Journal of Fluency Disorders 31 (2006) 216–227

Effects of stuttering severity and therapy involvement

on attitudes towards people who stutter
Rodney M. Gabel ∗
Department of Communication Disorders, Bowling Green State University,
Bowling Green, OH 43403, United States
Received 28 December 2005; received in revised form 31 May 2006; accepted 31 May 2006

Abstract
The purpose of this study was to explore whether stuttering severity or therapy involvement had an effect
on the attitudes that individuals who do not stutter reported towards people who stutter (PWS). Two hundred
and sixty (260) university students participated in this study. Direct survey procedures consisting of a 25-item
semantic differential scale were utilized. Comparisons of the effects of stuttering severity, level of therapy
involvement, and the interaction of these variables were completed. Results suggested that both stuttering
severity and therapy involvement had significant effects on participants’ attitudes towards PWS. Findings
of this study support past research studies that has found that individuals who stutter mildly are perceived
more positively than those who are severe. Similarly, the data supported past research that has found that
PWS that attend therapy are perceived more positively than those who do not attend therapy. Surprisingly,
the interaction of these variables was not significant.
Educational objectives: The reader will be able to: (1) explain the possible effects of listeners’ attitudes
toward stuttering on the lives of PWS; (2) discuss how different factors might alter listeners’ attitudes towards
stuttering; (3) delineate how stuttering severity and involvement in therapy might impact listeners’ attitudes
towards PWS.
© 2006 Elsevier Inc. All rights reserved.

Keywords: Negative attitudes; Stereotyping; Stuttering severity; Benefits or therapy

Researchers and clinicians have argued for the use of broader conceptualization of stuttering
that describes not only the behaviors present in an individual’s speech, but also the impact that
stuttering has on the person’s life (Cooper, 1993; Guitar, 1998). Several authors have suggested

∗ Tel.: +1 419 372 7168

E-mail address: rgabel@bgnet.bgsu.edu.

0094-730X/$ – see front matter © 2006 Elsevier Inc. All rights reserved.
doi:10.1016/j.jfludis.2006.05.003
 R.M. Gabel / Journal of Fluency Disorders 31 (2006) 216–227 217

using models based on the World Health Organization’s (WHO) International Classification of
Functioning, Disability, and Health (ICF) to guide our description of stuttering (Yaruss, 1998;
Yaruss & Quesal, 2004). Recently, Yaruss and Quesal (2004) provided an updated application of
the ICF. This model describes the impact of stuttering using three categories. The first category
is functional limitation (impairment), which describes the physical or psychological factors that
may lead to stuttering behaviors. The next category is activity limitation (disability) experienced
by people who stutter (PWS). These activities include those that the individual will have difficulty
performing within a range that is considered normal. These activities may be those related to social,
academic, and occupational endeavors. The final category is participation restriction (handicap).
This category represents those real and perceived barriers that society or the individual may
construct in reaction to his or her stuttering (Yaruss & Quesal, 2004). The real or perceived barriers
may lead to limitations in social, educational, and vocational endeavors. These societal barriers
also have the potential to impact the person who stutters more severely than the physiological
manifestations of stuttering (Yaruss & Quesal, 2004). Societal barriers often come from how PWS
are evaluated by friends, family members, employers, teachers, and others. These evaluations often
take the form of negative stereotypical attitudes towards stuttering and people who stutter (PWS),
based solely on the singular characteristic of stuttering.
The ICF model explains how PWS can be impacted by listeners’ attitudes towards stutter-
ing. The model is supported by a large body of research that has found that the majority of
the populations sampled have reported negative attitudes towards PWS. These groups include
speech–language pathologists (SLPs) (Cooper & Cooper, 1996; Turnbaugh, Guitar, & Hoffman,
1979), educators (Crowe & Walton, 1981; Yeakle & Cooper, 1986), health care professionals
(Silverman & Bongey, 1997; Yairi & Carrico, 1992), lay people (Crowe & Cooper, 1977; Ham,
1990), college students (Ruscello, Lass, & Brown, 1988; Silverman & Paynter, 1990), employers
(Hurst & Cooper, 1983a), and vocational counselors (Hurst & Cooper, 1983b). In these studies,
PWS have been described as shy, nervous, anxious, withdrawn, self-conscious, tense, hesitant,
less competent, introverted, and insecure. Overall, it has been found that people who stutter may
encounter many individuals who will characterize them in a negative manner. However, it should
be noted that no negative personality traits have been identified that distinguish PWS from people
who do not stutter (Bloodstein, 1995; Guitar, 1998).
Society’s negative attitudes towards PWS are particularly problematic because negative atti-
tudes may lead PWS to be stigmatized. The concept of stigma or stigmatization has been described
as the process by which a single attribute leads an individual to become discredited or seen as
less of a person (Crocker, Major, & Steele, 1998; Goffman, 1963). Many types of people, includ-
ing individuals from different ethnic backgrounds, and individuals with disabilities, can become
stigmatized because of a singular attribute (e.g. religion, skin color, physical abnormality). Those
who have become stigmatized may be seen as less valued by society and may often develop a
negative social identity (Goffman, 1963). This label, or stigma, can have many negative con-
sequences including limited occupational, educational, and social opportunities (Crocker et al.,
1998; Goffman, 1963). Similarly, PWS may be perceived as having a negative social identity
merely because of their stuttering.

