Do the mothers of stutterer use different
styles than the mothers of fluent children?
Ayse Gül Güven, Ph.D.
Ondokuz Mayis University, Faculty of Medicine,
Department of ENT, Audiology and Speech Pathology Unit
Samsun 55139, Türkiye.
Filiz Bolat Sar, M.Sc.
Currently in private practice
Guven, A.G. & Sar, F.B. (2003) Do the mothers of stutterer use different communication styles than
the mothers of fluent children? International Journal of Psychosocial Rehabilitation. 8, 25-36.
Correspondence concerning this article should be addressed to the first author.
Address for correspondence:
Doç. Dr. Ayse Gül Güven,
Ondokuz Mayis University, Faculty of Medicine,
Department of ENT, Audiology and Speech Pathology Unit
Samsun 55139, Türkiye.
Fax: +90 362 457 6041
*This study was carried out as a part of second author’s master thesis.
The communication patterns used between Turkish mother and her stuttering child, and her normally fluent child were investigated. A total of 20 mother-stuttering child pairs and 20 mother-nonstuttering child pairs participated to the present study. All mother-child pairs were administered a structured game to facilitate spontaneous speech. Commands, questions, critical statement, no response and interruption were studied as negative statements. Verbal praise and verbal acknowledgement were accepted as positive statements. Interaction times and total amount of words were also measured. A Significant difference was found between both mother and children groups only in the total words used. No significant differences were found for any other communication styles. These findings suggest that the communicative behaviors of mothers of stutter children are not different than that of the mothers of nonstutter.
Stuttering is described as a disorder of fluency and characterized by part-word, whole-word and phrase repetitions, interjections, pauses and prolongations (Hegde, 1995). Perhaps no other speech problem has received more attention than stuttering. Wide variety of theories has been proposed based on the enormous amount of research findings. Some theories propose physiological factors for the onset of stuttering, such as bilateral hemispheric dominance (Curry & Gregory, 1969), right hemisphere dominance for speech (Curry & Gregory, 1969; Moore & Hynes, 1980), brain damage (Andrews, Craig, Feyer, Hoddinott, Howie, & Neilson, 1983; Shames & Raming, 1994), neuropsychological or neuromuscular dysfunction (Van Riper, 1990), laryngeal dysfunction (Reich, Till & Goldsmith, 1981), and central auditory dysfunction (Hall & Jerger, 1978). Data on the frequency of stuttering among relatives of those who stutter have led investigators to propose a genetic component to stuttering (Ambrose, Yairi, & Cox, 1993; Howie, 1981; Poulos & Webster, 1991; Yairi, 1983; Yairi & Ambrose, 1992). Others suggest environmental factors for both the onset and the maintenance of stuttering, such as communicative stress (Schulze & Johannsen, 1991), anxiety (Craig, 1990), personality and negative parent-child interactions (Egolf, Shames, Johnson, & Kasprisin-Burelli, 1972; Peters & Starkweather, 1989; Meyers, 1990).
Although the recent advances in imaging techniques have shifted our attention to the neurological and/or physiological factors for the onset or the cause of stuttering (Wu, Maguire, Riley, Fallon, LaCasse, et al., 1995; De Nil, Kroll, Kapur, & Houle, 2000), communication environment that the stutterer lives in may contribute to the maintenance of the stuttering. Moreover the communication environment that the stutterer child lives in may even play an important role in the success or failure of the speech therapy. Throughout the literature there are enormous amount of studies devoted to this issue. Studies done about communication patterns of parent and child generally focus on the negative or positive nature of the statements as well as the frequency of questions and commands that the parents used with their stuttering children (Egolf et al., 1972; Kasprisin-Burelli, Egolf & Shames, 1972; Langolis, Hanrahan & Inouye, 1986). Egolf et al., (1972) suggested that the parents of stutters used negative statements, such as verbal aggression, silence, and interruptions more excessively than the parents of nonstutters. In their study Kasprisin-Burelli et.al., (1972) found that the parents of stutters displayed more negative verbal interactions and interrupted their child more frequently than did the parents of nonstutters. Mordecai (1979) reported that the parents of stutters used negative verbal profiles more than the parents of nonstutters. It was also reported that while the parents of stutters do not allow their children to respond to a question before asking another question, the parents of nonstutters were generally more positive in their verbal interactions. Langlois et al., (1986) found that the mothers of nonstuttering children used significantly more statements (declaratives) than the mothers of stuttering children, and mothers of stuttering children asked more questions (interrogatives) and made more demands (imperatives).
