Arab school teachers’ knowledge, beliefs and reactions regarding stuttering

Journal of Fluency Disorders 37 (2012) 54–69

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Journal of Fluency Disorders

Arab school teachers’ knowledge, beliefs and reactions regardingstuttering

Fauzia A. Abdallaa,∗, Kenneth O. St. Louisb,1

a Department of Communication Sciences, College for Women, Kuwait University, P.O. Box 5969, Safat 13060, Kuwaitb Department of Speech Pathology & Audiology, West Virginia University, 805 Allen Hall, P.O. Box 6122, Morgantown, WV 26506-6122, USA

a r t i c l e i n f o

Article history:Received 6 August 2011Received in revised form16 November 2011Accepted 28 November 2011Available online 21 December 2011

Keywords:StutteringAttitudesCross-culturalArab teachersStereotyping

a b s t r a c t

Purpose: Stereotypes toward stuttering and people who stutter (PWS) are widespread inthe general public irrespective of age, level of education, culture, geographic location andprofession. Negative attitudes held by persons of authority like teachers can lead to social,economic and educational obstacles in the lives of PWS.Method: The current study used an Arabic translation of an adapted version of the PublicOpinion Survey of Human Attributes-Stuttering (POSHA-S) to explore Arab teachers’ knowl-edge and attitudes toward stuttering as well as strategies they adopt to cope with theproblem in class. The participants were 262 in-service and 209 pre-service public schoolteachers in Kuwait. The results are contrasted to those of Arab parents in Kuwait reportedearlier.Results: Although many of the teachers knew a person who stutters well and were sensitivein their interactions with PWS, major findings of this study suggest that many were misin-formed about the causes of stuttering and held stereotypical views about PWS, comparableto those reported in the literature. Very few differences were noted between opinions ofteachers who were still in training and those who were practicing for an average of 11 years.Conclusion: The study underscores the need for awareness campaigns that target not onlyteachers who are currently working but also those still in training to dispel misconceptionsabout stuttering and ensure a better educational environment for PWS.

Educational objectives: At the end of this activity the reader will be able to: (1) describeknowledge of stuttering and attitudes toward students who stutter and classroom strate-gies perceived to be helpful by pre-service and in-service teachers in Kuwait; (2) identifystereotypes toward stuttering across cultures, professions and geographic locations; and(3) list similarities and differences in attitude and knowledge of stuttering between parentsand teachers.

© 2011 Elsevier Inc. All rights reserved.

1. Introduction

1.1. Stereotypes and stuttering

Stuttering has been identified universally in people of various ethnic and cultural backgrounds (Cooper & Cooper, 1993).A plethora of research studies has provided evidence that the public view of stuttering is generally unfavorable and that

∗ Corresponding author. Tel.: +965 2498 3179; fax: +965 2530461.E-mail addresses: [email protected] (F.A. Abdalla), [email protected] (K.O. St. Louis).

1 Tel.: +1 304 293 2946; fax: +1 304 293 2905.

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F.A. Abdalla, K.O. St. Louis / Journal of Fluency Disorders 37 (2012) 54–69 55

isteners often ascribe negative traits like anxious, shy, nervous, unassertive or introverted to people who stutter (PWS) (e.g.,lood, Blood, Tellis, & Gabel, 2003; Craig, Tran, & Craig, 2003; Doody, Kalinowski, Armson, & Stuart, 1993; Klassen, 2001;zdemir, St. Louis, & Topbas , 2011b; St. Louis, 2005; Van Borsel, Verniers, & Bouvry, 1999).

These perceptions appear to hold true for listeners of varying ages, e.g., children as young as four years (Ezrati-Vinacour,latzky, & Yairi, 2001), adolescents (Flynn and St Louis, 2011), college students (Dorsey & Guenther, 2000) and for lay peoplend parents of children who stutter (CWS) (e.g., Crowe & Cooper, 1977; Ham, 1990; Mayo, Mayo, Jenkins, & Graves, 2004).vidence also supports that similar perceptions exist in various professional groups, e.g., teachers, school administrators,pecial educators and vocational counselors (Crowe & Walton, 1981; Hurst & Cooper, 1983; Lass et al., 1992, 1994; Ruscello,ass, Schmitt, & Pannbacker, 1994; Yeakle & Cooper, 1986) and even speech language clinicians (e.g., Cooper & Cooper, 1996;airi & Williams, 1970).

Another prevalent public belief is that stuttering has psychological causes (e.g., Boyle, Blood, & Blood, 2009). Despiteonsiderable research that demonstrates that the alleged “stuttering stereotype” has no basis (Bloodstein & Ratner, 2008),hese stereotypes persist. Interestingly, previous reports suggest that listeners’ exposure to or familiarity with PWS does noteem to influence these perceptions (Craig et al., 2003; Doody et al., 1993). Investigators have also documented that manyWS experience negative effects like depression and discrimination as a result of their stuttering (Corcoran & Stewart, 1998;richton-Smith, 2002; Plexico, Manning, & Levitt, 2009).

A review of the literature points to some theories that explain how stereotyping arises and what its effects are. Accordingo the anchoring-adjustment theory, people often form stereotypes about stuttering based on their own experiences withormal disfluencies (MacKinnon, Hall, & McIntyre, 2007). For example, when people who do not stutter are nervous andxperience normal disfluencies, they may associate such negative feelings (nervousness) with the stuttering exhibited byWS.

In his well-known work on stigma, Goffman (1963) explains that a stigmatized person experiences “spoiled identity” dueo deviant labels others associate with a single characteristic that the person may possess. Because of this single difference,he person is viewed as being defective in every aspect of his or her life. Wright (1983) calls this the “spread phenomenon”hereby undesirable perceptions of a particular disability (e.g., stuttering) spread or generalize to beliefs about the wholeerson (e.g., the person’s other characteristics like competence, intelligence and personality). Perceptions such as these mayontribute to negative stereotyping of PWS and lead to behaviors that may discriminate and create social, educational andccupational obstacles for the stigmatized individual (Gabel, Blood, Tellis, & Althouse, 2004; Smart, 2001). This in turn mayesult in PWS beginning to believe that they possess the unbecoming characteristics ascribed to them by a limited numberf people and thus contributing to negative self-concept (Crocker, Major, & Steele, 1998; Manning, 2010).

.2. Measures of attitudes toward stuttering

Attitudes, knowledge and beliefs about stuttering have been measured using diverse techniques, e.g., face-to-face or tele-hone interviews (de Britto Pereira, Rossi, & Van Borsel, 2008; Ham, 1990), semantic-differential scales (Burley & Rinaldi,986), self-administered written questionnaires consisting of open or closed-ended questions (St. Louis, 2011; Yairi &illiams, 1970). Surveys vary in scope, purpose and topics covered. Some, like the Parental Attitudes toward Stuttering

nventory (PATS; Crowe & Cooper, 1977) sample parental attitudes, while the Teachers’ Perceptions of Stuttering InventoryTPSI; Yeakle & Cooper, 1986) examines beliefs of teachers and yet another, the Clinicians Attitude toward Stuttering Inven-ory (CATS; Cooper & Cooper, 1985) measures professional opinions regarding the nature and treatment of stuttering. Whilehese inventories have been published in peer-reviewed journals, their reliability has not been formally ascertained (Snyder,001). Researchers have recommended using a mixed quantitative and qualitative model to gain a broader understandingf the attitudes and stereotypes held by respondents (Panico, Healey, Brouwer, & Susca, 2005).