1. Effects of severity level and therapy involvement on attitudes towards PWS

Given the possible harmful effects of negative attitudes and perceptions towards PWS, it is
important to develop a better understanding of factors that might improve attitudes towards peo-
ple who stutter. Several research studies have explored whether certain factors are associated
218 R.M. Gabel / Journal of Fluency Disorders 31 (2006) 216–227

with improved attitudes towards PWS. For example, Turnbaugh et al. (1979) surveyed 36 SLPs
regarding their attitudes towards four constructs of PWS. These four constructs were “a typical
individual who stutters mildly,” “a typical individual who stutters moderately,” “a typical indi-
vidual who stutters severely,” and “a typical normally fluent individual.” The findings suggested
that SLPs reported more negative attitudes toward the three constructs that represented stuttering
severity than those reported of the normally fluent individual. The clinicians evaluated people with
all three levels of stuttering severity as being significantly more nervous, self-conscious, tense,
sensitive, anxious, fearful, afraid, hesitant, and insecure. The individual who stuttered severely
was evaluated more negatively than was the person who stuttered mildly. These findings suggested
that severity of stuttering affects attitudes towards people who stutter.
In a more recent study, Susca and Healey (2002) utilized a mixed-methods (qualitative and
quantitative) approach to explore the attitudes and perceptions that 60 listeners reported toward
different levels of simulated stuttering and fluency. To complete the study, a speech sample of a
single speaker simulating severe stuttering was digitally altered to create four samples of stuttered
speech, which differed in frequency of stuttering. The samples contained stuttering frequencies
of 15%, 5%, and 0%, while a fourth sample was altered to simulate changes in the signal often
seen after therapy (longer pause times, eliminating sudden onsets, etc.). Additionally, the authors
included a sample produced by a speaker who was normally fluent, for comparison. Findings of
the study suggested that listeners reported more negative quantitative reports toward the samples
that contained more stuttering than were reported toward the sample with less stuttering. Similarly,
qualitative results suggested that fewer positive comments were made toward those samples that
contained more stuttering.
Research also suggests that being involved in therapy and using certain therapy techniques
may also alter negative attitudes towards PWS. For example, stuttering modification therapy
programs often encourage individuals who stutter to be open about their stuttering (Breitenfeldt
& Lorenz, 1989; Sheehan, 1975). Acknowledging one’s stuttering, or telling others that one is
a person who stutters, is a therapy technique intended to help PWS become more comfortable
with their stuttering. One study by Collins and Blood (1988) explored the effect of stuttering
severity and the acknowledgement technique on the attitudes that listeners reported of PWS.
Eighty-four participants who did not stutter were asked to report their attitudes towards one
of four videotaped samples of individuals who stuttered. The samples contained two men who
stuttered, one who stuttered mildly, and one who stuttered severely. Each man appeared in two
short samples. During one of the samples, each man acknowledged his stuttering; during the other
they did not. The participants evaluated these samples utilizing a 14-item semantic differential
scale, and all participants answered four open-ended questions about the speakers. The results
of the study suggested that listeners reported more negative attitudes towards the individuals
who stuttered severely. Additionally, the individuals who acknowledged their stuttering were
rated more positively than those who did not. Thus, the combination of reduced severity and
acknowledging stuttering appeared to have a positive effect on listeners’ attitudes towards PWS.
One might expect that improving one’s fluency through being involved in a therapy program
may also improve listeners’ attitudes towards PWS. Craig and Calver (1991) explored the effects of
fluency shaping therapy on employers’ perceptions of PWS. Thirty-four employers were surveyed
regarding two groups of individuals who stuttered. One group had received fluency shaping ther-
apy, while the other group had not. The employers were aware that their employees had attended
therapy. All the participants who had attended therapy had improved their fluency following ther-
apy. The results suggested that the employers had more positive perceptions of the members of
the treatment group following therapy. The attitudes toward the individuals who had not received
 R.M. Gabel / Journal of Fluency Disorders 31 (2006) 216–227 219

