J. FLUENCY DISORD. 24 (1999), 281–292© 1999 Elsevier Science Inc. All rights reserved. 0094-730X/99/$–see front matter655 Avenue of the Americas, New York, NY 10010 PII S0094-730X(99)00020-0

THE RELATIONSHIP OFSELF-CONCEPTION TO PERCEIVED STUTTERING SEVERITY IN CHILDRENAND ADULTS WHO STUTTER

TOM GREEN

Bredtvet kompetansesenter, Oslo, Norway

This explorative study addresses differences in the experience history with stuttering of

children and adults

who stutter

. One-hundred persons, 40 elementary school children, and60 adults, were administered a Communication Situation Scale to indicate perceived sever-ity of their stuttering, and the Comprehensive System for the Rorschach Inkblot Test to indi-cate the degree to which their self-conception might be based on participation within socialinteractions. The findings showed a positive relationship between these two variables forchildren, especially with regard to interactions in dyads (pairs) and strangers, and a negativerelationship for adults in dyads. The findings also showed that the relationship betweenthese two variables was significantly inverse between children and adults, especially withregard to interactions in the above situations. © 1999 Elsevier Science Inc.

Key Words:

Stuttering; Self-conception; Psycho-social; Compensation; Rorschach

INTRODUCTION

Therapists and researchers have long assumed that self-conceptions in personswho stutter are related to their experiences with stuttering (Van Riper, 1953;1982). “Although stutterers show a wide variety of personality patterns, per-haps as wide as that in the normal speaking population, there is no doubt thatthe person who says to himself, “I am a stutterer,” formulates his self-conceptin a way that implies compulsive deviancy” (Van Riper, 1982, p. 226). Self-identification as a member of a minority and deviant group in adults who stut-ter has been demonstrated by Zelen, Sheehan, & Bugental (1954). Individualdifferences in the relationship of such identifications to perceived social ac-ceptance in adults who stutter, have been discussed by Green (1997b). The

Address correspondence to Tom Green, Bredtvet kompetansesenter, Bredtvetvn. 4, 0950 Oslo, Nor-way; E-mail: Tom Green@ks-Bredtvet.no

282 T. GREEN

author, however, has found no studies that have addressed how differences inthe experiences with stuttering between children and adults who stutter, maybe reflected in their respective self-conceptions. In order to facilitate such anexploratory study, a subject population of 100 children and adults, confirmedas persons who stutter, were evaluated with regard to the severity of their stut-tering to provide a test variable to correlate with self-conception as the majorvariable.

Self-conceptions generally emerge from social interactive experiences andcan take varying forms depending on the nature of the experience. For in-stance, assertive experiences within social situations can generally be ex-pected to be related to self-conceptions based upon participation within socialinteractions. Conversely, limited assertive experiences within social situationscan generally be expected to be related to self-conceptions based relativelyupon less participation (Bandura, 1986; Exner, 1993). The term “self-concep-tion” is used here with reference to “the self the individual himself perceives”(Rogers & Diamond, 1954, p.85).

Limited successful assertive experiences within social situations are oftenregarded to be reflected in the consequences of stuttering (Perkins, 1992;Sheehan, 1970). According to the above, limitations in regard to such experi-ences may not be thought to relate to self-conceptions based upon consider-able participation within social interactions. Nor may such experiences bethought to relate to anticipations that they can provide themselves with thesefacilitating interactive conditions for fluent speech (Green 1997c; Hartman,1994; Sheehan, 1958; 1970).

Therefore, might one not wonder if differences in the relationship betweenthe extent self-conceptions in persons who stutter may be based upon partici-pation within social interactions, and stuttering severity can be indicative ofdifferences in their histories with stuttering. For instance, in a population ofadults who stutter, self-evaluations of their capabilities to deal assertively withsocial situations are more likely to be influenced by the consequences of theirstuttering. One might wonder therefore, whether the relationship between theforegoing variables can be negative, indicative of histories with stutteringwhich range from mild to severe. In contrast, in a population of children whostutter, self-evaluations are less likely to be influenced by the consequences oftheir stuttering. One might wonder, therefore, whether the relationship be-tween the foregoing variables will not be negative for children, indicative ofhistories with stuttering that differ from that of adults. A major objective ofthis study is to explore the above issues.