The Public Opinion Survey on Human Attributes-Stuttering (POSHA-S) is a well-designed, standardized instrument thateasures public attitudes toward stuttering internationally (cf. St. Louis, 2011 for detailed descriptions). POSHA-S, likeany other instruments in the literature surveys a variety of behaviors, beliefs, reactions and emotions to identify stigma and

ocietal knowledge of stuttering (Blood et al., 2003; Gabel et al., 2004; Hulit & Wirtz, 1994; Klein & Hood, 2004). However,OSHA-S is unique in that it is designed to elicit attitudes toward stuttering, without explicitly stating that stuttering ishe targeted attribute and thereby minimizing response bias. Recent research has documented that POSHA-S has internalonsistency, is practical, reliable, valid, translatable and is not adversely impacted by modifications in rating scales or orderAl-Khaledi, Lincoln, McCabe, Packman, & Alshatti, 2009; St. Louis, Hancock, & Remley, 2010; St. Louis, Lubker, Yaruss, Adkins,

Pill, 2008; St. Louis, Lubker, Yaruss, & Aliveto, 2009; St. Louis, Reichel, Yaruss, & Lubker, 2009; St. Louis & Roberts, 2010).dditionally, POSHA-S is sensitive in detecting changes in attitudes following an awareness campaign (e.g., Flynn & St Louis,011) as well as differences emerging from convenience versus probability sampling (Özdemir et al., 2011b). The instrumentas been translated into and administered in several languages including Arabic (e.g., Al-Khaledi et al., 2009; St. Louis,005).

.3. Culture and perceptions of people who stutter

Although stuttering is known to exist worldwide, research on attitudes and knowledge of stuttering has predominantlyocused on Western culture (particularly Caucasians in the United States). More recently the research base has expanded to

56 F.A. Abdalla, K.O. St. Louis / Journal of Fluency Disorders 37 (2012) 54–69

include cultural groups from various parts of the world (St. Louis, 2005). These studies have confirmed that negative attitudestoward PWS exist across cultures and geographic locations, e.g., among African-American public and university students(Mayo et al., 2004; Williams & Mayo, 2000), Chinese adults (Xing Ming, Jing, Yi Wen, & Van Borsel, 2001), Arab parents(Al-Khaledi et al., 2009) as well as by people from geographic locations like Nepal, Bulgaria, Turkey, Brazil, South Africaand Cameroon (St. Louis, 2005; St. Louis, Andrade, Georgieva, & Troudt, 2005; St. Louis & Roberts, 2010). While negativestereotypes of PWS are widespread, studies have found culture specific variations such as the belief that stuttering is causedby ghosts/spirits (Robinson & Crowe, 2002) or emotional factors (de Britto Pereira et al., 2008) and the belief that prayer isan effective means for treating stuttering (Mayo et al., 2004).

Despite the fact that Islamic precepts prohibit discrimination against people with disabilities and promote care for thosein need (El Naggar Gaad, 2001), other regional or cultural practices may influence how Muslim Arabs react to individuals witha disorder. Negative attitudes and the social stigma of disability appear to be common among people of Middle Eastern roots(Sharifzadeh, 2004) and such societal attitudes have posed challenges for Arab parents of children with developmental dis-abilities (Crabtree, 2007; Karola, 2002). However, there is a dearth of research on knowledge and perceptions of PWS in Arabculture. And therefore, it is worth exploring if such views also extend to people who stutter given that oral communicationis an essential characteristic of being human (Emerick, 1988).

Although some of the views of Arab parents surveyed by Al-Khaledi et al. (2009) were positive, outdated knowledgeabout stuttering and negative attitudes toward PWS were also quite common. Using an Arabic translation of an adaptedversion of the POSHA-S2 (St. Louis, 2011), these researchers found that many parents attributed the cause of stuttering toemotional or psychological factors and more than half believed that stuttering results from parents’ over-reaction to thechild’s disfluencies. Stereotypical beliefs that PWS are shy and fearful were rife and 50% of the parents felt that PWS shouldnot work in influential jobs (e.g., politicians, doctors, lawyers and teachers).

1.4. Teacher opinions about stuttering and PWS

As shown previously, numerous studies have documented that stuttering stereotypes exist among diverse populations.Teachers are no exception to this. Woods and Williams (1976) found that elementary school teachers in their study hada higher tendency than the other participants (college students, SLPs and parents) to ascribe different traits to a maleperson who stutters than to a fluent speaker. Crowe and Walton (1981) examined attitudes of elementary school teachers inMississippi public schools toward stuttering using a written questionnaire. The teachers’ age, years of teaching experience,and educational level had no effect on their attitudes. However, previous knowledge about stuttering positively influencedthe teachers’ perceptions of PWS.

Yeakle and Cooper (1986) found that a number of school teachers in Alabama held unsupported beliefs about the etiologyof stuttering and personality traits of PWS. Their findings corroborated Crowe and Walton (1981)’s in that teachers withprevious course work in speech disorders demonstrated more desirable attitudes toward PWS, thus once again showing thateducation can help influence teachers’ perceptions of PWS. Lass et al. (1992) asked American school teachers to describefour hypothetical PWS (male child, female child, male adult and female adult). A large majority of the teachers assignednegative stereotypical personality characteristics to the hypothetical person who stutters: out of 287 adjectives they choseto describe the person who stutters, 192 (67%) were negative.

Heite (2000) polled 116 Icelandic teachers to explore how their beliefs about stuttering affected their reactions to PWSin the classroom. She found limitations in the teachers’ knowledge of stuttering and like many listeners elsewhere they toobased their judgments of PWS on cultural mythology and their own stress reactions. More recently, Irani and Gabel (2008)found American teachers were positive in rating PWS on three semantic differential descriptors, i.e., “sincere–insincere,”“physically normal–physically abnormal,” and “intelligent–unintelligent.”

Currently we know very little about attitudes and knowledge of teachers from Arab culture regarding stuttering andPWS. Abdalla and Al-Saddah (2009) conducted a pilot study to explore perceptions and knowledge about stuttering inschool teachers in Kuwait, using an Arabic translation of an adapted POSHA-S (St. Louis, 2011). The survey results revealedgaps in the teachers’ knowledge about stuttering but also some positive trends in their perceptions. They also conductedqualitative interviews to gather data about the school experiences of three Kuwaiti individuals who stutter. Time pressurewas a common theme that emerged in the qualitative interviews with all three participants. A striking example of theeffect of time pressure is clear in this recounting of one of the interviewees: “Some teachers pretended not to see my raisedhand; some pretended to be concerned with my feelings, advising me that because of my ‘situation/condition’ I should askquestions after class or during break time so I could avoid the embarrassment of stuttering in front of my classmates. I knew
the truth and I stopped communicating with most of my teachers.” While generalizations cannot be made based on personalreports of three individuals, remarks such as these are stark reminders of how the teacher’s attitude can have a negativeimpact on the student leading to feelings of marginalization.
2 In the Al-Khaledi et al. (2009) report, the instrument was identified as an adapted version of the POSHA-E (with “E” referring to experimental version).In fact, it was the last of three experimental versions. The rating scale therein has been adopted for the final version; hence, POSHA-S is a more accuratedescriptor.