therapy did not change over this time period. Thus, the results indicated that PWS were perceived
more positively when they had attended a therapy program. It is less clear whether the employers
were responding to their employees improved fluency, knowing that they had attended therapy,
or a combination of both factors.
Other studies have explored if therapy techniques to modify the severity of stuttering might
improve attitudes towards PWS. Manning, Burlison, & Thaxton (1999) conducted two studies
that explored listeners’ attitudes toward a speaker who stuttered. In the first study, 24 listeners
evaluated a speaker while he was stuttering (stuttering only) and when he was using cancel-
lation techniques (stuttering + cancellations). In the second study, listeners evaluated a speaker
while he was stuttering and while he was using pull-outs (stuttering + pull-outs). The study found
that listeners perceived the stuttering-only conditions more positively than both the cancellation
and pull-out conditions. Therefore, this study suggested that using these stuttering modification
techniques may actually increase negative attitudes towards people who stutter.

2. Summary

Research suggests that many groups of people who do not stutter will report negative attitudes
towards individuals who stutter (Cooper & Cooper, 1996; Crowe & Cooper, 1977; Crowe &
Walton, 1981; Hurst & Cooper, 1983a,b; Ruscello et al., 1988; Silverman & Bongey, 1997;
Silverman & Paynter, 1990; Yairi & Carrico, 1992; Yeakle & Cooper, 1986). It does appear that
individuals who have a mild form of stuttering are perceived less negatively than individuals who
have a severe form of stuttering (Collins & Blood, 1988; Susca & Healey, 2002; Turnbaugh et
al., 1979). In addition, the use of certain therapy procedures such as acknowledging stuttering
(Collins & Blood, 1988) and fluency shaping therapy (Craig & Calver, 1991) appear to improve
attitudes towards people who stutter. However, a study by Manning et al. (1999) found that certain
stuttering modification techniques negatively affected the attitudes that individuals have toward
people who stutter. The present study was designed to contribute to the understanding of factors
that contribute to altering attitudes towards stuttering. Specifically, the purpose of this study was
to explore whether severity level, knowing that a person who stutters was involved in therapy,
and the combination of these factors will change attitudes that individuals who do not stutter
report toward people who stutter. To date, no studies have explored whether these two factors will
combine to create an additive effect on listeners’ attitudes towards stuttering.

3. Methods

3.1. Participants and recruitment

Two hundred and sixty (260) students participated in this study. The mean age of the partic-
ipants was 22.7 years with a range of 19–48 years. The participants included 146 females and
114 males. The students were attending a large university in the eastern United States. Fourteen
participants were sophomores, 55 were juniors, 141 were seniors, and 50 were graduate students.
Two hundred twenty-six (226) of the participants were Caucasian, 17 were Asian, 8 were His-
panic/Latino, 4 were African-American, 3 were Indian, and 2 were Turkish. One hundred fourteen
(114) participants reported knowing a person who stutters and 146 did not.
Participants were recruited from a variety of majors. An undergraduate research assistant went
to individual classes during the summer and fall semesters to recruit the participants. The research
assistant described the purpose of the study and explained the exclusionary criterion. These classes
220 R.M. Gabel / Journal of Fluency Disorders 31 (2006) 216–227

ranged in size from 20 to 60 students. In all, 335 students were asked to participate in the study,
and 260 participants provided both their e-mail and mailing addresses. These 260 participants
completed the study. Thus, the response rate for the study can be estimated to be 77.6% (260/335).
All correspondence between the participants and the first author, including answering questions
and debriefing, was conducted via e-mail.
Three exclusionary criteria were utilized while recruiting participants for this study. First, none
of the respondents were majoring in communication disorders. Second, none of the participants
reported being a person who stutters. Third, individuals who had a close family member who
stuttered (father, mother, or siblings) were asked not to participate in this study. Finally, freshmen
were asked not to participate in this study due to their limited exposure to college life. It was
judged that students in their first year of college may not be representative of the university
population.