To measure the possible extent to which the self-conceptions of personswho stutter might be based upon participation within social interactions,within this study, the Comprehensive System (CS) for the Rorschach InkblotTest (Exner, 1993) was applied. Authorities have tended to differ with regardto the use of an unstructured test as the Rorschach, as a basis for measuring

SELF-CONCEPTION AND PERCEIVED STUTTERING 283

self-conceptions, as opposed to the use of structured tests, like questionnairesand scales. The Rorschach [self-conception and stuttering (severity)] how-ever, due to its unstructured nature, requires the subjects to respond subjec-tively as persons who stutter to ambiguous stimuli (inkblots). The major vari-able the Rorschach test was intended to measure, therefore, was not thesubject’s expressed self-perceptions of the ambiguous test stimuli. Rather, themajor variable intended to be measured is the participant’s subjective percep-tions of the ambiguous test stimuli, perceptions that might possibly relate totheir self-conceptions. The author acknowledges the inability to find any priorstudies which have attempted to correlate the subjective perceptions by per-sons who stutter of the Rorschach stimuli with the status of their fluency.

Rorschach CS differs radically from the traditional scoring and interpreta-tion procedures of Rorschach responses, in which the 10 inkblots adminis-tered to the subjects are regarded as stimulus to fantasy (Klopfer, et al., 1954).The Rorschach CS test is a perceptual-cognitive task, in which the inkblots areregarded as an ambiguous stimulus field onto which subjects must imposemore structure and organization than is obvious. The CS test is standardized,and is regarded as a reliable test of preferred perceptual cognitive styles per-sons tend to use in dealing with life situations (Exner, 1986; see also Ritzler,1996). For instance, subjects who respond primarily to details of the blots andrarely to the whole stimulus are inferred to be individuals who in their dailylife may tend to be more preoccupied with the details of their experiences,than able to grasp and cope with the broader significance of situations they en-counter (Exner & Weiner, 1995). Likewise, subjects who deliver more re-sponses involving whole human forms rather than part human as well as imag-inary human-like forms, are inferred to be individuals who may tend to basetheir self-conception relatively more on participation within social interac-tions (Exner, 1993).

In this exploratory study on stuttering, an effort is made to explore the pos-sibility whether stuttering may play a role in the formation of self-conceptionsin persons who stutter. In order to examine this possibility it is hypothesizedthat the relatively less the self-conceptions of adults who stutter are basedupon participation within social interactions, as measured by the RorschachCS, the more severe they perceive their stuttering to be. It is also hypothesizedthat the relationship between these two variables for children who stutter dif-fers from that of adults who stutter.

METHOD

Subjects and Procedures

Participants in the study consisted of 40 children, 11 girls and 29 boys (8–12years,

M

5

10 years and 4 months), and 60 adults, 12 woman and 48 men

284 T. GREEN

(20–56 years,

M

5

29 years), attending the National Centre for Logopedics inNorway for short-term stuttering treatment. Both age groups included individ-uals from different educational backgrounds: 37% of the adults who stutter,and 28% of the parents (the parent of each child with highest educationallevel) had 12 years or more of education. All subjects received consultationsfor their stuttering at their local centre for school services prior to attendingthe center. All assessments were administered individually at the center, withthe exception of half the children group who were assessed at their local cen-tre for school services.

MEASURES

Communication Situation Scale.

A children and an adult communica-tion situation scale were developed for this study to measure the subjects per-ceptions of the severity of their stuttering. The scale is derived from the Will-ingness to Communicate Scale by McCroskey & Richmond (1991). It consistsof 13 age-specific every-day communication situations comprising two typesof communicational contexts (group and dyad [pairs]), and three types of re-ceivers (strangers, acquaintances, and friends). In the adult scale, eight of thecommunication situations were related to dyad contexts (five with strangersand three with acquaintances and friends), and five were related to group con-texts (two with strangers and three with acquaintances and friend). In the chil-dren scale eight of the communication situations were related to dyad contexts(four with strangers, four with acquaintances and friends), and five were re-lated to group contexts (five with acquaintances and friends). The followingcategories were derived from these scales: Perceived stuttering severity; Per-ceived stuttering severity in dyads; Perceived stuttering severity in groups;Perceived stuttering severity with strangers; and Perceived stuttering severitywith acquaintances and friends. The subjects indicate on a scale from 1 to 4 (1

5

no stuttering; 2

5

mild; 3

5

moderate; 4

5

severe), how severe they per-ceived their stuttering to be in each of the 13 age-specific every-day commu-nication situations (see Appendixes 1 and 2 for list of items).

