St. Louis, Abdalla, Burgess & Kuhn Re: Mild vs Re: Severe Page 1

Public Attitudes Toward Mild Versus Severe Stuttering in the USA and Kuwait Poster Presented at the Stuttering Attitudes Research Symposium

Morgantown, West Virginia September 6, 2013 Kenneth O. St. Louis1 ! Fauzia Abdalla2 ! Megan E. Burgess1 ! Chelsea D. Kuhn1

1West Virginia University, Morgantown, WV 2Kuwait University, Kuwait City, Kuwait

I. INTRODUCTION

A. Research on effects of severity of stuttering on public attitudes toward stuttering are mixed 1. Some show better attitudes of the public toward a person with mild stuttering (e.g., Collins & Blood,

1990; Turnbaugh, Guitar & Hoffman, 1979) 2. Others show no difference as a function of severity (e.g., Gabel, Hughes & Daniels, 2009)

B. The Public Opinion Survey of Human Attributes—Stuttering (POSHA–S): respondents rate a hypothetical person who stutters (St. Louis, 2011, 2012) 1. POSHA–S developed as a standard measure of public attitudes for a wide variety of settings, groups,

languages & geographic areas (e.g., Abdalla & St. Louis, 2012; St. Louis, 2012) a. Severity unspecified

2. POSHA–S database contains 167 different samples representing 7197 respondents from 28 countries & 18 languages (circa April, 2013)

II. PURPOSE A. To determine differences in attitudes if people who stutter are described as mild vs severe B. To determine differences in attitudes toward people who stutter in two widely different cultures, the USA &

Kuwait III. METHOD

A. Two versions of POSHA–S created, translated to Arabic & handed out alternatively 1. 1-Relating to a hypothetical person with mild stuttering (Re: Mild) 2. 2-Relating to a hypothetical person with severe stuttering (Re: Severe) 3. Each version had mild (slight) & severe (strong) versions of four other attributes

a. Mildly vs severely mentally ill b. Somewhat obese (overweight) vs morbidly obese c. Mostly left handed vs completely left handed d. Fairly intelligent vs extremely intelligent

B. 2nd, 3rd & 4th authors recruited convenience samples of students (exclusively in Kuwait & mostly in the USA) 1. None were SLP students or practitioners

C. Respondents (see Table 1) 1. USA (in English)

a. 100 respondents (69% return rate) 1) (Re: Mild)—50 respondents: 22 males & 28 females 2) (Re: Severe)—50 respondents: 17 males, 33 females

2. Kuwait (in Arabic) 3. 111 respondents (74% return rate)

a. (Re: Mild)—56 respondents: 26 males & 30 females b. (Re: Severe)—55 respondents: 25 males, 30 females c. Reduced at random to 50 each with equal numbers of males & females

D. POSHA–S ratings converted to mean ratings from -100 to +100 scale (0 = neutral): Higher scores more positive 1. 60 standard comparisons (St. Louis, 2011)

a. Individual items b. Components (clusters of items) c. Subscores (clusters of components for Beliefs About People Who Stutter [BEL], Self Reactions

To People Who Stutter [SR] & Obesity / Mental Illness [OMI) d. Overall Stuttering Score (OSS) (mean of the two stuttering subscores)

2. Ran t tests for independent samples for all pair-wise comparisons

St. Louis, Abdalla, Burgess & Kuhn Re: Mild vs Re: Severe Page 2

a. Bonferroni correction (p ! .00417 [.05/12]) b. Cohen’s (1988) d effect sizes for statistically significant differences

3. Database comparisons with median sample mean ratings IV. RESULTS

A. Re: Mild & Re: Severe compared (Table 2 & Figures 1 & 2) B. Re: Mild vs Re: Severe

1. USA a. 4/60 (7%) significantly different (mean Cohen’s d = .70 “moderate-large”]); all favoring Re: Mild

1) Personal knowledge source for stuttering (item) 2) knowledge of stuttering (component) 3) impression of obesity (item) 4) Obesity/Mental Illness (subscore)

2. Kuwait a. 8/60 (13%) significantly different (mean d = .60 “moderate”]); all favoring Re: Mild

1) School source for stuttering knowledge (item) 2) Impression of stuttering (item) 3) Want overweight/obesity (item) 4) Impression of OMI (component) 5) Want/have OMI (component) 6) Social distance/sympathy (component) 7) Self Reaction to PWS (subscore)

3. Few items favored severe over mild a. E.g., should have job with good judgment & “people like me” to help (Kuwait) b. E.g., genetic cause & try to ignore stuttering (USA)

4. Some puzzling results a. Nonsignificantly better overall impressions of & wanting to be “fairly intelligent” than “extremely

intelligent” in USA respondents C. Comparison of USA & Kuwait to POSHA–S database median

1. Obesity/mental illness ratings similar in USA & Kuwait; median ratings between Re: Mild & Re: Severe

2. USA Beliefs higher & Kuwaiti Beliefs lower than median 3. USA & Kuwaiti Self Reactions higher than median 4. USA & Kuwaiti Re: Mild OSS higher than median

D. USA vs Kuwait 1. USA attitudes more positive than Kuwaiti attitudes: 20/60 (33%) (mean d = .62 [“moderate”])

a. 13/60 (22%) favoring USA over Kuwait b. 7/60 (11%) favoring USA over Kuwait

1) E.g., Sources of knowledge, comfort around a stuttering person & wanting/having obesity or mental illness