The results of these and similar studies put the parents on target. As a result, parents became a part of the therapy processes of stuttering (Starkweather, Gottwald & Halfond, 1990; Kelly & Conture, 1991; Bonelli, Dixon, Ratner & Onslow, 2000). Specifically parents were advised to modify their speech behaviors and avoid asking questions or interrupting child's speech excessively when talking with their children (Nippold & Rudzinski, 1995). Egolf et al. (1972) manipulated the verbal behaviors of parents during therapy session and found that while children stuttered more with their parents than with the clinician at the beginning of the therapy, over the time their fluency with their parents increased. Budd, Madison, Itzkowitz, George, and Price (1986) found that there were more speech disfluencies in parent-child interactions than therapist-child interactions during unstructured conversation, playing a game, oral reading or discussing a task. However the amount of disfluencies was significantly reduced through participating in the therapy program in which parents were given information about the therapy process and about how they need to interact verbally with their children. Therefore, it was suggested that through understanding the structure and patterns of communication in the family, the clinician could find the negative interaction patterns that cause maintenance of stuttering problem (Bergström, 1997).
However, contradictory results to these findings appeared throughout the stuttering literature. Meyers (1990) studied fathers’, mothers’, and peers’ patterns of verbal behaviors when interacting with preschool stutter through video recording them while playing with the stuttering child. She found that the fathers and mothers of young stutters were produced significantly more positive and routine statements and fewer negative statements than peers in conversations with their children. Both parents also asked more questions than peers did, but peers made significantly more comments than parents did. On the other hand, no significant differences were observed in negative interactions, comments, imperative statements, questions, or interruptions used by the stutters when interacting with their fathers, mothers, and peers. In the preliminary analysis of the differential effects of instructions to slow maternal speech rate or simplify the speech when conversing with normally fluent children, Ratner (1992) found no significant differences between the effects of the slowing speech rate and simplifying speech.
Kelly and Conture (1992) compared the mother-stuttering child pair with the mother-nonstuttering child pair in terms of interrupting behaviors, speaking rates and response time latencies. No significant differences were found between two groups of children or between the two groups of mothers for any of the three-paralinguistic behaviors. Although some studies proposed that questions asked by parents may increase the amount of disfluency in the speech of the stuttering children when answering these questions (Egolf et al., 1972; Langlois et al., 1986; Meyers, 1990), Weiss and Zebrowski (1992) found that questions did not lead to more disfluencies in the speech of the stutter children.
Kloth, Janssen, Kraaimaat, and Brutten (1995) reported that the results of a multiyear prospective study with 93 monolingual Dutch-speaking mothers and their preschool children. Twenty-eight of the mothers were diagnosed as stutters and 65 of them had a stutter husband. At the initial examination none of the children had any speech problems. However at the 1-year follow up sessions 26 of the children were diagnosed as an incipient stutters and the experimental group of this study was made up of these children and their mothers. The main result of Kloth et al.'s study was that the communicative style and speaking rate of the mothers did not show evidence of serving as factors contributing to the development of stuttering among children. No significant differences were found between mothers whose children developed stuttering and mothers whose children continued to have a normal fluency.
Ryan (2000) reported research findings of stuttering and nonstuttering preschool children and their mothers for speaking rate, conversational speech acts, interruptions and linguistic complexity. No significant differences were found between two groups of mothers and two groups of children in speaking rate, interruptions and linguistic complexity.