3.2. Procedures

3.2.1. Distribution of the surveys

The 260 participants were randomly assigned to four conditions. For each of the conditions, 65
subjects responded to a single description of a person who stuttered. The four conditions were: (a)
a male who stuttered severely and who has chosen to attend treatment to improve his stuttering,
(b) a male who stuttered mildly and who has chosen to attend therapy to improve his stuttering, (c)
a male who stuttered severely and who has chosen not to attend therapy to improve his stuttering,
and (d) a male who stutters mildly and who has chosen not to attend therapy to improve his
stuttering. These four conditions were selected to measure the effect of stuttering severity (mild
versus severe) and treatment status (chosen to attend treatment to improve his stuttering versus
chosen not to attend therapy to improve his stuttering) on participants’ attitudes towards stuttering.
It should be noted that the word “male” was used in each description due to the fact that more
men stutter than women (Bloodstein, 1995) and to avoid any bias that may occur due to gender.
Specific definitions of stuttering severity and therapy involvement were not provided to ensure
that all responses and ratings of these concepts were based on the participants’ internal standards
(Woods and Williams, 1976).

3.2.2. Instrumentation
A semantic differential scale was utilized in this study to measure the attitudes that participants
reported toward the four conditions (see Appendix A). The semantic differential scale was a 25-
item instrument used in prior research to identify attitudes towards PWS (Turnbaugh et al., 1979;
Woods and Williams, 1976). On this scale, 25 adjectives were paired with their 25 antonyms
found in dictionary listings (Woods and Williams, 1976). The bipolar pairs (e.g. secure–insecure)
were randomly assigned to the left and right columns in an equal number of items. A seven-point
scale appeared between each pair. The intervals were numbered and labeled from each adjective
to the middle number: “very much (1 or 7 on the scale),” “quite a bit (2 or 6 on the scale),”
“slightly (3 or 5 on the scale),” and “neutral (a 4 on the scale).” Participants were instructed to
choose the number corresponding to the traits that most likely described the in one of the four
conditions. In this way, the participants’ task was to rate one of the four descriptions of a person
who stutters using the 25 adjective scales. For presentation of the scales, the positive and negative
items were randomly distributed to either the high (a 7) and low end of the scale (a 1) based on
the suggestions made by Woods and Williams (1976). When scoring the scale, all negative items
were placed at the high end of the scale and all of the positive adjectives were placed on the low
 R.M. Gabel / Journal of Fluency Disorders 31 (2006) 216–227 221

end, as suggested by Woods and Williams (1976). Thus, if an individual felt negatively toward
the scenario of interest, his or her report was higher (closer to seven) than an individual who felt
positively toward the scenario.

3.3. Statistical analysis

3.3.1. Multivariate analysis of variance

The method utilized in this study provided a design in which several factors were investigated
simultaneously. A 2 (stuttering severity: mild or severe) × 2 (therapy status: chosen to attend
therapy or not chosen to attend therapy) multiple analysis of variance (MANOVA) was used to
analyze the effects of these variables on the students’ responses to the 25 item semantic differential
scale. The alpha level of 0.05 was used for all analyses.

3.3.2. Descriptive statistics

Descriptive measures (means and standard deviations) were used to supplement all analyses.
These statistics were completed for each item on the semantic differential scale based on each
main effect (stuttering severity and therapy status) and the interaction of the main effects. The
means were analyzed and discussed for relationships to possible trends in the results.

4. Results

Results of the MANOVA identified a significant effect for stuttering severity (F = 1.97;
p < 0.005). There was also a significant effect for therapy status (F = 2.31; p < 0.001). These
results suggested that both stuttering severity and therapy involvement improved the participants’
attitudes towards PWS. The interaction of the main effects (severity by therapy status) was not
significant (F = 1.50; p < 0.061). Thus, the combination of therapy involvement and severity did
not have an effect on the participants’ attitudes towards stuttering.
Individual item analyses exploring the effect of stuttering severity on each of the 25 items
was conducted. These results are summarized in Table 1. For these 25 items, the only significant
differences were for the items relaxed–tense and bragging–self-derogatory. For both of these items,
the condition of a person with severe stuttering was seen more negatively for relaxed–tense and
more positively for bragging–self-derogatory items. Thus, the person who stutters was perceived
as more tense and more self-derogatory. Though several other items approached significance,
these findings suggested that the overall effect of severity on the 25-item scale can be primarily
attributed to these two items.
The effect of therapy involvement on each of the 25 items was examined as a part of the
MANOVA. These results are summarized in Table 2. For these 25 items, there were signif-
icant differences for the items calm–nervous, cooperative–uncooperative, friendly–unfriendly,
pleasant–unpleasant, approaching–avoiding, confident–afraid, daring–hesitant, secure–insecure,
perfectionist–careless, and flexible–inflexible. For these items, the individual who had chosen to
attend therapy was seen as more calm, cooperative, friendly, pleasant, approaching, confident,
daring, secure, perfectionist, and flexible.
Analysis of the mean responses for stuttering severity (see Table 1) and therapy involvement
(see Table 2) show that all of the mean ratings for any of the adjective pairs were between 2.8 and
5.53. This finding suggested that none of the mean scores for either severity or therapy involvement
approached either extreme of the scale (a 1 or a 7). These participants were not reporting mean
scores suggesting an overly positive or negative attitude toward stuttering. The attitudes reported
222 R.M. Gabel / Journal of Fluency Disorders 31 (2006) 216–227

