their conceptual framework and view therapy as a way of resolving
these inconsistancies. For example, the clients may believe themselves
to be stammerers but have the attitude that stammering is unacceptable.
Their intention, therefore, would be to stammer in speaking situations,
based upon these beliefs, and the subsequent behaviour would be
disfluent. At the end of successful therapy these inconsistancies
should be resolved. The clients would believe themselves to be fluent
speakers, while retaining the attitude that stammering is unacceptable.
Their intention would be to speak fluently in speaking situations, and
speech behaviour would be fluent. For those more unsuccessful clients,
those who may have difficulty with therapeutic techniques or have the
problems in transfering fluent speech behaviours outside clinic, the
incongruities may remain unresolved. For example clients may retain
the belief that they are stammerers and feel that stammering behaviour
is preferable to the methods of control outlined in therapy. Their
intentions would be to stammer and their behaviour continue to be
disfluent. Other clients could demonstrate the predispositional states
such that they believe themselves incapable of behaviour change but
still have the attitude that fluent speech is preferable. Their intention

would be stammering behaviour and their speech remain disfluent. In

10

a final example, clients may show little behavioural or attitude
change retaining all the pre-therapy beliefs, attitudes, intentions
and behaviours. Thus, in all three examples the clients would show
reduced acquisition of fluency with accompanying poor transfer and

maintenance of those skills.

Purpose and Hypotheses

 

In view of the relationship between attitude and changes in speech
behaviour, there is a need for some pre-therapy measurement of attitudes
which could serve as an indicator of potential behaviour change.
Current attitudinal scales employed with stammerers appear to be
insufficiently definitive in isolating those aspects crucial to the
acquisition and maintenance of fluency. The Fishbein and Ajzen model,
however, has provided one way in which behaviour may be related to
attitude in a predictive manner and appears to be readily applicable
to the area of speech pathology. The purpose of this study, therefore,
is to correlate two components of the Fishbein and Ajzen model, namely
attitude and intention to behave, with behavioural changes in fluency
in stammering subjects.

This purpose has generated the following research hypotheses:

1. There is a positive relationship between stammerers'

attitude to their own speech and their intention to use
their own speech.

2. There is a positive relationship between stammerers'

attitude to a fluency controlling technique and their

intention to use such a technique.

11

There is a positive relationship between stammerers'
attitude to and their intentions to use a disfluent
speech pattern and lack of gain in fluent speech
behaviour.

There is a positive relationship between stammerers'
attitude to and their intentions to use a fluent speech

technique and gain in fluent speech behaviour.

PROCEDURES

Subjects

The subjects of this study were eight adult stammerers, six
males and two females. Their ages ranged from 18 to 44 years, with
a mean age of 27.6 years. The stammerers were selected for inclusion
after demonstrating no severe psychological disturbance, no mental
retardation and normal hearing based on subjective observations made
by the experimenter during an initial interview. The range of
their stammering difficulties, based upon the Stuttering Severity
Index (S.S.I. Riley, 1972), was from mild-moderate to severe. All
of the subjects had had previous speech therapy for their disfluencies

and these programmes included a wide variety of therapeutic approaches.

Therapy

All eight subjects were enrolled in an eight week programme of
group speech therapy and all signed a contract (of Appendix A)
indicating their committment to attend and participate in all group
therapy sessions. The experimenter acted as the Speech clinician for
the entire group, being present during all therapy sessions and
coordinating the daily activities. Other graduate clinicians were
used to assist in the various activities. The therapy programme
followed the basic format outlined by Shames and Florance (1980) with

some modifications based on the experimenter's personal clinical

12

13

experience. The initial four weeks of therapy were devoted to Phase I
of the Shames and Florance programme. The sessions were held four
times per week with each session lasting approximately two hours. The
goal was to establish volitional speed control by implementing the
technique of prolonged speech. This procedure is accepted by many
clinicians and researchers, since, as Andrews et al. (1980) state:

The evidence suggests that treatments based

on training the stutterer in prolonged and

gentle onset techniques are superior to other

types of treatment.
Unlike the Shames and Florance programme, a Delayed Auditory Feedback
(D.A.F.) unit was not used to establish this initial control. Instead
the prolonged speech was broken down into eight components which
consisted of:
1. prolongation of individual speech sounds

continuous vocalization throughout speech production

2
3. light contacts of the articulators
4

regular breathing

5. flow of speech within words and across word boundaries

6. regular pauses

7. general body relaxation

8. regulation of speed (i.e., adherence to Specified number of

syllables per minute).
The subjects were taught to identify and monitor each of these
components in their own Speech and in the speech of the other group

members.

14

The technique was introduced to the group using a demonstration
tape prepared and recorded by the experimenter at 60 syllables per
minute (s.p.m.). The subjects then worked through several practise
exercises, moving from reading to Spontaneous Speech, until they were
able to meet the criterion activity of two minutes of fluent spontaneous
speech using the technique within five s.p.m. of the specified rate.

If any disfluencies were noted within the two minute speech sample, the
activity was repeated until the subject attained the criterion. A
disfluency was defined according to Wingate's (1964) definition of
stammering which includes audible or silent repetitions or pro-
longations of sounds, syllables or monosyllabic words. Objectives for
therapy were set up on a weekly basis culminating in this criterion
activity (cf. Appendix B). Subjects progressed through four additional
speaking rates: 80$.p.m., IOOs.p.m., 130$.p.m., and 150$.p.m.,
satisfying the 100% fluency two minute criterion before being allowed
to increase their rate. During Phase I, activities were carried out
in pairs and small groups to maximize speaking time and with the total
group to encourage group interaction, responsibility, support and
motivation. Subjects also enlisted the help of one other person with
whom they Spent a Significant proportion of time outside the clinic.
This significant other (5.0.) was involved in monitoring the client's
speech and providing the clinician with reports concerning their home
practise exercises. The nature of these exercises was generally con-
solidation of work previously carried out in the group, for example,

reading or in conversation with the 5.0. at the speed currently employed

15

by the group. No practise was given that had not previously been
monitored by the clinician.

Phases II and III of the Shames and Florance approach were
introduced during the last four weeks of the programme. Phase II,
that of self reinforcement, required each subject to carry out four self

regulatory behaviours:

1. Self instruction

Motoric signal to emit
monitored or unmonitored
speech

Client deliberately emits
socially acceptable rate
and continuous phonation
Client self evaluates
correctness of her response
Client rewards herself with
unmonitored Speech.