Rorschach CS.

The administration of the Rorschach CS (Exner, 1993)was done according to Exner (1990). It consists of two parts: The 10 inkblotcards are first presented to the subject one at a time with the instruction to tellthe instructor what it might be. The inquiry phase is introduced with the ex-plicitly communicated objective of the examiner to see what the subject hasseen, where in the blot the subject has seen something, and what features ofthe blot that caused the subject to see it. The coding was done according toExner (1993), and consists of six parts of which one part is used in this study:Coding of identifiable objects or class of objects in the response. These con-tent codes are reported to be very stable among nonpatient adults, and some-

SELF-CONCEPTION AND PERCEIVED STUTTERING 285

what less stable among children over longer time periods, (Exner, 1993; Ex-ner, Thomas, & Mason, 1985). The following category was derived fromthese codings: Social interaction. This category indicates the relative extent towhich self-conception might be based upon participation within social interac-tions. It is derived from the number of responses involving the percept of awhole human form (i.e., man, woman, child), divided by total number of per-cepts of human forms, including whole human forms, part human forms (i.e.,head, arm, leg) as well as imaginary human-like forms (i.e., fairies, giants,devils), and imaginary human-like part forms (i.e., foot of giant, face of devil).A high score indicates that the relative extent to which self-conception isbased upon whole human percepts rather than on all forms of human perceptsis high. A low score indicates the opposite. Below, percept of whole humanforms is also referred to as the Social interaction nominator score, and perceptof all human forms is referred to as the Social interaction denominator score.

The validity of the Social interaction operalization is supported by severalstudies. In a study of 225 college students, Thomas, Exner, & Baker (1982)found that subjects who had a high difference score between real and ideal selfon the Gough Adjective Checklist, delivered substantially fewer responses in-cluding whole human percepts rather than other human percepts, comparedwith subjects who had a low difference score. Furthermore, the findings in theExner and Sanglade (1992) study of Rorschach changes following short-termtreatment of 35 subjects, showed that of 18 subjects who had fewer responseswith percepts of whole human forms than with other human forms when en-tering treatment, only 3 continued to show that configuration after treatment(see also Weiner & Exner, 1991).

Reliability of scoring procedures.

Two psychologists, trained in theRorschach CS scoring methods, scored the protocols according to Exner(1990). Interscorer agreements for the content codes used in this study was96%. Twenty protocols were used in the reliability analysis which was per-formed according to Weiner (1991).

Statistics.

All statistics were performed with SPSS 6.1.2. Frequency,correlational, and linear regression method were utilized in this study.

RESULTS

The mean and standard deviance of scores for the two groups on the Commu-nication Situation Scale are summarized in Table 1. Table 2 shows the meanand standard deviance scores on the Rorschach CS for the two groups. Table 2also shows the numerator score (whole human forms), denominator score(whole human forms, part human forms, and imaginary human-like forms), aswell as the denominator sub-codes of the category Social interaction.

The correlations between the Perceived stuttering severity categories andthe category Social interaction for adults and children are summarized in Ta-

286 T. GREEN

ble 3. For the adult group there was a significant negative correlation betweenPerceived stuttering severity in dyads and Social interaction. For the childrengroup there was a significant positive correlation between Perceived stutteringseverity and Social interaction, Perceived stuttering severity in dyads and So-cial interaction, and Perceived stuttering severity with strangers and Social in-teraction (Table 3).