Table 1
Results of the MANOVA conducted for stuttering severity
Adjective scale Mild mean (S.D.) Severe mean (S.D.)a F-value p-Value

Open–guarded 4.84 (1.35) 4.83 (1.24) 0.002 0.962

Calm–nervous 4.80 (1.38) 5.05 (1.33) 2.08 0.151
Cooperative–uncooperative 3.24 (1.54) 3.22 (1.43) 0.007 0.931
Bold–shy 5.06 (1.31) 5.02 (1.28) 0.083 0.774
Friendly–unfriendly 3.04 (1.33) 3.15 (1.33) 0.497 0.481
Self-assured–self-conscious 5.32 (1.42) 5.46 (1.41) 0.623 0.430
Relaxed–tense 4.79 (1.25) 5.08 (1.09) 4.06 0.045*
Sensitive–insensitive 3.12 (1.13) 2.93 (1.24) 1.70 0.194
Composed–anxious 4.72 (1.21) 4.99 (1.14) 3.60 0.059
Pleasant–unpleasant 3.25 (1.22) 3.23 (1.21) 0.011 0.918
Outgoing–withdrawn 4.66 (1.27) 4.85 (1.01) 1.70 0.194
Loud–quiet 5.04 (1.21) 5.25 (0.975) 2.48 0.117
Intelligent–dull 3.11 (1.28) 3.32 (1.23) 1.92 0.167
Talkative–reticent 4.73 (1.45) 5.03 (1.21) 3.28 0.071
Approaching–avoiding 4.54 (1.28) 4.80 (1.13) 3.09 0.080
Fearless–fearful 4.42 (1.08) 4.52 (1.02) 0.583 0.446
Aggressive–passive 4.49 (1.14) 4.68 (1.09) 1.77 0.185
Confident–afraid 4.53 (1.08) 4.59 (0.986) 0.233 0.630
Extroverted–introverted 4.91 (1.14) 4.82 (1.08) 0.447 0.504
Daring–hesitant 4.65 (1.24) 4.81 (1.06) 1.29 0.257
Secure–insecure 4.58 (1.35) 4.76 (1.17) 1.41 0.236
Emotional–bland 3.41 (0.970) 3.50 (0.847) 0.663 0.416
Perfectionist–careless 3.46 (1.04) 3.62 (0.874) 1.89 0.170
Bragging–self-derogatory 4.32 (0.932) 3.82 (0.852) 20.3 0.000*
Flexible–inflexible 3.72 (1.07) 3.72 (1.09) 0.000 1.00
a The mean is measured on a seven-point scale (1–7) that separates each adjective. For purposes of scoring, a higher

mean (closer to 7) suggests a more negative attitude and a lower adjective (closer to 1) suggests a more positive attitude.
* Significant at the 0.05 level.

by this group were more indicative of neutral attitudes, with certain items suggesting a stronger
predisposition given the type of description of the person who stutters that the participant was
evaluating.