(Shames and Florance 1980)

2. Self monitoring

3. Self evaluation

45

Self consequation

These four behaviours were introduced simultaneously and implemented
with the faster or more acceptable rates of speech within Phase III
activity schedule. Phase III, the transfer phase, involved the subjects
gradually and systematically extending their use of the technique into
non-clinical situations. The programmed activities continued to be
carried out in pairs, small groups and with the total group. The focus
of these sessions was to increase the "stability" of the subjects'
technique at 150$.p.m. Sessions centred around such fluency distractors
as difficult listeners, increased situational stress, emotional tapics
discussed in the presence of strangers and during video taping. No
formal criterion activities were used at this stage; but frequent
feedback and reinforcement was provided by group members, graduate

clinicians, and the experimenter. When the use of the technique fell

16

below the standard established by the group, the subject was asked to
repeat the activity. In addition to the activities outlined above,
some parts of sessions were held in non-clinical settings with subjects
required to maintain the technique. In order to reflect the transfer
of emphasis from practise within the clinic to practise in non-clinical
Situations, group therapy sessions were reduced to two two-hour meet—
ings per week and amounts of home practise increased. Assignments

were alloted to the individual subjects based on a hierarchy of

difficulty which they devised themselves.

Data Collection and Reducation
All subjects underwent the following battery of assessments prior
to the eight week therapy programme (pre test) and upon completion
of the programme (post test). Each subject was tested individually,

and the total evaluation took approximately 30 minutes.

Fluency Evaluation

 

The subject's fluency was evaluated from a three minute spontaneous
speech sample. At the beginning of the initial and final interview
each subject was asked by a previously unencountered adult female to
describe a black and white stimulus picture ("Cookie Jar Theft" from
the Boston Differential Diagnosis of Aphasia, Goodglass and Kaplan
1972). The sample was gathered at the beginning of the interview to
reduce adaptation of Speech behaviour resulting from familiarity of
the situation. A picture description task was used to increase

standardization of content while maintaining spontaneity of utterances.

17

The speech sample was recorded using a microphone and a Marantz stereo
cassette (deck model number 5020). The speech sample was analysed in
terms of the number of words spoken, total speaking time, words

spoken per minute, number of disfluent words and the percentage of
total disfluency. Disfluencies were classified using Wingate's (1964)
definition of stammering. An additional formal assessment of stammering
severity was obtained by administering the Stuttering Severity
Instrument (S.S.I.) (Riley 1972). This scale provides a percentile
score and severity rating by assessing three categories of stamering
behaviour, namely, frequency of disfluencies measured as a percentage,
average duration time of the three longest blocks and a rating of the

stammerer's physical concomitant movements (cf Appendix C).

Stammerers' Communication Attitudes

 

The revised Erickson $24 assessment of communication attitudes

(Andrews and Cutler 1974) was also administered. This scale has been
widely used by studies addressing the question of stammerers' attitudes
and, thus, served as a referent point with which to compare the

results of the present study (cf Appendix D).

Stimuli Used to Evaluate Attitudes and Intentions

 

Two stimulus tapes were used for both the assessment of stammerers'
attitude and intention. One tape consisted of the subject's three
minute spontaneous Speech sample collected in the initial interview,
as described in the previous section. This was identified as "own

Speech" tape. The second tape was a three minute recording of a male

18

speaker using the technique of prolonged speech used in the therapy
programme at a speaking rate of approximately 130s.p.m. This tape
was recorded on the same equipment and used the same stimulus picture
as the disfluent tape samples and was identified as the "technique
Speech" tape. The same tapes were used during the pre test and post
test evaluations. The order of presentation of the two stimulus tapes
and of the attitude and intention scales and questionnaires was

counterbalanced.

Procedure for the Evaluation of the Subjects' Attitude to Fluent and

 

Non-Fluent Speech

 

The first three minute sample tape was presented to subjects individually
from the cassette tape recorder (Marantz model 5020) through a set of
Pro/4AA Koss headphones. Using a Likert scale format, they were asked

to think of a specific Situation in which they

1. would very much dislike speaking in that technique

would dislike speaking in that technique

would neither dislike nor like speaking in that technique

would like speaking in that technique

U1 b m N
o o o 0

would very much like speaking in that technique

They recorded a situation under the corresponding interval on the attitude
scale. The statements used for this Scale referred to the subject's
favourable or unfavourable evaluation of the speech on the taped sample.

A Similiar method was used by Gardner and Thompson (1959) in their
Syracuse Scales of social relations. This method allowed subjects to

determine their own points of reference for the scale. Using this

19

evaluative approach, subjects were then asked to rate their attitude
toward various speaking situations if they had to talk in the manner
demonstrated on the tape. The thirty specific situations were drawn
in part from the Southern Illinois University Speech Situation Check
list (Shumak 1955). The subjects were required to assign a number
from 1 to 5 to each individual situation listed on the questionnaire
using the scale they had just determined. (cf Appendix E).
These scores were averaged by the experimenter to provide a

mean attitude score for each subject. The total procedure was then

repeated for the second stimulus tape.

Procedure for the Evaluation of the Subjects' Intention to Use

Fluent and Non-Fluent Speech

 

The same two stimulus tapes used in the evaluation of attitude were

used in the assessment of intention. Subjects listened to each sample
from the cassette recorder via headphones and determined a second
framecfl’reference for an intention scale. On this scale which
corresponds to 5 intervals (1-5), they were asked to think of a Specific
speaking situation in which they

1. would never use that technique of speech

would seldom use that technique of speech

would occasionally use that technique of speech

would frequently use that technique of speech

01-th

would always use that technique of speech.

20

The statements used on this scale referred to the subjects' own
evaluation of the probability that they would perform the speech
behaviour demonstrated on the stimulus tape. Subjects then rated
their intention to speak as demonstrated on tape, in the 30 speaking
situations described above, using the rating scale of 1 to 5 for
each situation (cf Appendix F). A mean intention score for each
subject was calculated by averaging the scores from these 30 situations.

The total procedure was then repeated for the second stimulus tape.

RESULTS

The following are the results based on the pre and post test
evaluations. An appraisal of the reliability and stability of the
attitude and intention scales introduced in this study will be made
along with the validity of the Fishbein and Ajzen model. The
behavioural fluency data, results of the $24 and attitude and
intentions scales will follow. The final section will report on the

correlations computed on the data.