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In an unpublished study, the first author and colleagues used an English and Arabic version of a 14 item semanticifferential scale to compare attitudes reported by Arab school teachers with those of teachers from the USA. The Americaneachers reported significantly more positive attitudes on 11 of 14 items in the scale as compared to the Arab teachers.pproximately a third of the Arab teachers assigned characteristics to PWS that were on the negative side of the semanticifferential scale, i.e., “not likeable,” “unsociable,” “hostile,” “unemployable,” and of “weak character.”

Further analyses of attitudes and knowledge of Arab teachers is necessary because neither of these studies gives us aomplete representation. Abdalla and Al-Saddah’s (2009) was a pilot study that analyzed a small sample of participants’esponses to selected POSHA-S items. The unpublished study used a semantic differential scale; a technique that may notccurately assess the respondent’s true perceptions of stuttering and PWS (Schlagheck, Gabel, & Hughes, 2009). For example,e do not learn about the teachers’ views of what causes stuttering and what strategies they consider helpful for studentsho stutter.

.5. Purpose of the study

School-age children spend a considerable amount of time at school and there is little doubt that teachers are authoritygures who can have a significant influence on their lives during these formative years. Values and theories teachers upholdan mold their teaching practices and student preferences (Kagan, 1992). Research in the field of education has also shownhat teachers’ expectations of their students’ abilities affect their instructional goals and methods (Mavropoulou & Padeliadu,000). Many adults who stutter testify that stuttering negatively impacted their self-confidence in school, academic capacitynd relationship with teachers and peers (Hayhow, Cray, & Enderby, 2002; Hugh-Jones & Smith, 1999; Klompas & Ross, 2004).eightened communication apprehension and perceived depressed communicative competence in adolescents who stutteran be associated with negative attitudes to school and overall inferior educational achievement (Blood, Blood, Tellis, & Gabel,001). Moreover, bullying and teasing are additional setbacks that students who stutter confront in school, e.g., Langevin2001) reported 81% of students experienced this problem as a direct result of their stuttering.

As noted earlier, negative attitudes toward PWS appear to be universal, and it is essential that more studies be undertakeno determine which aspects are universal and which ones are specific to certain cultural groups. Exploring attitudes of non-

estern cultural groups about stuttering is important, both because we live in an increasingly pluralistic society and becauseuch knowledge has crucial scientific value. Attitudes of significant others (parents and teachers) and the larger communitys vital to the therapeutic process. As Crowe and Walton (1981, p. 167) noted over three decades ago, “identification ofndesirable teacher attitudes toward stuttering, coupled with a teacher education program, possibly could ensure thatommunicative interactions within the classroom complement the therapeutic process.”

The purpose of the current study is to collect information about Arab teachers’ knowledge and beliefs about stutteringnd PWS. Probing teachers’ perception about stuttering will provide us with insight into not only the level of their awarenessut more importantly on how they deal with students who stutter in the classroom. Three questions guided this research:a) What are the Arab teachers’ knowledge of stuttering and attitudes toward PWS and what strategies do they believe areelpful? (b) Are teacher trainees (pre-service) comparable in their attitudes and knowledge about stuttering to experiencedeachers (in-service)? (c) What are the similarities and differences in attitude and knowledge of stuttering between Arabeachers in this study and those of Arab parents surveyed by Al-Khaledi et al. (2009).

. Method

.1. Questionnaire

This field study used an adapted version of the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S, St. Louis,011) to measure Arab teachers’ beliefs, attitudes and knowledge of stuttering and PWS. The final questionnaire consistedf a total of 39 items. Twenty-two of these were taken from the POSHA-S and 17 items related to characteristics of stutteringnd ways the teachers deal with PWS in the class were adapted from Crowe and Walton (1981), Guitar (2006), Heite2000) and Yeakle and Cooper (1986). The questionnaire used a paper-and-pencil format and asked participants to respondo each statement by answering “Yes,” “No,” or “Not sure.” The survey package consisted of a cover page that providedhe respondents with information about the study, instructions on how to complete the survey, consent to participate andeassurance that anonymity will be maintained. The survey commenced with a demographic section that asked participants’irth place, date of birth, age, gender, religion, race, citizenship, languages spoken, marital status, educational background,urrent job, place of employment or study (name of school or institution) and grade levels currently teaching (elementary,iddle or high school). This was then followed by five questions to probe if they stutter, and a question each to see if they have

friend or relative who stutters, have taught PWS in the past, presently teach a person who stutters, had previous knowledgebout stuttering, know how to obtain information about stuttering and the source of their knowledge about stuttering. The
emainder of the questionnaire consisted of detailed ratings regarding etiology and characteristics of stuttering, who shouldelp PWS, self-reactions to stuttering (e.g., feel impatient), effect of the disorder on PWS such as ability to lead a normal
ife, views about the personality traits of PWS (e.g., are shy or fearful) and what action the teacher would take to help thetudent who stutters in the classroom (e.g., excuse the person who stutters from class discussions and oral tasks).


Table 1Demographic data for the two groups of respondents (pre-service teachers [PT] and in-service teachers [IT]).

PT IT

Number in sample 209 262Mean age in years (range) 19.6 (19–30) 36.6 (19–59)Gender, n (%)

Males 2 (1.0%) 138 (52.7%)Females 207 (99.0%) 124 (47.3%)

Education, n (%)High school diploma 209 (100%) 1 (.4%)Undergraduate degree – 258 (98.5%)Other (2-year-college or postgraduate) – 3 (1.2%)

Marital status (married), n (%) 50 (23.9%) 221 (84.4%)Work/educational setting, n (%)

Attend college of basic education 120 (57.4%) –Attend Kuwait University–Faculty of Education 89 (42.6%) –Teach elementary grades – 67 (25.6%)Teach intermediate grades – 122 (46.6%)Teach secondary school level – 73 (27.9%)

Nationality, n (%)Kuwaiti 191 (91.4%) 108 (41.2%)Egyptian – 116 (44.3%)Syrian – 14 (5.5%)Saudi 8 (3.8%) 5 (1.9%)Jordanian 1 (.5%) 4 (1.5%)Tunisian – 4 (1.5%)Other 4 (2%) 4 (1.5%)

Regional group, n (%)Gulf Arab 199 (97.5%) 114 (44.7%)Other Arab 5 (2.5%) 141 (55.3%)

Years of teaching experience: mean (SD) – 11.5 (8.6)Had previous knowledge about stuttering (yes), n (%) 68 (32.5%) 78 (29.8%)Know friend/Relative who stutters (yes) n (%) 116 (55.5%) 113 (43.1%)
Taught student(s) who stutters in the past (yes), n (%) – 181 (69.1%)Presently teaching student(s) who stutters (yes), n (%) – 105 (40.1%)
The inventory was translated into Arabic by a fluent bilingual translator. A second bilingual linguist then back-translatedthe instrument into English following the procedure specified in St. Louis (2005). Two independent bilingual linguists atKuwait University verified the accuracy and reliability of the translations. The verification revealed no substantive problemswith the translation. St. Louis and Roberts (2010) compared both French and English versions of an earlier experimentalversion of the questionnaire (the POSHA-E) in two distinct cultures (Canada and Cameroon), concluding that translation andback-translation were valid procedures.