2. Country differences for Re: Mild & Re: Severe a. Re: Mild: 9/60 (15%) significant (mean d = .93 [“large”]) b. Re: Severe: 10/60 (17%) significant (mean d = .88 [“large”])

V. IMPLICATIONS A. Severity of stuttering, however interpreted, is related to POSHA–S attitudes for Americans & Kuwaitis

1. Conclusion robust in two widely different cultures & languages 2. Attitudes toward mild stuttering generally better than for severe stuttering

a. Consistent with role-entrapment results of Gabel et al. (2008) b. Yet not true for all items

3. Even so, severity for hypothetical stuttering is a weak predictor a. Possible that stronger differences would emerge with actual models (e.g., shown by Collins &

Blood, 1988) B. American attitudes better than Kuwaiti attitudes overall

1. Much more so for Beliefs about PWS than Self Reactions to PWS REFERENCES Abdalla, F., & St. Louis, K. O. (2012). Arab school teachers' knowledge, beliefs and reactions regarding stuttering.

Journal of Fluency Disorders, 37, 54-69.

St. Louis, Abdalla, Burgess & Kuhn Re: Mild vs Re: Severe Page 3

Cohen, J. (1988). Statistical power for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum. Collins, C., & Blood, G. W. (1988). Acknowledgement and severity of stuttering as factors influencing

nonstutterers’ and stutterers’ perceptions of stutterers. Journal of Speech and Hearing Disorders, 55, 75–81.

Gabel, R. M., Hughes, S., Daniels, D. (2008). Effects of stuttering severity and therapy involvement on role entrapment of people who stutter. Journal of Communication Disorders, 41, 146-158.

St. Louis, K. O. (2011). The Public Opinion Survey of Human Attributes–Stuttering (POSHA–S): Summary framework and empirical comparisons. Journal of Fluency Disorders, 36, 256-261.

St. Louis, K. O. (2012). Research and development for a public attitude instrument for stuttering. Journal of Communication Disorders, 45, 129–146.

Turnbaugh, K., Guitar, B., & Hoffman, P. (1979). Speech clinicians’ attribution of personality traits as a function of stuttering severity. Journal of Speech and Hearing Research, 22, 37–45.

Table 1. Demographic Means

Demographic Variable US Re: Mild US Re: Severe Kuw Re: Mild Kuw Re:

Severe Number 50 50 50 50 Age (yr) 23.9 25.3 20.8 21.1 Education (yr) 13.3 13.1 13.1 12.7 Male / Female (%) 44 / 56 34 / 66 50 / 50 50 / 50 Student / Working (%) 86 / 24 84 / 30 98 / 0 100 / 0 Married / Parent (%) 8 / 8 12 / 12 20 / 14 6 / 4 Income Score (-100 to +100) 1 15 22 32 Race (Cauc / Arab+Kuwaiti / Other (%) 90 / 0 / 10 98 / 0 / 2 0 / 89 / 11 0 / 100 / 0 Religion (Christian / Muslim / Other (%) 95 / 0 / 5 93 / 2 / 5 0 / 100 / 0 0 / 100 / 0 Self Identification (%) Obese 16 0 22 2 Mentally Ill 4 0 2 0 Stuttering 6 0 4 4 No Persons Known (%) Obese 2 12 6 12 Mentally Ill 32 38 40 58 Stuttering 26 52 20 40 Table 2. Samples from USA & Kuwait, data from USA students re: “stuttering” (no reference to severity) & POSHA-S database

(Sub)Score USA OMI

Kuwait OMI

USA BEL

Kuwait BEL

USA SR

Kuwait SR

USA OSS

Kuwait OSS

Re: Mild* -28 -27 40 23 8 15 24 19 Re: Severe* -44 -44 41 18 1 -1 21 9 Database Median -33 34 -3 15 *Also applies to other attributes (i.e., obesity and mental illness)

St. Louis, Abdalla, Burgess & Kuhn Re: Mild vs Re: Severe Page 4

Figure 1. Summary graph of American respondents’ ratings of Re: Mild vs Re: Severe

Figure 2. Summary graph of Kuwaiti respondents’ ratings of Re: Mild vs Re: Severe

-100

-75

-50

-25

0

25

50

75

100 BELIEFS: ABOUT PWS

TRAITS

HELP

CAUSE

POTENTIAL

OBESITY/MENTAL ILLNESS

Impression

Want/Have

Amount Known

SELF REACTIONS: TO PWS

HELPING

DISTANCE/SYMPATHY

KNOWLEDGE

SOURCE

USA Re: Mild

USA Re: Severe

Lowest

Highest

Median

OVERALL STUTTERING SCORE USA Re: Mild 24 USA Re: Severe 21

-100

-75

-50

-25

0

25

50

75

100 BELIEFS: ABOUT PWS

TRAITS

HELP

CAUSE

POTENTIAL

OBESITY/MENTAL ILLNESS

Impression

Want/Have

Amount Known

SELF REACTIONS: TO PWS

HELPING

DISTANCE/SYMPATHY

KNOWLEDGE

SOURCE

Kuwait Re: Mild

Kuwait Re: Severe

Lowest

Highest

Median

OVERALL STUTTERING SCORE Kuwait Re: Mild 19 Kuwait Re: Severe 8