Reliability and Validity of the Model

 

Reliability of the Attitude and Intention Scales

 

The internal consistancy reliability for both attitude to own
speech and attitude to technique speech was computed using the
coefficient alpha. Alpha is a statistic which reflects the degree of
random response error and it was used here it examine the average
inter-item correlation among the thirty items. Its properties are
identical to the correlation coefficient and it may be interpreted
as such. The results, which are summarized in Table 1, showed that
attitude to own speech and attitude to technique at the pre test
evaluation had a correlation of r=.97. During the post test
evaluation attitude to own speech had a higher correlation, r=.98

and attitude to technique speech a correlation of r=.90.

21

22

Table 1

Summary of the attitude and intention
internal reliability alpha co-efficients obtained at the
pre test and post test evaluations

 

 

 

 

 

Pre Test Post Test
Attitude to own speech r = .97 r = .98
Attitude to technique
speech r = .97 r = .90
Intention to use own speech r = .94 r = .97
Intention to use technique
speech r = .97 r = .93

 

 

 

The reliability coefficient for both intention to use own speech
and intention to use technique speech was computed by correlating
the thirty individual items in the same way, and a summary of the
results can be found in Table 1. Pre test analyses indicated that
intention to use own speech had a correlation of r=.94 and intention
to use technique a correlation of r=.97. The correlation for
intention to use own speech on the post test was r=.97, whereas a
.93 correlation was obtained for intention to use technique. With
the correlations all .90 or higher, the reliability of both the
attitude and intention measures was considered adequate for this

investigation.

23

Stability of the Attitude and Intention Scales

Stability coefficients were computed on all the attitude and
intention measures. Using the subjects' mean attitude and intention
scores at the pre and post test evaluations, an analysis of the
measure's reliability over time was obtained. The results showed a
positive correlation for both attitude measures, attitude to own
speech (r=.84 at p= <.05) and attitude to technique speech (r=.85
at p= <.05). Lower correlations were obtained for the intention
measures, intention to use own Speech (r=.69 at p= <.05), and

intention to use technique (r=.23 at p= <.05).

Validity of the Model

 

The Fishbein and Ajzen model pr0poses a positive relation-
ship between attitude and intention to behave and also between
intention to behave and overt behaviour. With regard to validating
these relationships, correlations were calculated between the
attitude and intention scales at the pre test and post test evaluations.
This was carried out using each of the eight subjects' mean values
from the appropriate attitude and intention scales. The pre test
correlations were r=.74 for attitude to and intention to use own
speech and r=.72 for attitude to and intention to use technique. At
the post test evaluation a correlation of r=.91 was obtained between
the two scales using their own speech, whereas a lower correlation of
r=.32 occurred between attitude to and intention to use technique

speech.

24

Similiarly, correlations were computed between pre test and
post test intention to use own speech and intention to use technique
speech scores and fluency gains. This was calculated using each
of the subjects' mean value from the intention scale and the subjects'
mean percentage fluency gains. A summary of the results can be found
in Table 2. A correlation of -.38 was obtained for intention to use
own speech at the pre test and fluency gains and r=-.44 at the post
test. A correlation of r=.76 was obtained for intention to use

technique at the pre test and r=.65 at the post test.

Table 2

Summary of the correlation coefficients
obtained at the pre and post test
evaluations for intention and fluency gains.

 

 

 

Pre test Post test
Intention to use own speech =-.38 r=-.44
Intention to use technique r=.76 r=.65

 

 

 

Summary of the Scores of the Variables
The data obtained from the eight subjects' fluency evaluations,
S.S.I.'S, and attitude and intention scales in the pre and post tests
is summarized in Table 3 and will be referred to throughout this

section.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Aummu umoa

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m open»

26

Fluency Evaluation

The results of the pre test spontaneous speech sample showed that
the subjects initially presented a wide range of stammering behaviours.
The range of disfluency percentages in the three minute picture
description task was 6% to 75%, with a group mean of 25%, whereas the
severity rating on the Stuttering Severity Index (S.S.I.) ranged from
mild-moderate to severe. Since a moderate stammerer on the 5.5.1. is
represented by a total raw score of 16 and above, Six of the eight
subjects used in this investigation were moderate to severe stammerers.
In the post test fluency evaluations the range of percentage dis-
fluencies in the spontaneous speech samples was between 2% and 13%, with
a group mean of 6% and the severity rating ranged from mild to moderate.
One group member, B.A., increased her mean percentage disfluencies by
1%, from 6% to 7%. The remaining seven subjects increased fluency
by an average of 19%, with a range of 6% to 67%. Coupled with the
increase in fluency, there was also a general increase in average

words per minute. The mean gain for the group was 25 words per minute

(w.p.m.).

"Communication Attitudes" ($24)

 

The group mean on the pre test scores for the revised Erickson
$24 assessment of communication attitudes was 17 with a range of 9
to 24. The post test assessment showed a group mean of 11, and the
range of scores was from 3 to 20. While one subject, R.C., increased
his score by 1 point, this proved to be the exception as all other

subjects decreased their scores by an average of 6 points.

27

Attitude Evaluation

In both the pre and post tests the assessment of attitude to the
subject's own Speech and to technique speech Showed a wide range of
mean scores within the possible 1 to 5 scale. The group mean pre
test score for attitude to own speech was 2.6, and this decreased
slightly to 2.4 in the post test. Five of the individuals diSplayed
a pre test to post test change score of 0.0 or 0.1. However, the
high variability in range of the individual change scores was not
reflected in the subject's mean score; for example, subject B.B.
decreased 1.5 points, from 3.6 to 2.1, in the post test. The group
mean pre test score for attitude to technique speech was 2.9 and
the post test mean was 2.7. There was also a wide range in change
scores of the subjects' attitudes to the technique, the range
being from 0.2 (subject 5.5.) to -1.5 (subject B.B.). Subject

G.K. demonstrated no change.

Intention Evaluation

In both pre and post tests the assessment of intention to use
the subjects' own speech and to use technique speech showed a wide
variety of individual scores. The group mean pre test score for
intention to use own speech was 3.1; this increased to 3.6 in the post
test assessment. As with the attitude scores, there was much
individual variability, with the range of change scores occurring
between 1.5 (B.A.) and -.5 (G.K.), with subjects R.B. and J.J. showing
no change. The group mean pre test score for intention to use

technique speech was 3.2, and this also increased to 3.7 in the post

28

test. The range of change scores for this scale was 2.7 (R.C.)

to -.6 (G.K.).