2.2. Participants and survey distribution

Participants for this study were residents of Kuwait. Kuwait is a small nation (approximately 17,820 km2) situated in thenortheastern section of the Arabian Peninsula bordering Iraq and Saudi Arabia. In-service public school teachers (n = 262) andpre-service teachers (n = 209) at educational institutions in Kuwait participated in this study. Table 1 provides characteristicsof the in-service teachers (IT) and the pre-service teachers (PT).

The in-service teachers were recruited from three of six governorates in Kuwait selected at random (total of 15 schools,five from each governorate). Teachers in Kuwait are assigned to different governorates depending on the need, and manyexpatriate teachers are also hired and placed in schools across the country. Hence, the sample of teachers responding tothe questionnaire is most likely representative of the general population of teachers in Kuwait. Özdemir, St. Louis, andTopbas (2011a) found significant differences between POSHA-S scores obtained through a convenience versus probabilitysampling. This study also used probability sampling in order that the findings would be generalizable to the region (Kuwait).Approval to conduct this study was obtained from the Kuwait Ministry of Education. Five schools (two elementary, twointermediate and one secondary) from each governorate were randomly selected from a list of all public schools obtainedfrom the ministry. Recruitment of the school teachers was facilitated by principals of the schools contacted for this study.Research assistants from the Department of Communication Sciences at Kuwait University provided the school principalswith packages containing a cover letter, consent form and the questionnaire. The principals then distributed the packagesto teachers in their respective schools. The completed packages were then returned in sealed envelopes to the research
assistants by the school principals. A total of 600 surveys were distributed, 200 each for the following levels: elementary(grades 1–5), intermediate (grades 6–9) and secondary (grades 10–12). A total of 457 questionnaires (76.3% response rate)were returned, of which 275 (45.8%) were complete and usable. Those excluded included incomplete surveys. Furtherquestionnaires from 13 in-service teachers were excluded because they indicated that they stuttered. As shown in Table 1,

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24 in-service teachers (47.3%) were females and 138 (52.7%) were males, with a mean age of 36.6 years. These in-serviceeachers were predominately of Arab descent: 41.2% were Kuwaitis, 44.3% Egyptians, 5.5% Syrians, 1.9% Saudis, 1.5% Jordaniannd 1.5% Tunisian. They taught various grade levels: 25.6% in elementary school, 46.6% in intermediate school and 27.9% inecondary school. They reported a teaching experience ranging from 1 to 32 years (mean = 11.5 years).

The pre-service teachers were recruited from two educational settings: the College of Basic Education (Kuwaiti Publicuthority of Applied Education and Training) and the Faculty of Education at Kuwait University. Pre-service teachers in theirecond year of training in these two institutions were randomly selected. Instructors assisted by distributing the surveysuring their lectures. Research assistants collected these after the end of the class. A total of 400 surveys were distributed inoth institutions. Three hundred and one were returned (75.3% response rate), of which 220 were complete and usable, androm these, 11 respondents were eliminated because they reported that they stuttered. Accordingly, a total of 209 surveysrom the pre-service group (52.3%) were used in the analyses, 89 from Kuwait University, and 120 from the College of Basicducation. Both programs have very few male students; hence, 99% of the sampled pre-service teachers were females. Most91.4%) of the pre-service teachers were Kuwaiti citizens with a mean age of 19.6 years.

.3. Data analysis

Responses obtained from the detailed section of the questionnaire were analyzed to explore the knowledge and attitudesf the Arab teachers toward stuttering. We also examined typical reactions to students who stutter and strategies theeachers adopt in the classroom to deal with the problem. Group comparisons were conducted to determine if the responsesf the pre-service teachers who were younger and less educated/experienced differed from those of the in-service teachers.hen viable we compared the teachers’ data from the present study to Al-Khaledi et al. (2009)’s findings on knowledge and

ttitudes of parents from Kuwait toward PWS. A total of 424 Arabic-speaking parents participated in their study. Of these2% were females while 38% were males. Thirty seven percent were 40 years of age or more and at least 64% of the parentsad attained a bachelor degree or higher level of education. We used general descriptive statistics (frequency distributionross-tabulations) and non-parametric chi-square test for independence to explore the participants’ responses. Criterion fortatistical significance was set at p-values of ≤.05.

. Results

.1. Experience with stuttering

The participants were asked four questions to probe their familiarity, knowledge and experience with stuttering. Overall,he pre-service and in-service teachers were different in their familiarity with PWS, i.e., 43% of the in-service teachers and 56%f the pre-service group reported knowing a friend or relative who stuttered. Only 31% of the professionals indicated they hadrevious knowledge about stuttering, and the sources of this information were predominately the internet, media and books.ery few (7% total teachers) knew about the disorder through interactions with specialists in the field of communicationisorders and seminars. As for direct experience with students who stutter, a substantial majority of the in-service teachers69%) had taught PWS at some stage. At the time of the study, 40% indicated that they were teaching a student who stutters.

Chi-square test for independence (with Yates Continuity Correction) was used to explore the relationship between thetatement “I have a friend/relative who stutters” and each of the 39 items used in this study (Sections 3.2–3.6 below provideore details on the 39 items). The tests revealed no significant association between this statement and any of the 39 items

p > .05). Essentially, knowing a close person who stutters appeared to have no influence on the knowledge, beliefs andeactions of teachers toward stuttering and PWS.

.2. Opinions on causes of stuttering and sources for help

Many teachers appeared to hold unsubstantiated beliefs regarding what causes stuttering. As shown in Table 2, 81%ttributed the cause to “psychological problems” which concurs with opinions held by Arab parents (82% as reported inl-Khaledi et al., 2009). Another sizeable percentage of teachers (76%) linked the cause to a “very frightening event.” Slightlyver half of the teachers (58%) ascribed it to “genetic inheritance,” a finding that was somewhat higher than what Arabarents believed (43%) in Al-Khaledi et al. (2009). Fewer teachers subscribed to other causes such as “ghosts, demons orpirits” (12%), “learning or habits” (26%) and a “virus or disease.” It was encouraging to see that nearly all of the teacherselieved PWS should be helped by speech-language pathologists (96%) although a majority still felt they should be seen byedical doctors (56%). Eleven percent of the teachers agreed that other individuals who stutter can also assist. According tol-Khaledi et al. (2009), (86)% of Arab parents viewed speech-language pathologists as professionals who can assist PWS.

Chi square statistics revealed inter-professional differences in response ratios for two items whereby significantly more
re-service teachers (18%) than in-service teachers (8%) agreed that stuttering is caused by: “ghosts, demons or spirits,” [�2
2, n = 465) = 12.3, p < .002, Cramer’s V = .163] or “a very frightening event,” [�2 (2, n = 470) = 23, p < .001, Cramer’s V = .217],6% and 68%, respectively. According to Cohen’s (1988) criteria, Cramer’s vs between .1 and .3 is “small,” between .3 and .5

s “medium,” and above .5 is “large.”


