Expert Answer:Compare & Contrast 2 research articles about fluen


Solved by verified expert:Introduction: A one paragraph introduction needs to introduce the reader to the main topic(s) of the paper. Things you should consider including are answers to the following: Why is this topic important? What is the main purpose of your paper? Be sure to gradually introduce the reader to the topic and provide some context for understanding the articles.Main Text: Pretend that the person who reads your paper has never read these articles. What key points would your reader need to learn about in order to understand the information? Organize your writing around your selected themes. Do not waste time providing research details that are not necessary to understanding the key points addressed. Remember the big picture and provide enough detail to make sense of the information — but not so much as to overwhelm the reader. Conclusion: After discussing the main themes, wrap up with a conclusion. Be sure to tie your conclusion to the introduction.Length: The entire paper should be three pages, NOT including your cover page and references. Formatting: Use a 12 point font, standard double-spacing, 1 inch margins.First Page: You may include a cover page if you wish, but the cover page does not count toward the 3 pages needed for this assignment. The first page of the actual paper should contain a centered title, followed by a blank line, then the text of the paper. See APA manual for examples.Page Header: All pages of an APA text need numbered Page Headers in the upper right corner. The Page Header should contain your last name, a few words of the title and a page number. Headers: The paper should have a header between the introduction and body, and parallel headers as appropriate throughout the rest of your paper. See APA manual.References: The articles should be cited and placed in a reference list at the end of the paper (does not count towards the 3 pages assigned). Style: All APA rules should be followed for headers, citations, references, etc., even if we have not yet highlighted them in class. Use your APA manual!


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Research Article
Changing Nonstuttering Preschool
Children’s Stuttering Attitudes
Mary E. Weidner,a Kenneth O. St. Louis,b and Haley L. Gloverb
Purpose: Negative or uninformed stuttering attitudes
proliferate among the general public, and bourgeoning
research has shown that such attitudes might emerge
as early as the preschool years. Much remains unknown
about young children’s stuttering attitudes, and conclusive
recommendations to improve attitudes toward stuttering
have yet to be advanced. This study sought to determine
the effect of a new educational program on improving
stuttering attitudes among preschool children using objective
Method: Thirty-seven preschool children learned about
stuttering and sensitive peer interactions by participating
in the newly developed Attitude Change and Tolerance
program. The program teaches children about human
differences with an emphasis on stuttering and how to
interact with people who stutter. Children’s stuttering attitudes
were measured using the Public Opinion Survey of Human
Attributes–Stuttering/Child (Weidner & St. Louis, 2014)
before and after the program.
Results: Pre–post comparisons showed statistically
significant improvements in children’s overall stuttering
attitudes. In particular, children demonstrated gains relative to
their perceptions of and reactions toward people who stutter.
Conclusion: This study provides empirical evidence that
young children’s stuttering attitudes can be improved using
the Attitude Change and Tolerance program. In addition, it
supports previous research that negative stuttering attitudes
emerge as early as preschool.
people who stutter pursue careers that do not require high
speaking demands (Boyle, 2017). Negative beliefs about
stuttering and people who stutter have been clearly documented among older children and adults (see Hughes, 2015,
for a review) and have been suggested to emerge during early
childhood (Ambrose & Yairi, 1994; Langevin, Packman, &
Onslow, 2009; Weidner, St. Louis, Burgess, & LeMasters,
tuttering has long been misunderstood by the general public, which has contributed to the unfavorable
stereotyping, stigma, and bullying of people who
stutter (Boyle & Blood, 2015; Langevin, 2015). Hundreds
of studies from around the world have confirmed that negative stuttering attitudes (i.e., persons’ beliefs, feelings, and
reactions toward the disorder or the stuttering speaker) transcend culture, race, sex, education level, income level, profession, and religious affiliation and can have serious social
ramifications on the lives of people who stutter (see St. Louis,
2015a, for a review). Negative public stuttering attitudes can
impede the ability of people who stutter to form meaningful
relationships, advance in their careers, and maintain a high
quality of life (e.g., Boyle & Blood, 2015; Craig, Blumgart,
& Tran, 2009; Gabel, 2015; Klompas & Ross, 2004). In a
recent study of 310 adults who do not stutter, a majority
reported that the general public might experience discomfort
talking to people who stutter and would recommend that
Department of Communication Disorders, Marshall University,
Huntington, WV
West Virginia University, Morgantown
Correspondence to Mary E. Weidner:
Editor-in-Chief: Julie Barkmeier-Kraemer
Editor: Stacy Betz
Received January 21, 2018
Revision received April 22, 2018
Accepted June 1, 2018
Stuttering Attitudes in Early Childhood
Even though children may not be able to accurately
define the word “stuttering” until the later school-age years
(Culatta & Sloan, 1977; Mowrer, Fairbanks, & Cantor,
1980; Putorek, Myers, Hall, St. Louis, & Weidner, 2018),
it has been consistently shown that young children who
do and do not stutter have awareness of the disorder
(Ambrose & Yairi, 1994; Ezrati-Vinacour, Platzky, & Yairi,
2001; Griffin & Leahy, 2007). Using videos of characters
who do and do not stutter, Ezrati-Vinacour and colleagues
(2001) asked children ages 3–7 to judge whether or not the
characters talked the same way. From a sample of 79 children, approximately 25% of 3-year-olds, 56% of 5-year-olds,
and 63% of 7-year-olds accurately remarked that the characters spoke differently. Importantly, children’s acuity in
detecting speech fluency patterns often accompanies their
Disclosure: The authors have declared that no competing interests existed at the time
of publication.