To shed light on this ongoing controversy, Nippold and Rudzinski (1995) made a thorough critical review of the literature concerning the role of parents' speech behaviors in relation to their children's stuttering. In the review, they reported that there is a little evidence to support the differences between parents of stutter and nonstutter children in the way they talk with their children. Support to this conclusion came from Yairi (1997). He pointed out that findings on differences between speaking rates of parents of stutter and nonstutter children are mostly negative one and any differences in relative speaking rate are almost likely to reflect not the parent's behaviors but the child's.
Since the literature is composed of contradictory findings regarding to this issue it was aimed to look at these verbal behavioral patterns all at once in the present study. Therefore, it is present study’s aim to find out what would be the results with Turkish mothers and their stuttering children for commands, questions, critical statement, no response and interruptions as negative statement as well as verbal praise and verbal acknowledgment as positive statements. At first glance Turkish mothers would be observed as over protector, highly demanding yet ready to do and talk for their children (Akkök, 2000). Published research on verbal communication patterns of Turkish Mothers not even exist. Therefore, the present study was carried out to see whether the communication styles of Turkish mothers with their stuttering children are different than that of the mothers discussed in the literature.
Participants for this study were 40 standard Turkish speaking mother-child pairs, including 20 children who stutter and their mothers, and 20 age and sex matched nonstuttering children and their mothers. Educational level of mothers was also matched. Children who were reported having hearing, articulation, voice, language, psychological/emotional, physical or fluency (for the nonstuttering children) problems were not included to the present study.
Stuttering Children: The 20 stuttering children, 18 boys and 2 girls, had a mean age of 8:9 (range 7:2-12:4). The mothers and stutters that participated in this study were selected from child psychiatry clinic of one of the University Hospital in Ankara and from private rehabilitation centers for communicatively disordered children. Mothers were contacted right after the initial evaluation for stuttering and asked if they would participate to the research study. Therefore none of the children had received stuttering therapy prior to the study. Mother's report and diagnosis by speech-language pathologist and/or psychologist were used as the criteria for inclusion in this group.
Nonstuttering children: The 20 nonstuttering children, 18 boys and 2 girls, had a mean age of 8:9 (range 7:0-12:1). These children and their mothers were recruited from different state primary schools in Ankara. If mother and school counselor had not expressed any concern about their speech fluency, these children were included to the study.
All children were subjected to the further evaluation by the speech pathologist and psychologist following data collection. They read 150 words written age appropriate material. Five or more within-word disfluencies out of 150 words were accepted as criteria for stuttering group, two or less within-word disfluencies out of 150 words were regarded as criteria for the nonstuttering group.
Data Collection and Instruments
All 40 children first interacted with the experimenter then with their mother during a structured experimental condition, which took approximately 5 minutes per child-experimenter pair and 10 minutes per mother-child pair. Data collection was completed in one session. To facilitate spontaneous speech two sets of pictures were prepared as puzzles. A famous Turkish singer's face was used as the first set by the experimenter to familiarize mother-child pair to the experimental condition. This picture was divided into nine big and easy to recognize pieces. A whole picture and the pieces of the same picture were used together.
The mother to carry on the experimental condition with her child used another set in 23 pieces. An “Athletic girl picture” in 14 pieces was used as a target figure together with nine pieces of an “Athletic boy picture” as a distracter in mother-child pairs.
The entire mother-child interaction was audio taped by using two high quality tape recorders (Sony TCM-313 Cassette-Corder). The verbatim longhand transcriptions of the records were done using Sanyo TRC- 8080 Memo-Scriber by the experimenters. A Mother-Child Verbal Interaction Assessment Form was prepared for this study. Items used in this form were obtained from different studies (Aragona & Eyberg, 1981; Campbell, Breaux, Ewing, Szomowski & Pierce, 1986; Golinkoff & Ames, 1979; Kelly & Conture, 1992; Langlois et al. 1986; Meyers, 1989; Meyers, 1990; Meyers & Freeman, 1985b, 1985c). Based on the information obtained from the literature the following items were included in the assessment form: Commands, questions, critical statement, no response and interruption as negative statements; verbal praise and verbal acknowledgement as positive statements, and interaction time and total words. A detailed explanation of these items was given in the Appendix A. Three independent trained raters then went over the transcribed speech. They coded verbal behaviors while they were listening the tapes by counting the number of commands, questions, critical statements, no responses, interruptions, verbal praises, verbal acknowledgements, total words, and interaction time used by both mother and her child.