Table 2Causes of stuttering and referral for help. Percentages of pre-service and in-service teachers as well as parents (Al-Khaledi et al., 2009) who responded yes,no or not sure to each item.

Statement Response Group

In-service teachers Pre-service teachers Teachers (total) Parents (Al-Khaledi et al., 2009)

I believe stuttering is caused byPsychological problems Yes (%) 80.2 82.1 81.1 82

No (%) 10.9 10.6 10.8 9Unsure (%) 8.9 7.2 8.1 8

Genetic inheritance Yes (%) 53.4 63.2 57.7 43No (%) 32.8 26.8 30.2 33Unsure (%) 13.7 10 12.1 24

Ghosts, demons or spirits Yes (%) 7.8 17.9 12.3No (%) 70.9* 58.9 65.6Unsure (%) 21.3 23.2 22.1

A very frightening event Yes (%) 67.6 86.1 75.7No (%) 17.6* 6.3 12.6Unsure (%) 14.8 7.6 11.7

Learning or habits Yes (%) 24.3 27.8 25.9No (%) 55.6 56 55.8Unsure (%) 20.1 16.2 18.3

A virus or disease Yes (%) 16.5 12.9 14.9No (%) 61.2 67 63.8Unsure (%) 22.3 20.1 21.3

I believe stuttering should be helped byA medical doctor Yes (%) 57.9 54.5 56.4

No (%) 34.5 35.9 35.1Unsure (%) 7.7 9.6 8.5

A speech and language therapist Yes (%) 95 96.7 95.8 86No (%) 3.1 1 2.1 5Unsure (%) 1.9 2.3 2.1 8

Other people who stutter Yes (%) 9.6 12.5 10.9No (%) 76.2 72.6 74.6
Unsure (%) 14.2 14.9 14.5
* �2 significant at p < .05, tested on entire distribution.

3.3. Opinions on characteristics, recovery and severity of stuttering

Fig. 1 presents behaviors associated with stuttering by the two groups of participants. The majority of teachers recognizedcommon forms of fluency breakdowns such as “repetitions” (82%) and blocks or “sudden stops and inability in getting theword out” (87%). Additionally, they seemed aware that stuttering can “vary in severity” from one person to the other (95%).

Fig. 1. Percentages of in-service and pre-service teachers who responded yes questions on characteristics, recovery and severity of stuttering.


Table 3Beliefs about PWS. Percentages of pre-service and in-service teachers as well as parents (Al-Khaledi et al., 2009) who responded yes, no or not sure to eachitem.


In-serviceteachers

Pre-serviceteachers

Teachers (total) Parents(Al-Khaledi et al., 2009)

People who stutterShould try to hide their stuttering Yes (%) 20.5 19.5 20.1

No (%) 72.1 67.8 70.2Unsure (%) 7.4 12.7 9.7

Are nervous or excitable Yes (%) 70.5 72.9 71.6 34No (%) 18.8 14 16.7 39Unsure (%) 10.7 13 11.7 27

Shy or fearful Yes (%) 80.5 84.1 82 73No (%) 10.3 7.2 9 18Unsure (%) 9.2 8.7 9 8

Have themselves to blame for their stuttering Yes (%) 30.3 41.1 35No (%) 41.7* 36.2 39.4Unsure (%) 28 22.7 25.6

Have lower level of academic performance inschool (lower than average IQ for parents)

Yes (%) 16.6 15.9 16.3 9

No (%) 73.4 70.7 72.2 71Unsure (%) 10 13.5 11.5 20

Can lead normal lives Yes (%) 71.6 74.2 72.8 90No (%) 16.1 12 14.2 4Unsure (%) 12.3 13.8 13 5

Can do any job they want Yes (%) 45.8 36.1 41.5No (%) 40.4 45.7 42.7Unsure (%) 13.8 18.2 15.8

Can make friends Yes (%) 85.9 91.4 88.3No (%) 7.6 3.8 5.9

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owever, other core characteristics of stuttering like “prolongations of sounds” and secondary features like “tension in facialuscles” met with less certainty, 49% and 56.3%, respectively. A small minority of teachers were confused whether “seizures”

haracterize the speech of PWS (12% said yes, 31% were unsure).As can be seen in Fig. 1, three items revealed statistically significant differences between the two groups of teachers.

enerally, the pre-service were significantly higher in considering “repetitions,” (pre-service = 87%; in-service = 78%), [�2

2, n = 471) = 12.3, p < .009, Cramer’s V = .138] and “prolongations,” (pre-service = 58%; in-service = 43%), [�2 (2, n = 466) = 11, < .004, Cramer’s V = .154] as core behaviors of stuttering. Moreover, they displayed stronger views that PWS can recoverithout help (p = 001) [�2 (2, n = 470) = 19.7, p < .001, Cramer’s V = .204].

.4. Attitudes and beliefs about stuttering and PWS

Table 3 contrasts responses of three groups of participants (pre-service teachers, in-service teachers and parents) to eighttatements on attitudes and beliefs about stuttering and PWS. Approximately three quarters of the teachers held positivettitudes given that they felt that PWS “can lead normal lives” (73%), and about four fifths “can make friends” (88%). Despitehe fact that over 70% of the teachers deemed that PWS do not have a “lower level of academic performance in school,” only2% believed they “can do any job they want.” As can be discerned from Table 3, the percentages obtained for the teachersere comparable to those attained for Arab parents in Al-Khaledi et al. (2009).

Nonetheless, stereotypical beliefs about stuttering were evident from the data. Seventy-two percent of the teacherserceived PWS as being “nervous or excitable” even though only 34% of the Arab parents in Al-Khaledi et al. (2009) viewedhem as such. By contrast, the Arab parents (Al-Khaledi et al., 2009) shared the stereotypical personality traits that PWSere “shy or fearful” held by the teachers, 73% and 82%, respectively. The teachers diverged in their responses regarding the

tatement that PWS “have themselves to blame for the stuttering,” with 35% saying ‘yes’ and 39% disagreeing. Few (20%)elt that PWS “should try to hide their stuttering.” Chi square statistics revealed no significant differences between the two
rofessional groups, pre-service and in-service teachers, in their response ratios to these items about their beliefs with thexception of one item. Slightly more pre-service teachers (41%) stated “PWS have themselves to blame for their stuttering”han the in-service teachers (30%), �2 (2, n = 468) = 5.98, p = .050, Cramer’s V = .113.


Table 4Reactions when talking with a PWS. Percentages of pre-service and in-service teachers as well as parents (Al-Khaledi et al., 2009) who responded yes, noor not sure to each item.