Correlations Between FluencyLBehaviourS and
Attitude and Intention Scales

The individual's initial severity may have had a biasing effect
on correlations between stammering behaviour and the attitude and
intention scales employed in this study. A subject with a high
stammering percentage initially would have a greater potential for
change than someone with a low stammering percentage. For example,
subject S.S., who demonstrated 75% disfluency during pre therapy
conditions had a much greater potential for change than the subject
R.B. who illustrated 9% disfluencies on the pre test evaluation.
Thus, the individual's percentage change from the pre and post
test scores for fluency and stammering severity (5.5.1.) was
calculated to allow for the initial severity level. The following

computation was made:

Pre test % - post test %

 

x 100
pre test %

Thus, subjects 5.3. and R.B. showed an 89% and 67% gain in fluency,
respectively, using the transformation outlined above (i.e.,
"transformatiod'score) as opposed to 67% and 6% reSpectively without
the tranformation (cf Table 4). The use of these "transformed" scores
enabled subjects' scores to be compared with one another using Similiar
criteria. (There was no necessity to carry out a transformation on the

attitude and intention scores as subjects' intitial severity had been

29

accounted for as they determined their own anchor points on the scales
initially.)

In relation to the models of successful and unsuccessful clients
proposed earlier, it was thought relevant to further identify the levels
of attitude and intention within the group members. Subjects were
thus divided into those with high or low attitudes and/or intentions
during the pre test. A high category was defined as having a mean score
of 3.0 or greater on the 1 to 5 point scale and a low category was

defined as having a mean score below 3.0 on the same 1 to 5 point scale.

Attitude,_Intention and Fluengy Gains

 

Using the scores outlined above, a comparison was made between
the behavioural indicators of therapeutic progress and those subjects
with high or low attitude or intentions on the pre test. The results
are summarized on Table 4. Those six stammerers who had low attitude
to their own speech and had low intentions to use their own Speech
showed an average gain in fluency of 77%, whereas those two subjects
with a high attitude to and high intention to use their own speech
demonstrated a 29% increase. Those subjects with a high attitude to
the technique Speech or a high intention to use technique speech showed
greater fluency gains (74% and 78% respectively) compared to those
subjects with a low attitude (55%) or a low intention (47%) to use

technique Speech.

Attitude, Intention and Stammering Severity (S.S.I.)

 

A Similiar comparison was made using the mean percentage reduction

in S.S.I. scores and high and low attitude and intention scores.

30

 

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mooannsm co .oz m m S S o N m N moumflnsm co .oz

 

 

 

 

 

 

 

 

 

 

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c mpnmh

zucmapm to comwconeou

31

The results are summarized in Table 4. Those subjects with a low
attitude to and/or low intention to use their own speech had a mean
percentage of S.S.I. reduction of 49%, whereas the high attitude to
and/or high intention subjects had reductions averaging 22%. Those
subjects with high attitude or high intention to use the technique
speech, meanwhile, showed a greater reduction of severity (47%

and 53% reSpectively) than those subjects with a low attitude (33%) and

low intention (19%) to use technique Speech.

Attitude, Intention and "Communication Attitudes" ($24)

 

An additional comparison was made using the mean percentage
reduction in $24 "communication attitudes" scores and high or low
attitude and intention scores. Subjects who had a high attitude
and intention to their own speech showed greater reduction in the
Erickson scores (46%) than those subjects with low attitude and
intention (32%). With regard to technique speech the results
were conflicting. The comparison revealed that subjects with low
attitude to and high intention to use technique speech showed greater
reduction in $24 scores (38% and 41% respectively) than those subjects
with high attitude and low intention to use technique speech (33% and

27% respectively).

Multiple Regression
A multiple regression analysis was implemented on the data and
are summarized in Table 5. The pre test scores of attitude to own

Speech, intention to use own Speech, attitude to technique speech,

32
intention to use technique speech and the Erickson $24 scores were
the predictor variables, and the percentage fluency gain measured
during the spontaneous speech sample was the dependent variable. (It
should be noted that the Erickson $24 scale is not normally employed
as a predictor of fluency gains but is usually used purely as a
measure of attitude and attitude change.) Intention to use technique
was found to have the highest correlation with fluency gain, having
an r score of .76 at .03 level of significance. The only other variable
to have a positive correlation with fluency gains was the attitude
to technique Speech (r=.56, p value of .53). Both the attitude and
intention to use own Speech Scores and the Erickson 524 scale were
negatively correlated with fluency gains, with r values of -.46, -.38
and -.11 respectively. Combining two or more variables to predict
fluency gains is exemplified in the multiple r column of Table 5. The
r2 change column shows that the Erickson $24 adds a further .11 to
the multiple r when added to the predictor variable of intention to
use technique Speech but at a p value of >.05. The remaining three

variables added little to the overall r also at p= >.05.

33

Table 5

Summary of multiple regression
analysis using subjects' pre test
scores to predict fluency gains

 

 

 

 

 

 

Signif-
2 icance
Simple Multiple r (Individual
r r Change Beta)
Intention to use technique
speech (pre test) .76 .76 .58 .03
Erickson $24 (pre test) -.11 .83 .11 .24
Attitude to own speech
(pre test) -.46 .84 .02 .63
Intention to use own speech
(pre test) -.38 .85 .02 .68
Attitude to technique speech
(pre test) .56 .89 .06 .53

 

 

 

 

 

DISCUSSION

The results from this study indicated that the eight subjects
demonstrated a wide range of stammering diffculties, attitudes, and
behavioural intentions. They showed fluency gains averaging
19% and an accompanying average increase of 25 words per minute
following the eight week programme of group therapy. In addition,
there were notable normalizations in the subjects's "communication

attitudes", as assessed by the Erickson $24 scale.

The Model

It may be recalled that the Fishbein and Ajzen model (1975) of
attitudes, intentions and behaviours proposed earlier conceptualizes
behaviour as a function of intention to behave and intention as a
function of attitude. Thus, evidence of a high correlation between
attitude and intention and between intention and behaviour and a some-
what lower correlation between attitude and behaviour would support
the framework of this model for stammering behaviour.