American Journal of Speech-Language Pathology • Vol. 27 • 1445–1457 • November 2018 • Copyright © 2018 American Speech-Language-Hearing Association
development of attitudes toward them. In a study that
examined preschool children’s attitudes toward their own
speech, children who stutter held significantly worse attitudes compared to fluent children compared to a speaker
who stutters (Vanryckeghem, Brutten, & Hernandez, 2005).
In addition, Griffin and Leahy (2007) used videos of
puppets who did and did not stutter to gauge stuttering
awareness and attitudes of eighteen 3- to 5-year-old children. Results revealed that 78% of children reported that
the stuttered speech was “different,” and nearly half of
the children reacted negatively when listening to the puppet
who stutters.
Langevin and colleagues (2009) used a qualitative
approach to investigate the reactions among typically fluent
preschoolers toward their stuttering peers. The researchers
video-recorded the interactions of four preschool children
who stutter with their fluent peers during play. Of the four
children, one child did not experience any negative reactions. For the other three children, peer reactions toward
instances of stuttering were generally positive or neutral
(ranging from 71.4% to 97.2%). There were also notable
negative responses (ranging from 2.8% to 28.6%), which
involved the nonstuttering peer changing the topic or activity, exhibiting outward confusion, walking away, interrupting, mocking, and ignoring the stuttering child. In such
cases, the preschoolers who stuttered were judged to have
a disadvantage in leading play activities, participating in
dramatic play, and resolving conflicts.
Weidner and St. Louis (2014) advanced a quantitative
approach to measure young children’s stuttering attitudes,
the Public Opinion Survey of Human Attributes–Stuttering/
Child (POSHA-S/Child). Preliminary use of the POSHA-S/
Child among 27 nonstuttering preschool-age children and
24 nonstuttering kindergarten children from a mid-Atlantic
state in the United States showed that negative or uninformed
stuttering attitudes are detectable by the age of 4 years
(Weidner, St. Louis, et al., 2015). Children expressed little
knowledge about the causes of stuttering and how to appropriately interact with a person who stutters. For example,
most children reported they would say, “slow down,” and
would finish the words of a peer who stutters. In studies of
preferences of adults and children who stutter regarding the
type of support they desired, these responses were regarded
as undesired (St. Louis et al., 2017; Weidner, Coleman,
et al., 2015). The young children also noted they would be
“worried” if they, their family, or their friends stuttered. A
replication study of preschoolers’ stuttering attitudes was
carried out with 31 Turkish children using a Turkish translation of the POSHA-S/Child (Weidner, St. Louis, Nakisci,
& Özdemir, 2017). The Turkish preschoolers’ stuttering
attitudes were compared to the results of the American preschool sample from the aforementioned study. Despite
the obvious cultural differences between the samples, the
American and Turkish preschoolers had the exact same
overall stuttering attitude score. Results suggested that young
children’s stuttering attitudes might not be influenced by
one’s culture but rather may accompany their developmental ability to perceive differences in others.
Importantly, there seems to be a progression in the
intensity and magnitude of negative stuttering attitudes
as children mature. In preschool, children who stutter may
be at risk for occasional social distancing or exclusion and
undesired listener responses (Ezrati-Vinacour et al., 2001;
Griffin & Leahy, 2007; Langevin et al., 2009; Weidner,
Coleman, et al., 2015). By the school-age years, however,
it has been shown that over 80% of children who stutter
experience overt teasing and bullying secondary to their
stuttering (Langevin, Bortnick, Hammer, & Wiebe, 1998;
Mooney & Smith, 1995). This may involve mocking stuttered speech, name calling, social exclusion, and attributing
low social status (Blood & Blood, 2004; Davis, Howell, &
Cooke, 2002; Evans, Healey, Kawai, & Rowland, 2008;
Hartford & Leahy, 2007; Langevin, 2015; Yaruss, Murphy,
Quesal, & Reardon, 2004). In three different retrospective
studies, adults who stutter recounted the challenges they
experienced as a child who stutters, which collectively included physical and verbal bullying, difficulty in making
friendships, decreased classroom participation, fear of being
negatively evaluated, and low self-image (Blood & Blood,
2016; Daniels, Gabel, & Hughes, 2012; Hugh-Jones &
Smith, 1999). These experiences can have long-lasting negative effects on one’s psychosocial well-being and self-image.