5. Discussion

Results of this study suggest that both stuttering severity and knowing that an individual
is involved in therapy affected participants’ attitudes towards PWS. The person who stuttered
severely was described as likely being more tense and more self-derogatory than the individual
who stuttered mildly. The individual involved in therapy was described as more calm, cooperative,
friendly, pleasant, approaching, confident, daring, secure, perfectionist, and flexible. These find-
ings support the hypothesis that those who stutter mildly are perceived more positively than those
who are more severe. Additionally, the hypothesis that those who attend therapy are perceived
more positively than those individuals who forego therapy was supported. There did not appear
to be an interactive effect between the two factors.
The finding that reduced severity (mild stuttering) had a positive impact on attitudes towards
PWS seems to be supportive of other studies (Collins & Blood, 1988; Susca & Healey, 2002;
Turnbaugh et al., 1979). Similar to past research, this study found that if an individual stuttered
 R.M. Gabel / Journal of Fluency Disorders 31 (2006) 216–227 223

Table 2
Results of the MANOVA conducted for therapy involvement
Adjective scale Attending therapy, Not attending therapy, F-value p-Value
mean (S.D.) mean (S.D.)a

Open–guarded 4.75 (1.23) 4.92 (1.35) 1.01 0.316

Calm–nervous 4.68 (1.31) 5.18 (1.37) 9.14 0.003*
Cooperative–uncooperative 2.83 (1.36) 3.63 (1.49) 20.3 0.000*
Bold–shy 4.92 (1.27) 5.15 (1.31) 2.07 0.151
Friendly–unfriendly 2.91 (1.28) 3.29 (1.35) 5.31 0.022*
Self-assured–self-conscious 5.25 (1.45) 5.53 (1.37) 2.49 0.116
Relaxed–tense 4.82 (1.15) 5.04 (1.20) 2.20 0.139
Sensitive–insensitive 3.03 (1.19) 3.02 (1.19) 0.003 0.958
Composed–anxious 4.79 (1.09) 4.92 (1.26) 0.712 0.400
Pleasant–unpleasant 3.05 (1.26) 3.42 (1.14) 6.10 0.014*
Outgoing–withdrawn 4.68 (1.11) 4.83 (1.19) 1.18 0.279
Loud–quiet 5.13 (1.04) 5.16 (1.17) 0.051 0.822
Intelligent–dull 3.12 (1.32) 3.32 (1.19) 1.66 0.199
Talkative–reticent 4.79 (1.25) 4.98 (1.43) 1.35 0.247
Approaching–avoiding 4.50 (1.16) 4.84 (1.25) 5.17 0.024*
Fearless–fearful 4.42 (0.963) 4.52 (1.14) 0.583 0.446
Aggressive–passive 4.56 (1.09) 4.61 (1.15) 0.111 0.740
Confident–afraid 4.42 (0.963) 4.70 (1.08) 4.72 0.031*
Extroverted–introverted 4.79 (1.12) 4.93 (1.10) 1.01 0.317
Daring–hesitant 4.56 (1.13) 4.89 (1.16) 5.41 0.021*
Secure–insecure 4.47 (1.21) 4.87 (1.30) 6.63 0.011*
Emotional–bland 3.47 (0.899) 3.44 (0.923) 0.074 0.786
Perfectionist–careless 3.38 (0.982) 3.71 (0.910) 7.93 0.005*
Bragging–self-derogatory 4.12 (.868) 4.02 (0.980) 0.814 0.368
Flexible–inflexible 3.42 (1.03) 4.01 (1.05) 20.6 0.000*
a The mean is measured on a seven point scale (1–7) that separates each adjective. For purposes of scoring, a higher

mean (closer to 7) suggests a more negative attitude and a lower adjective (closer to 1) suggests a more positive attitude.
* Significant at the 0.05 level.

more severely, he or she was described more negatively than those individuals who stutter mildly.
The finding that severity impacted attitudes towards PWS appeared to be a fairly consistent finding
in the literature. However, this was only for two of the 25 scales, so the overall effect of severity
level may be relatively limited.
The results of the study also suggested that being involved in a therapy program improved
attitudes towards PWS. These findings were consistent with those of Craig and Calver (1991)
and Collins and Blood (1988). It should be noted that these findings do not agree with those
of Manning et al. (1999) who noted that certain stuttering modification techniques negatively
affected the attitudes that individuals had toward PWS. It should be noted that this study did not
provide the participants with information about the type of therapy, so these findings do not speak
to the disagreement in findings between past studies.
The finding that being in therapy has a positive effect on attitudes towards PWS has impor-
tant implications for therapy. Most therapy programs for PWS target the speech of PWS by
increasing fluency, decreasing stuttering severity, or both. Additionally, therapy may assist PWS
in changing related cognitive and emotional responses towards stuttering. Clinicians have specu-
lated that therapy may also change the attitudes that listeners report toward PWS (Guitar, 1998;
Van Riper, 1982). The findings of this study, along with others (Collins & Blood, 1988; Craig
224 R.M. Gabel / Journal of Fluency Disorders 31 (2006) 216–227