An analysis of the stability coefficients generally showed good
correlations between attitude and intention to use own Speech (r=.74,
pre test; r=.91, post test), and attitude and intention to use
technique speech (r=.72 pre test, and r=.32, post test). The poorer
correlation which was found between attitude to and intention to use

technique Speech in the post test, however, may be a reflection of

34

35

the group member's realization of the degree of mental effort required
to carry out speaking in technique after years of unmonitored speech.
Having completed a programme of therapy which instructed them primarily
in the monitoring and evaluation of those features implicit in a Specific
Speech technique, the subjects were much more aware of the amount of
mental control involved in the implementation of this Speech and,
therefore, more realistic in their intentions to use it.

When examining behavioural correlates in relation to the proposed
model, one would anticipate attitude and intention to use own speech
to correlate negatively with the measures of increase in fluent
behaviour and attitude and intention to use technique to correlate
positively with such fluency gains. Also, as previously mentioned,
intention should correlate more strongly with behaviour than attitude.
The measures of attitude to and intention to use own Speech in the
pre tests (r=-.46 and r=-.38, respectively) and in the post tests
(r=-.50 and r=-.44, respectively) all correlate negatively with fluency
measures and, therefore, support the model. The relationship between
attitude, intention and behaviour was also arranged in the manner
predicted by the model, with attitude more negatively correlated with
fluency than intention in both the pre and post tests. The measures
of attitude to and intention to use technique speech at both the
pre and post test times also lend support to the model. Positive
correlations with fluent behaviour were obtained, with intention more
positively correlated (pre test r=.76; post test r=.65) than attitude

(pre test r=.56; post test r=.56) in all cases. Thus, the present

36

study appears to lend a good deal of support to the conceptual framework
of Fishbein and Ajzen.

However, the model pr0posed does extend the relationships outlined
above, such that behavioural intentions can be predicted from attitude
components and also that observable behaviours can be determined from
intentions. The results of this study should, therefore, be viewed in
terms of the predictive value of the model; and a critical appraisal
can be made from the results obtained regarding the prediction of
fluent speech behaviour from behavioural intentions. Despite the small
number of subjects, the multiple regression analysis indicated that
intention to use technique (measured at the pre test) to be the best
predictor of fluency gain. Attitude to technique Speech pre test was
found to have the second highest correlation, ableit at a low level of
significance.

The model would attribute attitude with Some predictive value,
although not as high in value as behavioural intention. In predicting
fluency gains, attitude to technique speech had an r value of .56 and
intention to use technique a value of .76.

Further detailed analysis of the relationships between attitude,
intention and fluency proved to be noteworthy. When the subjects
were divided into those with high and low attitudes or intentions at
the pre test, a definite pattern emerged. Stammerers with low attitudes
and intentions to use their own Speech and those with high attitudes
and intentions to use technique speech showed considerably greater
fluency gains, 43% and 25% respectively, than those subjects with

high attitudes and intentions to use their own speech and those with

37

low attitudes and intentions to use technique speech. Thus, the
stammerer who presents him or herself for therapy with a positive
predispositional state or attitude to fluent speech and high
intentions to use a fluent speech technique and/or a negative view of
his or her own Speech and a desire not to use a disfluent pattern will
show more improvement in therapy than a stammerer without these
dispositions.

In the light of these present findings the various hypotheses
that were put forward in the earlier chapter regarding those stammerers
who fail to achieve the optimum fluency gains may be extended. A
stammerer who would Show reduced acquisition of fluency with accompanying
difficulties with transfer and maintenance would typically have a high
regard for his or her own speech and high intentions to use it and/or
low attitude to the fluency technique to be taught in therapy and poor
intentions to use it prior to enrollment in speech therapy. Such
an occurrence should alert the clinician to the possibility of the
client experiencing difficulties in therapy.

Such a significant relationship between pre therapy measures of
attitude and intention and post therapy fluency gains would point to
the value a standardized assessment of these variables would have for the
practising Speech pathologist. They would provide him/her with a
predicator of the possible outcome of therapy for any one particular

client.

38

"Communication Attitudes"(§24)_

While showing a reasonable degree of reliability in the pre test
and post test scores (r=.79), there was a notably low correlation between
either of the Erickson scores and fluency gains. When subjects were
categorized into those with high and low attitudes and intentions to
use their own speech and to use the technique, the Erickson scores
did not follow the form predicted by the Fishbein model. Only in the
case of one of the variables, intention to use technique Speech,
were the results in the direction hypothesized, with greater reduction,
41% in Erickson scores shown by these subjects with high intention
as opposed to 27% reduction shown by those with low intention to use
the technique. Thus, the data from the study indicates that the
Erickson scores cannot be interpreted as having a predictive function
and, indeed, do not porport to have such a function. As Andrew and
Culter (1974) comment, the $24 is designed primarily "to identify
covert communication attitudes" and, therefore, it acts purely as an
assessment of attitude and attitude change. The intention scale when
used to describe intention toward using the technique implemented in
the therapy programme, appears to have a much greater predictive value,

namely r=.76.

Therapy

A few comments should be made in relation to the relatively new

therapy programme implemented in this study. The mean percentage fluency

39

gain achieved by the group, 19%, would indicate that it is an effective
programme, to which the group responded well. The regime has several
advantages, notably the group interaction and the general structured
approach, both of which the subjects felt were of great benefit. 0f
the innovative aspects of the programme, the use of self instruction and
self consequation proved somewhat more problematic. Some subjects did
not respond well to the motoric signal that was employed with the self
instruction and felt it drew attention to their behaviour during
transfer activities. Modifications to reduce this effect were made

by reducing the magnitude of the signal; and these met with varying
degrees of success. Self consequation, while seeming to be an
effective reinforcer, encountered practical difficulties in

spontaneous speech activities. It proved difficult to self consequate
for the required percentage of the utterance (i.e. 20%) when the client
was usually unaware of the length of his total utterance until it had
actually been completed. The features of self monitoring and self
evaluation appeared to be successful in giving the clients a feeling of

responsibility for their speech and an additional feeling of control.