In-serviceteachers

Pre-serviceteachers

Teachers(total)

Parents(Al-Khaledi et al., 2009)

If I were talking to PWS I wouldTry to act like the person was

talking normallyYes (%) 96.1 98.1 97

No (%) 3.1 1.4 2.3Unsure (%) .8 .5 .7

Make a joke about stuttering Yes (%) 5.7 5.3 5.5No (%) 93.1 93.7 93.4Unsure (%) 1.2 1 1.1

Fill in the person’s words Yes (%) 58.6 62.5 60.3 50No (%) 36.8 31.7 34.5 42Unsure (%) 4.6 5.8 5.2 7

Feel impatient (not want to waitwhile the person stutters)

Yes (%) 7.3 5.3 6.4

No (%) 89.6 88 89Unsure (%) 3.1 6.7 4.6

Feel comfortable or relaxed Yes (%) 56 56.3 56.1 26No (%) 29 24 26.8 51Unsure (%) 15 19.7 17.1 23

Feel pity for the person Yes (%) 71 53.1 63 55No (%) 24.7* 39.2 31.2 36
Unsure (%) 4.3 7.7 5.8 9

3.5. Participants’ reactions when talking with PWS

The teachers reported a variety of reactions they would display when talking with a student who stutters as can be seen inTable 4. Nearly all would “try to act like the person was talking normally” (97%) and would “not make a joke about stuttering”(93.7%). Despite 56% saying they would feel “comfortable or relaxed,” more than half (63%) would “feel pity” for the studentwho stutters. A further inconsistency in the participants’ responses was that 89% alleged they would not feel “impatient,”yet 60% said they would “fill in the person’s words.” Descriptively as can be observed in Table 4, the Arab parents studied byAl-Khaledi et al. (2009) displayed response scores that were sometimes lower than those of the teachers. Half of the parents(50%) as opposed to 60% of the teachers reported they would “fill in the person’s words.” However, more teachers reportedthey would feel “comfortable or relaxed” (56%) in contrast with only 26% of the parents indicating this feeling. The samepattern was also noted for “feeling pity,” 55% and 63%, respectively for the parents and teachers.

A comparison between the in-service and the pre-service teachers for the six statements related to reactions exhibitedwhen speaking to a student who stutters revealed significant group differences were found for only one item. A largerpercentage of the in-service teachers (71%) stated “feeling pity for the person” than the pre-service teachers (53%), �2 (2,n = 468) = 16.1, p = .001, Cramer’s V = .185.

3.6. Opinions on how to deal with PWS in the classroom

Fig. 2 presents the teachers’ views of how they would handle stuttering in the classroom. Some of their responsesdemonstrated that they were sensitive to PWS, e.g., 88% agreed that it would help if “other students who tease or makefun of PWS’ speech are warned or punished” and most (94%) rejected the idea of “punishing the student when he/shestutters in class.” Close to half (42%) believed it would be beneficial for the student who stutters to “discuss his/her feelingsabout stuttering openly with other students” and 65% opposed “excusing the student who stutters from class discussionsand oral tasks.” As for what the student should do when he or she stutters, 84% advised that the student should “repeat theword until she can get it out,” 55% recommended that she “thinks of what she wants to say before speaking,” and another55% felt “taking a deep breath before speaking” is helpful. Although 60% said it would help if the student who stutters “slowsdown” or “relaxes,” 36% came up with the contradictory suggestion of “speaking fast so the listener would not get a chanceto notice the stuttering.”

The two groups of respondents, pre-service and in-service teachers, displayed equivalent beliefs in the strategies theyfelt would help the student who stutters with the exception of one statement. In-service teachers (67%) were significantlymore likely to tell the person to “slow down” or “relax” than the pre-service teachers (50%), �2 (2, n = 469) = 16.5, p = .001,Cramer’s V = .188.


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Fig. 2. The teachers’ strategies for dealing with PWS in the classroom. Percentages of teachers who responded yes to each item.

. Discussion

This study used an Arabic version of POSHA-S (St. Louis, 2011) to explore the knowledge, attitudes and reactions of 471 Arabublic school teachers from across Kuwait to students who stutter. Determining the teachers’ knowledge and perceptions oftuttering was seen as a pre-requisite step for dispelling misconceptions and eventually increasing sensitivity to the problemnd reducing negative attitudes toward PWS. The results showed that while some of the teachers demonstrated positiveerceptions of certain aspects of stuttering, inadequate knowledge about the disorder still remains. Nearly three-fourths ofhe teachers in this study held undesirable stereotypes about PWS, similar to parallel studies conducted on various societalroups in the U.S. and other parts of the world like Canada, Belgium, Bulgaria, Brazil, Cameroon, China, Kuwait, Nepal, Southfrica, Turkey, Nepal and South Africa (Al-Khaledi et al., 2009; Bebout & Arthur, 1992; Cooper & Cooper, 1985, 1996; Cooper

Rustin, 1985; Crowe & Walton, 1981; de Britto Pereira et al., 2008; Dorsey & Guenther, 2000; Hurst & Cooper, 1983; Lasst al., 1992, 1994; Mayo et al., 2004; Ragsdale & Ashby, 1982; Schlagheck et al., 2009; St. Louis et al., 2005; St. Louis & Roberts,010; Turnbaugh, Guitar, & Hoffman, 1981; Van Borsel et al., 1999; Woods & Williams, 1976; Xing Ming et al., 2001; Yairi

Williams, 1970; Yeakle & Cooper, 1986). With the exceptions of a few items, the teachers who were still in training wereenerally akin in their views about stuttering and PWS to teachers who have been practicing in the field for an average of1 years. A comparison between the teachers in this study and Arab parents (Al-Khaledi et al., 2009) revealed similar gaps

n their knowledge about stuttering (e.g., etiology of stuttering) as well as in the stereotypical beliefs they held about PWSe.g., “shy” or “fearful”). Such prejudice would put the student who stutters at an obvious disadvantage.

.1. Knowledge about stuttering

The results of this study suggest that the respondents had reasonable awareness and exposure to stuttering. About 49% ofhe teachers indicated knowing a friend or a relative who stutters and 69% of the in-service teachers had direct contact with

student who stutters in their classrooms. One would presume that the teachers may have drawn knowledge of stutteringrom past experience with PWS and that those who knew PWS would express more realistic attitudes toward the disorders reported by Klassen (2001) and Yeakle and Cooper (1986). However, as suggested by past research (e.g., Craig et al.,003; Dorsey & Guenther, 2000; Gabel et al., 2004; McGee, Kalinowski, & Stuart, 1996; Snyder, 2001), family relationshipr personal exposure to stuttering did not seem to influence the teachers’ attitudes toward PWS. It seems lack of familiarityith PWS cannot explain some of the stereotypes held by teachers (White & Collins, 1984).

The responses of the teachers confirmed the well documented public confusion about the etiology of stuttering. Althoughome agreed with a genetic causal component as supported in the literature (Ambrose, 2004) and the belief that PWS canecover spontaneously, the majority of the teachers attributed stuttering to psychological problems or a very frighteningvent. Arab parents in Kuwait (Al-Khaledi et al., 2009) and laypeople from other geographic locations like Nepal, Turkey andouth Africa (St. Louis, 2005) also believed psychological factors to be the strongest causal component. This is not surprisingiven that in the past even clinicians seemed to hold a similar view; 50% of clinicians believed that PWS have psychologicalroblems (St. Louis & Lass, 1981). A considerable body of research provides evidence that rejects this assumption (Bloodstein

Ratner, 2008; Guitar, 2006).
The fact that 15% of the teachers believed virus or disease could lead to stuttering (and 21% unsure) suggests that poten-
ially stigmatizing beliefs still exist. Extreme misinformation was noted by Nichols (1987) who reported that 30% of universitytudents thought stuttering was caused by a sexually transmitted disease. Like many participants around the globe includ-ng speech-language pathologists (St. Louis, 2005), the Arab teachers (particularly the younger, pre-service group) did not


soundly reject ghosts, demons or spirits as causal agents for stuttering. Such views suggest that causation external to theperson who stutters is still prevalent (Robinson & Crowe, 2002). For example, some African Americans attribute the prob-lem to “the work of the devil” while many Arabs may associate the onset of a disease/problem with the “evil eye” (Zahr &Hattar-Pollara, 1998)

It was rather reassuring to find a large majority of the teachers were of the opinion that PWS should be helped by SLPs.At present in Kuwaiti public schools, students who stutter are seen by psychologists or social workers (Abdalla & Al-Saddah,2009). In fact, 80% of Arab parents felt a psychologist should help PWS (Al-Khaledi et al., 2009). Unfortunately in our studywe did not ask if PWS should be assisted by psychologists. We suspect some of the teachers would have agreed given thatthis is the professional who currently serves these students in their work settings and the fact that many believe that thedisorder has psychological causes.