In fact, “self-stigma” may arise if people who stutter internalize the negative stereotypes and discrimination they experience (Boyle, 2013).
Stuttering Attitude Change in Children
and Adolescents
Some studies have shown promise in improving
adults’ stuttering attitudes through education, videos, and
personal contact (e.g., Abdalla & St. Louis, 2014; Boyle,
Dioguardi, & Pate, 2016, 2017), but only a few studies
have sought to improve stuttering attitudes among typically fluent children and adolescents. In a study by Flynn
and St. Louis (2011), high school students filled out the
Public Opinion Survey of Human Attributes–Stuttering
(POSHA-S; St. Louis, 2011) questionnaire before and
after an oral presentation by a person who stutters or after
watching MTV True Life: I Stutter, which was followed
by a shortened oral presentation. Both conditions evoked
about equally significant attitude improvement. A 7-year
follow-up study with 37 of the original 84 participants indicated that their positive stuttering attitudes remained
improved, compared to a control group, since the intervention (St. Louis & Flynn, 2018). By contrast, two recent
studies, also using the POSHA-S, showed that middle
school, high school, and university students experienced
little to no attitude change following video-based stuttering interventions (Kuhn & St. Louis, 2015; Węsierska,
Błachnio, Przepiórka, & St. Louis, 2015). It is unclear what
variables may have accounted for the equivocal findings
(e.g., intervention methodology), but these preliminary
studies offer evidence that adolescence might not be an
optimal period to effect a desirable degree of improvement
in stuttering attitudes.
American Journal of Speech-Language Pathology • Vol. 27 • 1445–1457 • November 2018
There are only a few known studies that have investigated attitude change among school-age and preschool-age
children. In a large-scale feasibility study by Langevin and
Prasad (2012), over 600 school-age children participated
in a multimodal educational program, the Teasing and
Bullying: Unacceptable Behavior (TAB) program. The program is composed of classroom lessons, a video of a child
who stutters, a guided discussion, as well as take-home
activities. Changes in stuttering attitudes were determined
using the Peer Attitudes Toward Children Who Stutter
Scale (Langevin, 2009). The study showed that the TAB
program resulted in better stuttering attitudes, increased
interest in stuttering, as well as improved attitudes toward
bullying among school-age children (Langevin, 2000, 2015;
Langevin & Prasad, 2012). The TAB program was among
the first to show that school-age children’s stuttering attitudes are amenable to change.
Recognizing that stuttering attitudes emerge prior to
the school-age years, Weidner and St. Louis (2015) carried
out a pilot study aimed to improve preschool children’s
stuttering attitudes using a newly developed education program. The program, which is the Attitude Change and
Tolerance (InterACT) program (Weidner, 2015), teaches
young children about the nature and causes of stuttering
and how to appropriately respond to peers who stutter. Preliminary results using the POSHA-S/Child revealed notable
improvement in preschoolers’ stuttering attitudes following the program, but the small sample size (N = 6) prevented
the researchers from drawing confident conclusions about
the nuances of children’s attitude change. Nevertheless, the
pilot provided compelling support for the study’s expansion with a larger sample size.
Studies have consistently shown that young children
hold unfavorable attitudes toward people who stutter, and
without an educational intervention about stuttering, such
attitudes are likely to persist. Given that negative stuttering
attitudes emerge during the preschool years, it is logical
to assume that efforts to mitigate those attitudes should be
carried out during that same period. Doing so will help
determine the malleability of young children’s attitudes
and potentially advance effective interventions that might
be used in clinical or educational contexts. Teaching children about stuttering and differentiating between helpful
and unhelpful responses to stuttered speech could potentially lead to better communication and social experiences
for people who stutter.
The purpose of this study was to measure and compare nonstuttering preschoolers’ stuttering attitudes before
and after an educational program. Similar to Weidner and
St. Louis (2015), the researchers administered the POSHA-S/
Child before and after the InterACT program. Although
methodologically similar, none of the children in the pilot
were included in the analysis of the current study. It was
hypothesized that preschool children would hold negative
or uninformed stuttering attitudes prior to the InterACT
program. Specifically, it was expected that children would
have little knowledge about the causes of stuttering and
how to appropriately react to people who stutter. It was
also expected that children’s overall stuttering attitudes
would improve following the InterACT program, with notable gains relative to more accurate knowledge about stuttering and improved reactions toward people who stutter.