& Calver, 1991), suggested that listeners do respond positively to knowing that a person is
attending some sort of therapy for stuttering. Thus, therapists should consider encouraging their
clients to disclose that he or she is attending therapy, because it may improve how he or she is
viewed.
Despite the finding that there was no interactive effect for the two variables, the results of
this study may suggest that the participants’ attitudes were affected most by therapy involvement
or a combination of both variables. This may be due to the participants’ assumptions regarding
the expected benefits of stuttering therapy. This might be especially true if they believed the
results of most stuttering therapies to be reductions in stuttering severity and improved fluency,
which is essentially the case (Guitar, 1998; Van Riper, 1982). In this way, the two variables
may not be truly independent of each other, since one variable, reduced severity, may have been
perceived to be the result of the other: attending therapy. This study did not control for what
individuals might perceive as the goals of stuttering therapy. In past research, the effects of
specific types of therapy on attitudes towards stuttering, such as stuttering modification (Manning
et al., 1999) and fluency shaping (Craig & Calver, 1991), have reported conflicting findings.
The current study may suggest that the benefits of attending therapy may be more complex
than previously believed. Future studies should continue to explore whether different types of
therapy lead to more positive or negative stereotypes of PWS reported by individual who do not
stutter.
In this study, the participants reported mean responses that primarily fell within a range of
mildly positive (between 2.0 and 4.0) or mildly negative (4.0–6.0). One might interpret these
findings as suggesting that these participants mainly felt neutral toward PWS. Caution should be
noted in that mean data are essentially an average of the reports made by these participants. In fact,
the best explanation for these more neutral responses toward PWS is that the participants had great
variability in their responses toward PWS, with some respondents providing more positive, and
others responding with more negative, attitudes toward PWS. It is clear that several of the adjective
scales did elicit a more positive attitude (items scored less than 4.0) while several received a mean
score that was more negative (items scored greater than 4.0).
As with any research study, there are several potential concerns related to the design that was
utilized. One issue that may have impacted the findings of this study was the mode of presenting
a written description of stuttering, instead of some sort of audio or video sample of an individual
either stuttering or simulating stuttering. Though many studies have used written descriptions to
measure negative attitudes and stereotyping of PWS (Ruscello et al., 1988; Silverman & Bongey,
1997; Silverman & Paynter, 1990; Turnbaugh et al., 1979; Woods and Williams, 1976), it is
clear that this design requires that the individual participants have an understanding of stuttering
and can differentiate between severity levels and therapy involvement, without hearing or seeing
the concepts. Though these results may be impacted by presentation mode, these findings do
corroborate findings from studies exploring severity that have utilized video (Collins & Blood,
1988) and audio (Susca and Healey, 2001), and seemed to reflect those that have explored effects
of therapy (Craig & Calver, 1991). Thus, these findings generally supported past research findings
exploring similar concepts using different modalities.
Another potential issue is the use of college students as the only research group for the study.
These students, from a single university, were utilized due to this being a fairly convenient group
from which to survey. Caution should be used when attempting to generalize these findings to
other populations. It should be noted that college students have consistently reported negative
stereotypical attitudes towards PWS in past research studies (Ruscello et al., 1988; Silverman
& Paynter, 1990) similar to other populations that have been studied (Cooper & Cooper, 1996;
 R.M. Gabel / Journal of Fluency Disorders 31 (2006) 216–227 225

Crowe & Cooper, 1977; Crowe & Walton, 1981; Hurst & Cooper, 1983a,b; Silverman & Bongey,
1997; Yairi & Carrico, 1992; Yeakle & Cooper, 1986). Therefore, one can assume with some
confidence that other populations will report a similar attitude related to these variables.
The final issue with this study is the use of the 25-item semantic differential scale. This scale
has been widely used to study attitudes towards PWS and was therefore chosen for use in this
study. Despite the wide use of this scale in the literature, it only explores a limited number of
descriptions of PWS. Recently, several studies have suggested that, to understand attitudes and
stereotyping of PWS fully, both qualitative and quantitative methods should be used (Panico,
Healey, Brouwer, and Susca, 2005; Susca & Healey, 2001, 2002). These authors suggested that
use of a mixed quantitative and qualitative method allows for a deeper understanding of attitudes
towards PWS. Future research might consider using both quantitative and qualitative designs to
explore the effects of severity and therapy on attitudes towards PWS.