Implications for Further Research
While the results of the study appear to indicate the advantages
of the Fishbein and Ajzen model, it is recognised that there ia a need
to further refine the assessment used in this study. Specifically,

validation studies are required for both the attitude and intention

4O

scales; and additional reliability studies using larger groups of
subjects are needed. There is also a need to generalize the results

of the study, not only to subjects of differing ages and severity
ranges, and of differing economic and educational status etc., but also to
those involved in therapy programmes other than the Shames and Florence
regime employed in this study. It would be of clinical significance

if the model could be proved to be applicable to regimes involving

the "stutter more fluently approach" and also those with no group
interaction. Once these studies have been carried out, it is felt

that the proposed model would have several advantages over the existing
attitude Scales and therapeutic implications for the practising
clinician. Implementation of the scales used in this study would

allow the therapist to predict a client's suitability for therapy
and/or determine whether or not there was a need to integrate a
programme of attitude change or modification into his or her therapeutic
intervention. Arising out of such a programme of attitude change in
therapy comes the necessity to determine what method of attitude change
is most effective within a therapeutic regime, and further research

would need to define this more closely.

Summary and ConclusiOns
It was the purpose of this study to apply the Fishbein and Ajzen
model of attitude, intention and behaviour to stammerers' evaluations
and use of their own disfluent speech and a fluency controlling speech

pattern. Subjects were eight adult stammerers who participated in an

41

eight week group therapy programme. The questions posed by the study
related to the theoretical framework of the proposed model, which
suggested a positive relationship between attitude and intention to
behave and intention to behave and overt behaviour. The Specific
variables involved were attitude to and intention to use own speech and
attitude to and intention to use technique speech.

The results of this investigation have lent support to the
Fishbein and Ajzen model and also confirmed the additional value of
the model in predicting fluency gains on the basis of pre-therapy
attitude and intention scores. In this light the study answers
the need recognised by Ryan (1979) for a measure of attitude which
would have a "predictive function for determining the outcome of

therapy."

LIST OF REFERENCES

42

List of References

Ammons, R., and Johnson, W. The construction and application of
a test of attitude toward stuttering. Journal of Speech
Disorders, 1944, 9, 39-49.

 

Andrews, G., and Cutler, J. Stuttering therapy: The relation
between changes in symptom level and attitudes. Journal
of Speech and Hearing Disorders, 1974, 39, 312-319.

Andrews, G., Guitar, 8., and Howie, P. Meta-analysis of the
effects of stuttering treatment. Journal of Speech and
HearingyDisorders, 1980, 45, 287-307.

Ajzen, 1., and Fishbein, M. Attitudes and normative variables as
predictors of specific behaviors. Journal of Personality
and Social Psychology, 1973, 27, 41-57.

Ajzen, 1., and Fishbein, M. Attitude-behavior relations: A
theoretical analysis and review of empirical research.
Psychological Bulletin, 1977, 84, 888-918.

Boberg, E., Howie, P., and Woods, L. Maintenance of fluency:
Review. Journal of Fluency_Disorders, 1979, 4, 93-116.

Boberg, E., and Sawyer, L. The maintenance of fluency fellowing
intensive therapy. Human Comunication, 1977, 2, 21-28.

 

Erickson, R.L. Assessing communication attitudes among stutterers.
Journal of Speech and Hearing Research, 1969, 12, 711-724.

Fishbein, M., and Ajzen, I. Belief, attitude, intention and
behavior: An introduction to theory and research.
Reading, Mass.:Addison-Wesley, 1975.

Gardner, E.F., and Thompson, G.G. Syracuse scales of social
relations. Manuals for elementary, iunior high and senior
high levels. Yonkers, New York: World Books, 1959.

 

Goodglass, H., and Kaplan, E. Boston Diagnostic Aphasia Test.
London: Henry Kimpton, 1972.

Gregory, H. An assessment of the results of stuttering therapy.

Final Report, ResearCh and Demonstration Project. 1725-5
HEW 1969.

43

44

Guitar, B. Pretreatment factors associated with the outcome of
stuttering therapy. Journal of Speech and Hearing Research,
1976, 19, 590-600.

Guitar, B., and Bass, C. Stuttering therapy: The relation between
attitude change and long-term outcome. Journal of Speech
and Hearing Disorders, 1978, 43, 392-400.

Hanna, R., and Owen, N. Facilitating transfer and maintenance of
fluency in stuttering. Journal of Speech and Hearigg
Disorders, 1977, 42, 65-76.

 

Johnson, W. The influence of stuttering on the personality.
University of Iowa Studies in Child Welfare. Iowa City:
University of Iowa, 1932.

 

Johnson, W. The influence of stuttering on the attitudes and
adaptations of the stutterer. Journal of Social Psychology,
1934, 5, 415-420. (a)

Johnson, W. Stutterers' attitudes toward stuttering. Journal of
Abnormal Psychology, 1934, 29, 32-44. (b)

 

Johnson, W., Darley, F.L., and Spriestersbach, D.C. Diagnostic
Methods in Speech Pathology. New York: Harper and Row.,
1963.

 

 

Kimmell, M. Studies in the psychology of stuttering: IX. The
nature and effect of stutterers' avoidance reactions.
Journal of Speech Disorders, 1938, 3, 95-100.

 

Knower, F.H. A study of speech attitudes and adjustments. Speech
Monggraphs, 1938, 5, 130-203.

 

Perkins, W. From psychoanalysis to discoordination. In H. Gregory
(Ed.), Controversies about Stuttering Therapy. Baltimore,
Maryland: unIVerSity Park Press, 1979.

 

Riley, G. A stuttering severity instrument for children and adults.
Journal of Speech and Hearing Disorders, 1972, 37, 314-322.

 

Ryan, 8. Speech therapy in a framework of operant conditioning and
programmed learning. In H. Gregory (Ed.), Controversies
about Stutteripg Therapy. Baltimore, Maryland: University
Park Press, 1979.

 

Ryan, M.J., and Bonfield, E.H. The Fishbein extended model and
consumer behavior. Journal of Consumer Research, 1975,
2, 18-36.

 

 

45

Shames, G.H., and Florance, C. L. Stutter-free Speech. Columbus,
Ohio: Charles E. Merrill, 1980.

Sheehan, J. Conflict theory and avoidance-reduction therapy. In
J. Eisenson (Ed.), Stuttering: A Second Symposium. New
York: Harper and Row, 1975.

Shumak, I.C. A Speech situation rating sheet for stutterers. In
W. Johnson (Ed.), Stutteringiin Children and Adults:
Thirty Years of Researchptithe University of Iowa.
Minneapolis: University of Minnesota Press, 1955.

Thach, M. A psychological approach to prediction of utilization
of health services and development of communications.
Dissertation Abstracts International, 1974, 35, 5514-8.