After the mother read and signed up the Fluency Research Informed Consent Form, she and her child had seated in a quiet room, free from distractions, containing a table and chairs. Then, the experimenter briefly explained the purpose of the study. The experimenter and the child seated at the table face-to-face across from each other while mother was observing them. The experimenter took the whole picture of the “face of the singer” and put the pieces of this picture in front of the child. Then the following instructions were given to the child:
`Things in front of you are the pieces of a face of a girl. The whole picture of the face is in my hand. I am going to describe the face of the girl and you are going to put the pieces together according to this description. I cannot look at your picture and you cannot look at my picture until you complete the face of the girl. Your mother is going to observe us silently. After you complete this picture you are going to make another one with your mother. Are you ready? Let's begin`. Experimenter then started to the session. Same instructions were used with all children during this demonstration.
After the first part was completed mother replaced the experimenter’s seat. “Athletic girl picture” was given to the mother. The pieces of this picture together with some pieces of athletic boy picture were put in front of the child. The following instructions were given to the mother: “Pieces of this picture are in front of your child. You are going to describe this picture to your child and your child will put the pieces together depending on your description. You will not show your picture to your child and will not look at your child’s picture until the picture is complete”. Then the experimenter gave the following instructions to the child: “The whole picture of a girl is in front of your mother. Now, you are going to listen to your mother carefully and put the pieces together, like when you do a puzzle, depending on your mother’s descriptions. However, we mixed some pieces of another picture into the pieces of the girl’s picture to make the game more complex. Therefore, you do not need to put all the pieces together. You will not show your picture to your mother and will not look at your mother’s picture until you complete the whole picture”.
A screen was put on the table between the child and the mother to prevent them looking in front of each other. The experimenter stated that the session was going to be audio taped and sat unobtrusively away from the mother and child, and audio taped the entire session.
To assess reliability of communication styles used by both mothers of stutters and nonstutters, three independent raters coded the entire set of transcripts. Several sets of Kappa coefficients were calculated for communication styles used by both mother and children groups.
A series of two-tailed independent sample t-test were performed to compare the mothers of stutters with the mothers of nonstutters, and stutters with nonstutters in terms of questions, commands, critical statements, no response, interruptions, verbal praises, verbal acknowledgements, and interaction time. The corrected raw scores of all communicative styles for the overall amount of the verbal output were used for this analysis.
The Kappa agreement index of communicative items for mothers group was 0.73 for interruption, 0.58 for no response, 0.79 for questions, 0.65 for verbal acknowledgement, 0.63 for verbal praise, 0.85 for commands, 0.66 for critical statements and 1.00 for total words for the mothers of stutters. Kappa agreement for the mothers of nonstutter was 0.59 for interruption, 0.38 for no response, 0.84 for questions, 0.95 for verbal acknowledgement, 0.69 for verbal praise, 0.65 for commands, 0.87 for critical statements and 0.94 for total words. Based on proposed conventions for assessing the `goodness` of Kappa by Fleiss (1981) values of 0.60 through 0.75 are considered good (interruptions, verbal acknowledgement, verbal praise, critical statements for the mothers of stutters, and verbal praise and commands for the mothers of nonstutters). Values between 0.76 and 1.00 are considered excellent (questions, commands and total words for the mothers of stutters and, questions, verbal acknowledgement, critical statements and total words for the mothers of nonstutters).