Many of the teachers displayed knowledge that is consistent with the traditional understanding of stuttering, e.g., thatstuttering varies in severity from one person to another and that repetitions and blocks are generic behaviors associ-ated with stuttering. About half of the respondents had some knowledge about secondary behaviors like ‘facial tension’.The significance of repetitions in listener judgments of stuttering is well established (Guitar, 2006; Ham, 1990). Cooperand Cooper (1993) also stated that sound repetitions and secondary behaviors (physical concomitants) constitute uni-versally observed features of stuttering across cultures. Statistical analyses of the teachers’ responses revealed that thepre-service group appeared to be more accurate in identifying these characteristics of stuttering than the in-serviceteachers.

4.2. Beliefs about stuttering and PWS

Whether the teachers were pre-service or in-service there were no differences in how they viewed PWS (Table 3). One ofthe most consistent finding relates to negative stereotypes toward PWS such as “nervous or excitable” and “shy or fearful.”Similar stereotypes have been documented extensively across cultures, ages, professions and geographic regions (e.g., Al-Khaledi et al., 2009; Cooper & Cooper, 1996; Dorsey & Guenther, 2000; Mayo et al., 2004; Özdemir et al., 2011b; St. Louis,2005; St. Louis et al., 2005; St. Louis & Roberts, 2010). The stereotypes that have surfaced in the current study appear to alsocorroborate descriptions reported in the first author’s unpublished study wherein a semantic differential scale revealed thatbetween 31% and 48% of the Arab teachers in Kuwait considered PWS as being “not likeable”, “unsociable”, “hostile”, of “weakcharacter” and “unemployable.” A few studies have explored why these stereotypes arise (Boyle et al., 2009; MacKinnonet al., 2007; White & Collins, 1984). The anchoring-adjustment theory (MacKinnon et al., 2007) explains that individualsfirst form stereotypes about stuttering based on their own experiences with normal disfluencies and relating these with theself-perception of nervousness and anxiety. In other words similar to White and Collins’ (1984) explanation, fluent speakersassociate normal disfluencies that surface when they are nervous with stuttering-like disfluencies experienced by a personwho stutters.

Although the teachers appeared to associate negative traits with PWS, many believed in their intelligence (academicperformance), ability to make friends and lead normal lives. A sizeable number also did not feel PWS should try to hidetheir stuttering. The fact that only 42% of the teachers felt PWS “can do any job they want” appears to go with findings ofrole entrapment documented in the literature (Gabel et al., 2004; Irani, Gabel, Hughes, Swartz, & Palasik, 2009). Like theschool teachers surveyed by Irani, Abdalla, and Gabel (in press) the participants in this study seem to believe that careersthat require more speaking are not well-suited for PWS. These results also lend support to those that have examined theemployment experiences of PWS (Klein & Hood, 2004).

Who should be held responsible for the stuttering? Respondents were indecisive on this question. Only 35% agreed thatPWS should blame themselves for the problem but more than a quarter were unsure. This uncertainty could be related tothe various beliefs regarding the etiology of stuttering. If one believes the problem is external to the person who stutters,e.g., work of ghosts/demons/spirits (Robinson & Crowe, 2002) or to genetic causes (Boyle et al., 2009), then it follows thatthe person who stutters cannot be blamed for the disorder.

4.3. Reactions and managing stuttering

An analysis of the participants’ responses generally portrayed that Arab teachers in Kuwait would behave consideratelywhen conversing with PWS or handling the problem in class. For example, many would try to “act as if the person wastalking normally” and would never punish a student for stuttering. The chances of joking about the stuttering was highlyunlikely, a point that seems to back the teachers’ low tolerance for teasing. It is reassuring that many of the teachers recognizeteasing as an issue even though we are uncertain if PWS will bring it to the teacher’s attention. Studies have replicated thatelementary school pupils who stutter are more vulnerable to bullying and teasing than others (Langevin, 2009; Langevin,Bortnick, Hammer, & Wiebe, 1998) and are viewed negatively by normally fluent peers (Langevin, Packman, & Onslow,
2009). These problems can lead to rejection and difficulties in establishing relationships (Davis, Howell, & Cooke, 2002).Hugh-Jones and Smith (1999) found that 83% of adult stutterers confirmed being bullied or teased in school. Clearly, livingwith this problem can be associated with low self-esteem, increased anxiety, problems with academic work and decreasededucational fulfillment (O’Brian, Jones, Packman, Menzies, & Onslow, 2011).

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According to Karola (2002, p. 47), “within the Arab world, a child who has a problem is considered “muskene” to be pitied,onsequently a family feels dishonored or shamed and has difficulty admitting when a child needs particular attention.”ore than half of the teachers expressed feeling pity for a student who stutters, a tendency that was greater in the older,ore experienced group of teachers than the pre-service group.Approximately half of the respondents said they would not feel comfortable or relaxed when interacting with PWS.

untapalli, Everheart, Kalinowski, Nanjundeswaran, and Saltuklaroglu (2007) found a connection between a fluent listener’smotional state and speech disfluencies. While viewing and listening to the speech of a person who stutters, normally fluentisteners studied by these researchers showed a significant deceleration in heart rate and an increase in skin conductance.he participants also displayed a tendency to self-rate themselves as becoming uncomfortable, nervous, tense, sad, avoiding,mbarrassed, and even annoyed.

In the presence of PWS, listeners have been observed to avoid eye contact, finish the person’s utterance or interject whenhere is a pause in the exchange (Kamhi, 2003). Approximately 90% of the teachers stated they would not feel impatient,owever 60% agreed they would fill in a stuttering person’s words. The urge to fill in may not have stemmed from impatienceer se but might be an action taken to help the person become “unstuck.” The assumption by some listeners that PWS are

ndividuals “in need of help” (Mayo et al., 2008, p. 1) lends support for this speculation. However, qualitative data fromhree Kuwaiti students who stutter (Abdalla & Al-Saddah, 2009) reveals a conflicting picture to the present study’s findingswhere 90% of teachers rejected feeling impatient when talking with PWS). The three Kuwaiti interviewees identified timeressure as a challenge in school because teachers would often fail to give them time to complete their thoughts or allowhem to express themselves freely. One of them remarked that her teachers often advised her to ask her questions after classr during the break because she stutters. We submit that recommendations such as these can have negative effects on PWSften leading to feelings of marginalization.