6. Conclusion

In conclusion, this study found that both knowledge of severity level and therapy involvement
had a positive effect on attitudes toward PWS. These findings supported past research in that
PWS mildly are viewed more positively than those who stutter severely. Also, the data appeared
to support past research in that attending therapy for stuttering appeared to improve attitudes
towards stuttering. There may be two possible explanations for these findings. First, there is a
direct effect for each variable on attitudes towards PWS that operate independent of the other. This
explanation is supported by the lack of an interaction effect. The second possible interpretation is
that there is indeed an additive effect of the two variables on improving attitudes towards PWS,
in such a way that improvements secondary to therapy (mild stuttering) are additive to the effect
of simply attending therapy. Thus, attending therapy is the primary effect on improving attitudes;
especially if the rater(s) assume(s) that most therapies for stuttering lead to a reduction in stuttering
severity. Due to the importance of listeners’ attitudes on the lives of people who stutter, this area
of research should be explored further research in future studies.

CONTINUING EDUCATION
Effects of stuttering severity and therapy involvement on attitudes towards people who
stutter
QUESTIONS

1. Past research has shown that increased stuttering severity:

a. has no effect on the attitudes that people who do not stutter have toward PWS
b. has a positive effect on the attitudes that people who do not stutter have toward PWS
c. has a negative effect on the attitudes that people who do not stutter have toward PWS
d. both a and b
2. In the past research, negative attitudes towards stuttering have been reported by the following
group(s):
a. teachers
b. college students
c. employers
d. all of the above
226 R.M. Gabel / Journal of Fluency Disorders 31 (2006) 216–227

3. The study utilized which type of design:

a. experimental
b. qualitative
c. descriptive—survey
d. mixed design—both qualitative and quantitative
4. The participants in this study included:
a. university students
b. teachers
c. SLPs
d. employers
5. The results of the study were the following:
a. increased stuttering severity and therapy involvement improved attitudes towards PWS
b. there was an interaction for reduced severity and involvement in therapy
c. reduced severity and attending therapy improved attitudes towards people who stutter, as
well as an interaction for these two factors
d. reduced severity and attending therapy improved attitudes towards people who stutter

Appendix A

The 25-item Semantic Differential Scale, adapted from Wood and Williams (1976)

Very Quite Slightly Neutral Slightly Quite Very

much a bit a bit much

1. Open 1 2 3 4 5 6 7 Guarded
2. Nervous 1 2 3 4 5 6 7 Calm
3. Cooperative 1 2 3 4 5 6 7 Uncooperative
4. Shy 1 2 3 4 5 6 7 Bold
5. Friendly 1 2 3 4 5 6 7 Unfriendly
6. Self-Conscious 1 2 3 4 5 6 7 Self-Assured
7. Tense 1 2 3 4 5 6 7 Relaxed
8. Sensitive 1 2 3 4 5 6 7 Insensitive
9. Anxious 1 2 3 4 5 6 7 Composed
10. Pleasant 1 2 3 4 5 6 7 Unpleasant
11. Withdrawn 1 2 3 4 5 6 7 Outgoing
12. Quiet 1 2 3 4 5 6 7 Loud
13. Intelligent 1 2 3 4 5 6 7 Dull
14. Talkative 1 2 3 4 5 6 7 Reticent
15. Avoiding 1 2 3 4 5 6 7 Approaching
16. Fearful 1 2 3 4 5 6 7 Fearless
17. Aggressive 1 2 3 4 5 6 7 Passive
18. Afraid 1 2 3 4 5 6 7 Confident
19. Introverted 1 2 3 4 5 6 7 Extroverted
20. Daring 1 2 3 4 5 6 7 Hesitant
21. Secure 1 2 3 4 5 6 7 Insecure
22. Emotional 1 2 3 4 5 6 7 Bland
23. Perfectionistic 1 2 3 4 5 6 7 Careless
24. Bragging 1 2 3 4 5 6 7 Self-derogatory
25. Inflexible 1 2 3 4 5 6 7 Flexible
 R.M. Gabel / Journal of Fluency Disorders 31 (2006) 216–227 227

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Rodney M. Gabel, PhD, is an assistant professor of communication disorders at Bowling Green State University (BGSU).
He conducts research into stuttering and directs the Intensive Stuttering Clinic for Adolescents and Adults at BGSU. He
holds the certificate of clinical competence (SLP) and is a board recognized specialist in fluency disorders.