The relationship between the category Perceived stuttering severity and the cat-egory Social interaction was significantly different for the adults and childrenwhen Linear regression method was used (

R

2

5

0.10,

df

5

3;96,

F

sign

5

0.018) (

p

,

0.01). Linear regression method also showed that this relationship was signifi-cantly different for the two groups with regard to communication in dyads (

R

2

5

0.15,

df

5

3;96,

F

sign

5

0.001) (

p

,

0.000) (see Figure 1), and communicationwith strangers (

R

2

5

0.13,

df

5

3;96,

F

sign

5

0.004) (

p

,

0.000). The relationshipbetween the category Perceived stuttering severity with groups and Perceived stut-tering severity with acquaintances and friends, and the category Social interactionwere not significantly different for adults and children. Linear regression method

Table 1.

Mean and Standard Deviance for Scores on the Communication Situation Scale for Adults and Children who Stutter

Perceived stuttering severityAdults

(

N

5

60)Children(

N

5

40)

M SD M SD

All situations 2.63 (0.57) 2.22 (0.42)In dyads 2.55 (0.52) 2.21 (0.45)With strangers 2.83 (0.60) 2.44 (0.70)In groups 2.76 (0.50) 2.23 (0.57)With acquaintances and friends 2.36 (0.49) 1.93 (0.42)

Table 2.

Mean and Standard Deviance for Scores on the Rorschach CS for Adults and Children who Stutter

Adults(

N

5

60)Children(

N

5

40)

M SD M SD

Social interaction 0.51 (0.28) 0.43 (0.27)Social interaction numerator 2.65 (1.87) 2.88 (2.12)Social interaction denominator 5.97 (4.02) 6.70 (3.50)Part human forms 1.40 (1.89) 1.38 (1.53)Imaginary human-like whole

forms 1.67 (1.59) 2.03 (1.56)Imaginary human-like part forms 0.25 (0.47) 0.45 (0.82)

SELF-CONCEPTION AND PERCEIVED STUTTERING 287

showed, respectively, (

R

2

5

0.03,

df

5

3;96,

F

sign

5

0.43) (

p

5

NS), and (

R

2

5

0.03,

df

5

3;96,

F

sign

5

0.42) (

p

5

NS).

DISCUSSION

The above findings supports the hypothesis that the more severe the adultsperceived their stuttering to be, in dyads, the relatively less their self-concep-tion might be based upon participation within Social interactions (as measuredby the Social interaction score on Rorschach CS). In contrast, the relativelymore self-conception of children who stutter might be based upon participa-

Table 3.

Correlations between Perceived Stuttering Severity Categories and the Category Social Interaction for Adults and Children who Stutter

Social interaction

Adults (

N

5

60)Perceived stuttering severity

2

0.22Perceived stuttering severity dyads

2

0.27*Perceived stuttering severity groups

2

0.07Perceived stuttering severity with strangers

2

0.24Perceived stuttering severity with acquaintances and friends 20.06

Children (N 5 40)Perceived stuttering severity 0.37*Perceived stuttering severity dyads 0.47**Perceived stuttering severity groups 0.11Perceived stuttering severity with strangers 0.45**Perceived stuttering severity with acquaintances and friends 0.13

*p , 0.05; **p , 0.01.

Figure 1. The relationship between the categories Social interaction and Perceivedstuttering severity in dyads, for children and adults who stutter.

288 T. GREEN

tion within Social interactions (as measured by the Rorschach CS), the moresevere they may perceive their suttering to be, especially in dyads and withstrangers. A significant inverse relationship between these categories for thetwo groups, in dyads, with strangers, and when all communication situationswere included in the analysis, may be regarded as suggestive of different ex-perience histories with stuttering: Although higher severity of perceived stut-tering severity appears to be related to continued participation in social inter-actions for the children who stutter, the contrary appears to apply to the adultswho stutter. Due to the tentative nature of the measures used in this study,however, any conclusive support of this suggestion cannot be made.