Williams, 0. Stuttering therapy for children. In L.E. Travis
(Ed.), Handbook of Speech Pathology and Audiolggy.
New York: Appleton-Century Crofts, 1971.

Williams, D.E. A perspective on approaches to stuttering therapy
In H. Gregory (Ed.), Controversies about Stuttering Therapy.
Baltimore, Maryland: UniverSity Park Press, 1979.

Wingate, M.E. A standard definition of stuttering. Journal of
Speech and Hearing Disorders, 1964, 29, 484-489.

APPENDICES

46

APPENDIX A
CONTRACT

47

 

1h

 

the

and

The

und

48

APPENDIX.A
CONTRACT

I have freely consented to take part in a scientific study and
therapy programme being conducted in the Department of Audiology

and Speech Sciences at Michigan State University

The study and programme have been explained to me and I

understand the explanation that has been given.

I agree to attend all the evaluation and therapy sessions of the

programme.

I understand that I am free to discontinue my participation in

the study at any time.

I understand that any results will be treated in strict confidence
and that I will remain anonymous. Within these restrictions, I
understand that general results may be presented at professional
meetings and may appear in appropriate professional journals and

other publications.

Signed:

 

Date:

 

APPENDIX B
THERAPY AND TRANSFER OBJECTIVES

49

50

APPENDIX B
THERAPY OBJECTIVES

EEK—1
1. Orientation
2. Introduction of technique at 60 syllables per minute
Parallel production of technique at 60$.p.m.
Reading using production of technique at 6OS.p.m.

Producing automatic speech sequences at 6OS.p.m.

0301-50.)

Producing Short phrases in answer to questions in technique

at 60$.p.m.

Producing single sentences spontaneously in technique at 6OS.p.m.
8. Producing several sentences spontaneously in technique at 605.p.m.
9. Introduction of technique at 80$.p.m.

10. Parallel production of technique at 80s.p.m.

CRITERION FOR WEEK 1
Production of one three minute spontaneous speech sample at 6OS.p.m.

without disfluency infront of the group.

51

THREAPY OBJECTIVES

usage

1. Reading using technique at 80$.p.m.

2. Producing automatic speech sequences at 80$.p.m.

3. Producing short phrases in answer to questions at 80$.p.m.

4. Producing single sentences Spontaneously at 80$.p.m.

5. Producing several sentences spontaneously at 80$.p.m.

6. Introudction of technique at 100$.p.m.

7. Parallel production of technique at IOOs.p.m.

8. Reading using production at IOOs.p.m.

9. Producing automatic speech sequences at IOOs.p.m.

10. Producing short phrases irianswervto questions in technique

at IOOs.p.m.

11. Producing single sentences spontaneously in technique at IOOs.p.m.

12. Producing several sentences spontaneously in technique at IOOs.p.m.

CRITERION FOR WEEK 2

 

Production of one three minute spontaneous speech sample at 60$.p.m.

and IOOs.p.m. infront of the group without disfluency.

52

THERAPY OBJECTIVES

BELL}.
1. Brief revision of previous Speeds and control technique
2. Introduction of technique at 13OS.p.m.
3. Parallel production of technique at 13OS.p.m.

Reading at 130$.p.m.

5. Producing automatic speech sequences at 13OS.p.m.
6. Producing short phrases in answer to questions at 13OS.p.m.
7. Producing single sentences spontaneously at 130$.p.m.
8. Producing several sentences spontaneously at 13OS.p.m.
9. Introduction to technique at 1505.p.m.

10. Reading at 150$.p.m.

11. Producing automatic speech sequences at 150$.p.m.

CRITERION FOR WEEK 3

 

Production of one three minute sample of spontaneous speech at

13OS.p.m. infront of the group without disfluency.

ability to change range of production of speech in technique voluntarily

at 60, 80, and 13OS.p.m.

Demonstration of

53

THERAPY OBJECTIVES

WEEK 4

1.

Nam-boom

10.

Producing short phrases in answer to questions to technique at
150$.p.m.

Producing single sentences spontaneously at 150$.p.m.
Producing several sentences spontaneously at 150$.p.m.
Discussion of attitudes related to fluency

Outline of phrase II of therapy

Review of volitional control of technique

Development of client's ability to use self instruction-client
signals and monitors. Clinician evaluates and consequates
Development of client's ability to self monitor and evaluate-
client signals, monitors and evaluates. Clinician consequates
Development of client's ability to self consequate-

clinician signals a self reinforcement paradigm 4

Further development of client's ability to self consequate-

client controls self reinforcement paradigm

CRITERION FOR WEEK 4

 

Production of one three minute sample of Spontaneous Speech at

150$.p.m.irifront of the group. Demonstration of self monitoring,

self evaluation and self consequation over a 5 minute period.

54

TRANSFER OBJECTIVES

WEEKS 5-8
1. Devel0p transfer contract for each client

2. Develop hierarchy of situations in which transfer to be attained.

CRITERION
Subject signals Speech behaviour to be used and achieves 80%

monitored and 20% unmonitored speech

3. Within the clinic, vary audience, speaking situation and introduce

stress factors

CRITERION

Subject signals and achieves 80% monitored and 20% unmonitored speech

4. Environmental transfer; the number of situations in which

transfer of fluency takes place increases in number and duration

CRITERION

Subject signals and achieves 80% monitored and 20% unmonitored speech

5. Enviornmental transfer; subject monitors in blocks of time

CRITERION

Subject signals and achieves 80% monitored and 20% unmonitored Speech

APPENDIX C
STUTTERING SEVERITY INSTRUMENT

55

56

APPENDIX C
STUTTERING SEVERITY INSTRUMENT

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APPENDIX D
524

57

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V V U v v v v v v VV V v V V v v \J V V V V v

58

APPENDIX D
524

82‘

Answer the following questions by writing true (T)
or false (P) within the parenthesis:

I usually feel that I am making a favorable impression when I talk.
I find it easy to talk with almost anyone.

I find it easy to look at my audience while speaking to a group.

A person who is my teacher or my boss is hard to talk to.

Even the idea of giving a talk in public makes me afraid.

Some words are harder than others for me to say.

I forget all about myself shortly after I begin to give a speech.
I am a good mixer.

People sometimes seem uncomfortable when I am talking to them.

I dislike introducing one person to another.

I often ask questions in group discussions.

I find it easy to keep control of my voice when speaking.

I do not mind speaking before a group.