This study was carried out using a pre–post design
over a 3-week period in six different preschool classrooms. Children’s stuttering attitudes were measured
quantitatively using the POSHA-S/Child before and after
the InterACT program.
Attitude Instrument: The POSHA-S/Child
The POSHA-S/Child, which is an extension of its
adult counterpart, the POSHA-S, measures young children’s beliefs about stuttering and self-reactions toward
people who stutter. It can be used with children 3–10 years
of age and is administered verbally (i.e., for nonreaders
or novice readers), or filled out online or hard copy (i.e.,
for proficient readers). It includes a demographic section
to gather information about the child (e.g., health and
abilities, number of siblings, and participation in school
or day care) and the child’s family (e.g., income and
parent education level), which is filled out by a parent or
guardian. Children’s exposure to or personal experience
with stuttering, obesity, and wheelchair use is also reported. Obesity and wheelchair use are easily recognized
by children (e.g., Bell & Morgan, 2000; Hong, Kwon, &
Jeon, 2014) and have been historically viewed as stigmatizing conditions. Accordingly, the obesity and wheelchair items were included to better understand children’s
stuttering attitudes relative to other stigmatizing human
Stimulus Video
The child portion of the POSHA-S/Child begins
with a 1.25-min stimulus video featuring two animated stuttering avatars, one girl and one boy. The avatars engage
in a brief conversation about their interests (i.e., five lines
each) at a language level appropriate for young children.
Each of the avatars’ stuttering was recorded by the first
author. The (pseudo-)stuttering consists of initial sound
and syllable repetitions, prolongations, and blocks. Physical tension is marked using unnatural prosody, including rising pitch changes. The avatars’ stuttering is severe.
Following the video, the administrator defines the term
stuttering, “These children stutter. Stuttering is what happens
when a person’s words or sounds bounce l-l-l-ike this, or
stretch liiiiiike this, or when no words or sounds come out
l———ike this.”
Weidner et al.: Changing Preschool Children’s Stuttering Attitudes
After showing and explaining the video, the examiner proceeds to ask the child 40 “yes/no” questions about
stuttering. The items are grouped into seven components,
namely “Traits,” “Who Should Help,” “Cause,” “Potential,” “Accommodating/Helping,” “Distance/Sympathy,”
and “Knowledge” (refer to Table 2 for a list of the items
within each component). The first four of the abovelisted components are clustered into a “Beliefs” subscore,
and the remaining three components are clustered into a
“Self-Reactions” subscore. The Beliefs and Self-Reactions
subscores are averaged into an Overall Stuttering Score
(OSS). An Obesity and Wheelchair subscore is also measured, which reflects children’s preference and experience with those conditions. As previously stated, these
scores help to interpret children’s stuttering attitudes in the
context of other stigmatizing human attributes. Responses
are assigned a value where “no” = 1, “not sure” = 2,
and “yes” = 3. After that, scores are converted to a
−100 to +100 scale, wherein “no” responses are assigned
a value of −100 and “yes” responses are assigned a value
of +100, which yields a possible 201-unit range of scores.
“Unsure” responses are assigned a value of “0” as they
represent a neutral rating that is neither positive nor negative. The scores of some items (e.g., “I would laugh at a
child who stutters”) are inverted so that, for all items,
negative or uninformed attitudes correspond to lower
scores and positive or more informed attitudes correspond
to higher scores. The valence of items as being either
positive/informed or negative/uninformed was based on
preceding literature relative to our current understanding of stuttering symptomology and causes (Yairi &
Ambrose, 2013) as well as guidelines for supporting people who stutter (St. Louis et al., 2017; Weidner, Coleman,
et al., 2015).
Psychometric Properties
Substantial evidence supports the POSHA-S/
Child’s psychometric properties. The test–retest reliability of the instrument was recently confirmed in
a study of 99 children (St. Louis & Weidner, 2018).
Children in each grade level between preschool and fifth
grade completed the POSHA-S/Child 1–2 weeks apart
without receiving an educational intervention. Across all
respondents, the pre–post test administrations yielded
the same OSS (i.e., 10 at pretest and 10 at posttest),
an 82% absolute agreement on the 40 individual test
items, and a correlation of .65. These results showed
adequate test–retest reliability for preschool- and schoolage children. The concurrent and construct validity
of the instrument was further established in a study in
which 378 adults took both child and adult versions
of the POSHA-S (St. Louis, Weidner, & Mancini, 2016).
The OSSs on the two versions were nearly equivalent
(POSHA-S OSS = 30, POSHA-S/Child = 31) and provided additional evidence of the POSHA-S/Child’s sound
psychometric properties.
Intervention: The InterACT Program
Overvie …
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