About a quarter of the teachers in the current study felt they should adjust their classroom standards for PWS by excusinghem from oral discussions. This advice may be related to the belief that speaking is inherently difficult and thus oral activitiesn class and careers that require talking should be avoided by PWS. Although 70% of the teachers did not indicate that PWShould try to hide their stuttering, they expressed reservations about the idea of PWS openly discussing their feelings abouttuttering with other students.

An examination of Fig. 2 reveals that the most consistent advice teachers in Kuwait believed would help the per-on who stutters is to allow the individual to repeat until the word comes out. The next common suggestion wassking PWS to “slow down” or “relax” followed by recommending either “thinking” or “taking a deep breath” beforepeaking. The older and more experienced teachers (in-service group) were more likely to tell students to “slow down”han the trainees (pre-service teachers). Mayo et al. (2004) found that some African American adults believed thattuttering arises because of “speaking too fast” or “thinking faster than one can speak.” Therefore, instructing PWS toslow down’ or ‘relax’, ‘think before speaking’ may stem from the assumption that stuttering increases when speech isast.

.4. Conclusion, limitations and future directions

It is essential to measure the knowledge and attitudes of different cultural groups about stuttering and PWS as negativepinions about the disorder exist across cultures. This study found that the teachers behaved with sensitivity toward PWS.hey reported feeling pity, said they would not joke about the students’ stuttering and would take strong action against othertudents who bully or make fun of the person who stutters’ speech. They identified common characteristics of stutteringuch as repetitions and blocks and felt that PWS should be referred to SLPs for help.

On the other hand, despite familiarity with PWS, many teachers still held the following general misconceptions andtereotypes:

a) that frightening/traumatic event or psychological problems cause stuttering,b) that PWS are nervous, excitable, shy or fearful andc) that PWS cannot do any job they want (role entrapment).

Reactions and strategies reported by the teachers in the present study for coping with the students’ stuttering included:

a) allowing PWS to repeat till they can get the word out,b) filling in the person’s words andc) asking them to ‘slow down’ or ‘relax’.

Such unsubstantiated beliefs can negatively shape the teachers’ perceptions of the student who stutters. The student inurn can internalize some of these stereotypes causing them to accept the stereotypes, in effect reducing their self-esteem
nd limiting their ability to grow and learn.
According to Heite (2000, p. 2) “most teachers are naïve listeners, unprepared by either their training or theirackgrounds to deal with stuttering.” A number of authors, e.g., Blood and Blood (2004) and Yaruss, Murphy, Quesal,nd Reardon (2004), recommend that speech-language pathologists educate students and teachers about stuttering.


Given the shortage of speech-language clinicians in Kuwait coupled with the lack of teachers’ familiarity with thechallenges stuttering poses in the class, other strategies should be explored. The obvious need to educate preserviceand in-service teachers in Kuwait and other parts of the Arab world about stuttering cannot be over emphasized.Additionally, one strategy shown to substantially or dramatically effect positive changes in the attitudes of secondaryschoolchildren toward stuttering is to arrange for an informed person who stutters to talk about his stuttering to classes(Flynn & St Louis, 2011). Further research is needed to determine what kind of strategies can make a positive impactin changing attitudes of teachers toward PWS and making the school environment friendlier for the students withstuttering.

A limitation of this study was that the majority of teachers examined in this study were Kuwaiti or Egyptian nationals.The proportion of other Arab citizens was rather small. Therefore, it is unknown if teachers from other Arab countries in theregion uphold similar views. Future studies should explore generalizability of the present findings by surveying teachers fromother parts of the Arab world. Cross-cultural comparisons between Arab teachers and educators from other cultures/regions(e.g., Western countries) would also be valuable.

The comparison between parents using data from Al-Khaledi et al. (2009) and teachers in the present study should betreated as preliminary. Other confounding factors may explain the demographic differences between the two groups, e.g.,education and age. It would be worth exploring not only the views of Arab teachers and parents but also those of schoolexperiences of Arab PWS using a mixed quantitative and qualitative design.

In the Al-Khaledi et al. (2009) report, the instrument was identified as an adapted version of the POSHA-E (with “E”referring to experimental version). In fact, it was the last of three experimental versions. The rating scale therein has beenadopted for the final version; hence, POSHA-S is a more accurate descriptor.

CONTINUING EDUCATION

Arab school teachers’ knowledge, beliefs and reactions regarding stuttering

QUESTIONS

1. The majority of teachers in this study believed that stuttering is caused by:(a) Genetic inheritance(b) Ghosts, demons or spirits(c) Psychological problems(d) Virus or disease(e) None of the above

2. Most teachers were of the opinion that people who stutter (PWS) .(a) Have lower level of academic performance(b) Can lead normal lives(c) Should try to hide their stuttering(d) Cannot make friends(e) Can do any job they want

3. This study measured the knowledge and attitudes of teachers toward stuttering using .(a) Face to face interview(b) Semantic differential scale(c) Telephone interview(d) Arabic translation of the Public Opinions Survey on Human Attributes (POSHA)(e) Qualitative measure

4. A better understanding of the teachers’ attitudes toward students who stutter will help us in:(a) Designing awareness campaigns that will facilitate positive changes in teachers’ attitudes(b) Ensuring communicative interactions within the class supplement the therapeutic process(c) Making the educational environment friendlier for PWS(d) Designing awareness campaigns that will enhance teachers’ knowledge about stuttering(e) All of the above

5. This study showed that .(a) Pre-service teachers were better in their beliefs about stuttering than the in-service teachers because they were

younger(b) In-service teachers were better in their beliefs about stuttering than the pre-service teachers because they were more

experienced
(c) In-service teachers were better in their beliefs about stuttering than the pre-service teachers because they were more
educated(d) Pre-service teachers were generally comparable in their beliefs about stuttering to the in-service teachers(e) None of the above

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cknowledgements

A special gratitude goes to the Faculty of Education, Kuwait University, College of Basic Education, Kuwait Ministry ofducation, Principals of government schools and teachers for their contributions. We wish to acknowledge the assistancef students from the CSL department, Kuwait University in distributing & gathering the questionnaires. We thank Latifal-Salmi and Marwa Al-Rahmani for help with translation, Fatima Hassan for data rendering and Bharathi Prabhu for proofeading the article.

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aruss, J. S., Murphy, W. P., Quesal, R. W., & Reardon, N. A. (2004). Bullying and teasing: Helping children who stutter. New York: National Stuttering Association.eakle, M. K., & Cooper, E. B. (1986). Teacher perceptions of stuttering. Journal of Fluency Disorders, 11, 345–359.ahr, L. K., & Hattar-Pollara, M. (1998). Nursing care of Arab children: Consideration of cultural factors. Journal of Pediatric Nursing, 13, 249–355.

auzia A. Abdalla is an assistant professor in the Department of Communication Science at Kuwait University. She teaches and researches in the area
f stuttering and developmental language disorders.
enneth O. St. Louis, founder of the “International Project on Attitudes Toward Human Attributes,” has carried out research on attitudes of cliniciansnd the general public toward stuttering and other potentially stigmatizing conditions. He has published and presented widely on numerous aspectsf stuttering and cluttering for more than 35 years.

Documents

Arab school teachers’ knowledge, beliefs and reactions regarding stuttering