I do not talk well enough to do the kind of work I'd really like to do.
Ky speaking voice is rather pleasant and easy to listen to.

I am sometimes embarrassed by the way I talk.

I face most speaking situations with complete confidence.

There are few people I can talk with easily.

talk better than I write.

often feel nervous while talking.

find it hard to make talk when I meet new people.

feel pretty confident about my speaking ability.

wish that I could say things as clearly as others do.

Even though I knew the right answer I have often failed to give it
because I was afraid to speak out.

HHHHH

APPENDIX E
ATTITUDE RATING SCALE AND QUESTIONNAIRE

59

60

APPENDIX E
ATTITUDE RATING SCALE AND QUESTIONNAIRE

After listening to the sample of speech on tape A, look at the scale

drawn below:

 

1 2 3 4 5

l l l l i

I would I would I would' I would I would
'ERY MUCH DISLIKB NEITHER LIKE VERY MUCH
DISLIKE speaking DISLIKE NOR speaking LIKE
speaking in that LIKE speak- in that speaking
in that technique ing in that technique in that
technique when... tecnnique when... technique
when... when... . when...

Think of one situation, real or imagined, in which you would
DISLIKE speaking in the technique demonstrated on the tape.
Briefly write down the situation under point 1 on the scale.

Think of one situation, real or imagined, in which you would
LIKE speaking in the technique demonstrated on the tape.

Briefly write down the situation under point 5 on the scale.

Think of one situation, real or imagined, in which you would

VERY MUCH

VERY MUCH

NEITHER

DISLIKB NOR LIKE speaking in the technique demonstrated on the tape.

Briefly write down the situation under point 3 on the scale.

Think of one situation, real or imagined, in which you would
speaking in the technique demonstrated on the tape.
Briefly write down the situation under point 2 on the scale.

Think of one situation, real or imagined, in which you would
speaking in the technique demonstrated on the tape.
Briefly write down the situation under point 4 on the scale.

DISLIKE

LIKE

61

ATTITUDE RATING SCALE AND QUESTIONNAIRE

Listed oelow are a number of situations of varying difficulty.
Rate each of the situations 1, 2, 3, 4 or 5 using the scale you have

Just devised.

For example, if you would very much dislike speaking in the technique
of speech used on the tape when "talking with a close friend" then you
should place a number l_on the left of that situation en the list.
Please make sureoyou rate all the items on the list.

RATIRG SITUATION

- talking with a young child
- arguing with your parents
reading something previously prepared to a group
of strangers
talking on the telephone to an acquaintance
saying “hello" or "hi" to a friend
talking to an animal
talking to someone over whom you have authority
being rushed when speaking to a friend
swearing or cursing
apologizing to an acquaintance
telling a joke to friends
introducing yourself to someone you have met for the
first time ‘
talking with friends and acquaintances at a dinner
party .
refuting a friend's criticism
saying the “Pledge of Allegiance"
talking to your boss or employer while at work
talking when happy with friends
being asked to repeat an order in a restaurant or bar
talking to an acquaintance on a topic about which you
are very well informed
_talking to yourself when alone
counting l to 20
- talking to an acquaintance after he/she has teased
you about your speech
- recounting a personal experience to a friend
- using a sound/word that has been troublesome in the
past with a stranger
- requesting information from a stranger
- being alone with a member of the Opposite sex
- trying to get across your own point of view in a group
discussion
- answering questions from an acquaintance about your
speech
- visiting a friend who is ill
- being misunderstood by a stranger

APPENDIX F
INTENTION T0 BEHAVE
RATING SCALE AND QUESTIONNAIRE

62

63

APPENDIX F

INTENTION TO BEHAVE
RATING SCALE AND QUESTIONNAIRE

After listening to the sample of speecn on tape 1, look at the scale
drawn below:

 

1 . 2 3 4 5

L L i i i

I would I would I would I would I would
NEVER use SELDOM OCCASIONALL! FREQUENTLY ALWAYS
that use that use that use that use that
technique technique technique technique technique
of speech of speech of speech of speech of speech

when... when... when... when... when...

Think of one situation, real or imagined, in which you would NEVER
use the technique of speech demonstrated on the tape.
Briefly write down the situation under point 1 on the scale.

Think of one situation, real or imagined, in which you would ALWAYS
use the technique of speech demonstrated on the tape.
Briefly write down the situation under point 5 on the scale.

Think of one situation, real or imagined, in which you would OCCASIONALL!
use the technique of speech demonstrated on the tape.
Briefly write down the situation under point 3 on the seals.

Think of one situation, real or imagined, in which you would SELDOM
use the technique of speech demonstrated on the tape.
Briefly write down the situation under point 2 on the scale.

Think of one situation, real or imagined, in which you would PREQUENTLX
use the technique of speech demonstrated on the tape.
Briefly write down the situation under point 4 on the scale.

64

INTENTION TO BEHAVE
RATING SCALE AND QUESTIONNAIRE

Listed below are a number of situations of varying difficuIty.
Rate eacn of the situations 1,2, 3, 4 or 5 using the scale you have

just devised.

For example, if you would never-use the technique of speech demonstrated
on tne tape when "talking with a close friend" then you should place
a number l’on the

left of that situation on the lists:

Please make sure you rate all the items on the list.

RATING

SITUATION

talking with a young child

arguing with your parents

reading something previously prepared to a group
of strangers'

talking on the telephone to an acquaintance

saying "hello" or "hi" to a friend

talking to an animal

talking to someone over whom you have authority

being rushed when speaking to a friend

swearing or cursing

apologizing to an acquaintance

telling a joke to friends

introducing yourself to someone you have met for the

first time

talking with friends and acquaintances at a dinner
party

refuting a friend‘s criticism

saying the "Pledge of Allegiance"

talking to your boss or employer while at work

talking when happy with friends

being asked to repeat an order in a restaurant or bar

talking to an acquaintance on a topic about which you
are very well informed

talking to yourself when alone

counting l to 20

talking to an acquaintance after he/she has teased
you about your speech

recounting a personal experience to a friend

using a sound/word that has been troublesome in the

past with a stranger

requesting information from a stranger

being alone with a member of the opposite sex

trying to get across your own point of view in a group
discussion

answering questions from an acquaintance about your

speech
visiting a friend who is ill
being misunderstood by a stranger

HICH

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IHWIIWIIHIIWNIllllil‘l‘lHllllllHHlll‘HINHHI
93008404695

 

312