One explanation for the above findings is that the children’s self-evalua-tions of their capability to deal with social interactions, in contrast to theadult’s, do not tend to be done with reference to failures to assert themselvesthrough speech in social interactions (e.g., Bloodstein, 1960b; Bloodstein,1993; Culatta, et al., 1985; Hartman, 1994; Silverman, 1970). Generally,therefore, they may still anticipate that they can provide themselves with facil-itating interactive conditions for fluent speech production. This explanationconcurs with Dalton and Hardcastle (1989), and Van Riper (1971), who notedthat many young children do not appear to have begun to relate very much oftheir social speech experiences to an idea about themselves as a ‘stutterer,’ ina way that implies compulsive deviancy (e.g., Green, 1998). For instance,Woods (1974) reported findings indicating that while grade school childrenwho stutter tended to rate themselves as relatively poor speakers, this had littleeffect on their estimation of their social position among their classmates. Gen-erally, as other research has shown, children’s reactions to stressful social sit-uations, may often tend to be determined by their efforts to change or masterthe person, the environment, or the relation between them that is perceived asstressful (Altshuler & Ruble, 1989; Compas, Banez, & Malcarne, 1991; Reid,Dubow, & Carey, 1995).

Furthermore, one may also wonder if the finding that the children appear tobase their self-conception somewhat more on whole human percepts than theadults, do not only indicate that their concerns about their stuttering do not yetrepresent as big problem for them, but that their participation in social interac-tions reflects efforts to overcome the communicative impediments of theirstuttering. For instance, Bloodstein (1960a) found a large number of gradeschool children who did not systematically avoid any speech situations: “An8-year-old girl who stuttered severely was said to talk constantly, to be popu-lar, and to have been elected president of her class. A 10-year-old boy with se-vere stuttering had a reputation as a talker and frequently volunteered to speakin class” (Bloodstein, 1995, p. 50). As indicated by the above case examples,and noted by several authors, children have a strong need to assert themselvesthrough speech (Goldstein, 1948; Rosenthal, 1977), and their speech perfor-mances are usually consistent with their concept of self and ways of behavior

SELF-CONCEPTION AND PERCEIVED STUTTERING 289

(Rogers, 1947). The positive correlation between negative attitudes towardstheir speech and both perceived and observed stuttering severity in childrenwho stutter in some studies may also be regarded as supporting further discus-sion on the issue of possible compensatory psycho-social maneuvers by chil-dren who stutter (De Nil & Brutten, 1990; Green, 1998; Vanryckeghem &Brutten, 1996).

CONCLUSIONThis exploratory study addresses the complex theoretical and methodologicalissues related to tracing the meaning of experience histories with stuttering forpersons who stutter. Both environmental, personal, and behavioral influencescan be regarded as operating as interlocking determinants of each other in theformation of this meaning. The above findings cannot be regarded as conclu-sive support for the various assumptions discussed in this study. Exploring therelationship between self-conception and perceived stuttering severity in chil-dren and adults who stutter, however, appears to be one mean to illuminateand hopefully increase our knowledge about individual experience historieswith stuttering. More specifically, the findings may be regarded as supportingfurther research and discussion about the role of self-conception of a personwho stutters in future developmental models of stuttering (e.g., Green, 1997a,b). After all, why should fluency status relate to the subjective perception bypeople who stutter of the Rorschach stimuli (when they are not preoccupiedwith their stuttering), if not influenced by this perception? Further research onthe above issues, therefore, should concur with the suggestion made by Brutten(1975) and Brutten and Vanryckeghem (1993), to base developmental modelsof stuttering on differences in the experience history of persons who stutter.

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Appendix 1. List of Items in the Communication Situation Scale

Adults

1. Talking with a person you know well2. Presenting yourself3. Phoning a stranger4. Phoning an acquaintance5. Ording a ticket6. Talking with a shop assistant about prices and articles7. Talking with a boss8. Talking at the dinner table at home9. Talking with colleagues

10. Talking with a stranger, when others are listening11. Talking to an audience of unknown people12. Talking to an audience of known people13. Asking a stranger about the time

Appendix 2. List of Items in the Communication Situation Scale

Children

1. Talking with mother2. Talking with father3. Talking with your teacher4. Phoning a friend5. Talking on the phone6. Ordering a ticket7. Asking for something in a shop8. Talking at the dinner table at home9. Talking with class-mates in breaks

10. Talking with a stranger11. Asking questions in class12. Reading in class13. Answering questions in class