The Kappa agreement index of communicative items for children group was 0.59 for interruptions, 0.70 for no response, 1.00 for questions, 0.90 for verbal acknowledgement, 0.96 for interaction time, and 0.95 for total words for the stutter children. Kappa agreement for the nonstutter children was 0.65 for interruption, 0.60 for no response, 0.93 for questions, 0.88 for verbal acknowledgement, 1.00 for interaction time and, 1.00 for total words. Agreement was accepted as good for no response and excellent for questions, verbal acknowledgment, and interaction time and for total words for the stutter children. For the nonstutter children agreement was accepted as good for interruptions and no response, and excellent for questions, verbal acknowledgement, interaction time and total words.
Two-tailed independent sample t-test was performed to compare the mothers of stutter children with the mothers of nonstutter children as well as the stutters with the nonstutters for communicative analysis. Means, standard deviations and t-test results of corrected scores for the mother groups were presented in Table 1, and for the children groups were presented in Table 2. No significant differences were found for the all-communicative items for both groups with the exception of total words. There was a significant difference between mothers of nonstuttering children and stuttering children as well as between stuttering children and nonstuttering children on the total words used (Table 1 and Table 2). According to the results of the present study mothers of stutters used more words (Mean =177.43) than the mothers of nonstutters (Mean= 102.43), t (38) = -2.156, p= 0.037. Also stutter children used more words (Mean= 54.01) than nonstutter children (Mean= 23.7), t (38) = -2.03, p=0.049.
Table 1.Mean and Standard Deviation Scores, and t-test Results of Mother Groups for Each Communicative Items (corrected scores)
Mothers of Stutters
Mothers of nonstutters (N=20)
Level of significance
Interruption 2.66 3.64 1.02 1.89 -1.781 0.083 No response 0.86 1.13 1.84 3.85 1.093 0.281 Question 14.84 16.14 13.53 16.34 -0.254 0.801 Verbal acknowledgement 3.12 3.60 4.39 10.79 0.497 0.622 Verbal praise 0.23 0.40 0.23 0.68 0.00 1.000 Command 7.45 14.55 3.46 4.05 -1.182 0.245 Critical statement 3.72 9.96 2.04 3.37 -0.713 0.481 Total word 177.43 143.28 102.43 60.58 -2.156 0.037*df=38Table 2.Mean and Standard Deviation Scores, and t-test Results of Children Groups for Each Communicative Items (corrected scores)
Mean SD Nonstutters (N=20)
Interruption 9.45 19.07 12.18 42.36 0.263 0.794 No response 18.38 48.80 20.45 28.92 0.163 0.871 Question 11.59 13.81 26.71 84.23 0.792 0.433 Verbal acknowledgement 26.98 37.17 33.20 62.88 0.381 0.705 Interaction time (in seconds) 303.75 174.7 277.6 223.44 -0.55 0.588 Total word 54.01 62.41 23.70 23.49 -2.031 0.049*df=38
The verbal behavior patterns of the mothers of stuttering and the mothers of nonstuttering children were investigated in the present study. Commands, questions, verbal praise, verbal acknowledgement, critical statements, no response, interruptions, interaction times and the amount of words were the verbal behaviors under investigation.
Although the neurological aspects of the onset of the stuttering are stressed more and more in recent literature, parental verbal behavior is often cited as a major precipitating and maintaining factor in the onset and development of stuttering as well. The basic assumption of the parental prone theories is that the parents use excessive amount of questions, interruptions and negative verbal interactions when talking to their stuttering children leading a stressful communicative environment for the stutterer children. Therefore, parents are frequently counseled to avoid using negative verbal behavior with their stuttering children. Many programs for treating preschool stutters involve modification of parent child verbal interactions (Bonelli et al., 2000; Budd et al., 1986; Kelly & Conture, 1991; Starkweather, et.al., 1990). Even American Speech Hearing Association (ASHA, 1990) has addressed to this issue and the parents of young stutters were advised to speak more slowly, to avoid asking to many questions, to limit interruptions and criticism when talking with their children.
The results of the present study revealed that both the mothers of stutter and their stuttering children used more words than the mothers of nonstutters and their nonstuttering children. On the other hand, no significant differences were found in any of the other communication styles that the parents used between two groups of mothers or two groups of children. That means the Turkish mothers of stutters do not communicate differently with their stutter children than the Turkish mothers of nonstutters.
The results of this research parallel the findings of other studies (Kelly, 1990; Kelly & Conture, 1992; Meyers, 1990; Ryan, 2000; Weiss & Zebrowski, 1991, 1992) that also found that the parents of stutters do not differ in verbal interactions from the parents of nonstutters. There is, however, some literature suggesting that the parents of stutters differ in verbal interactions from the parents of nonstutters (Egolf et al., 1972; Kasprisin-Burelli et.al., 1972; Langlois et al., 1986; Mordecai, 1979). The present study was carried out in a structured experimental setting and in order to eliminate familiarization to material a self-made puzzle was used. Although this difference in research design between present and previous studies may have contributed to the present results, we believe that these differences are a true appearance of the population under investigation. Because it is quite possible that this experimental setting may elicit a reasonable stress environment both for mothers and children, however, even under these circumstances no differences were found.
Since the findings documented in the literature are contradictory, based on the results of the present study authors conclude that the effects of the parental verbal behaviors on the onset and or maintenance of stuttering are not as much important as it was thought. However one should not disregard the findings suggesting such effect. Rather, interpreting those results as an experienced difficulty when controlling their fluency by the stutters might be a better way
Therefore, we suggest that the focus of research related the onset and or maintenance of stuttering should move from the parental verbal behavior to another dimension. We also believe that this is the time to stop blaming parents for their verbal behaviors but approach to them more positively and increase their confidence that they can help to their children in learning fluent speech. Thus, the focus of therapy process of stutter children should move from modification of parental verbal behaviors to the involving parents actively to the transfer and maintenance studies of fluent speech.
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Appendix A. Definitions of Communicative Items
Command: There are two types of commands. First one is a direct command, which is a direct, clearly stated order or direction in declarative form (e.g., put that part under the neck of the picture). The other one is an indirect command, which is an indirect suggestion or question-command that attempts to lead the child’s verbal or physical activity (e.g., Will you put that part under the neck of the picture?) (Aragona & Eyberg, 1981).
Question: To Inquire or ask something to elicit information (e.g., did you find the legs? Did you finish the whole picture?). The listener is expected to respond either verbally or nonverbally (Langlois et al., 1986; Meyers, 1990).
Critical Statement: Utterances that state some kind of disagreement or comments using negative intonation, such as “Didn’t you understand what I tell?” “There is not a yellow part in this picture”. These interactions deny or disagree with the previous speaker, using expressions, such as “No”, “You don’t know”, and so on (Aragona & Eyberg, 1981; Meyers, 1990).
No Response: Participants of a conversation ignore each other in silence, such as pretending not to hear, not to answer the other’s question, and so on (Langlois et al., 1986).
Interruption: Interruptions are break in the continuity with a question or remark while the other person is talking. An interruption was counted if the listener began speaking before the speaker completed his or her utterance (Meyers & Freeman, 1985c).
Verbal Praise: Is a statement indicating verbal approval, encouragement and positive feedback about someone’s behavior, such as “Yes, that is right”, “That is difficult but you can do it”, “Great! You did an excellent job”, and so on (Aragona & Eyberg, 1981; Campbell et al., 1986).
Verbal acknowledgement: Is verbalizations, which contain no manifest content (e.g., “Okay, yes, all right”). These statements show that the listener accepts, approves, or recognizes the expressions or behaviors of the speaker. For example, mother’s reply of “Okay” when the child says, “I find the legs of the girl” (Aragona & Eyberg, 1981).
Interaction Time: Total time of conversation between mother and child in seconds (Meyers and Freeman, 1985a).
Total Words: The amount of words used in a given time period.
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