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An Investigation Of The Incidence Of Stuttering Among Elementary School Children In The Los Angeles City Schools

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An Investigation Of The Incidence Of Stuttering Among Elementary School Children In The Los Angeles City Schools

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Content INVESTIGATION OF THE INCIDENCE OF STUTTERING
AMONG ELEMENTARY SCHOOL CHILDREN IN THE
LOS ANGELES CITY SCHOOLS
by
Leo Sylvester Carroll
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(Speech)
January 1966
UNIVERSITY O F SOUTHERN CALIFORNIA
TH E GRADUATE SC H O O L
U N IV ERSITY PARK
LO S A N G ELES, .CA LIFO RN IA 9 0 0 0 7
This dissertation, written by
....... - L f i . f t . S . y l Y S . a t e . r . - . C A r . t o J L l .
under the direction of kxa. Dissertation Com
mittee, and approved by all its members, has
been presented to and accepted by the Graduate
School, in partial fulfillment of requirements
fo r the degree of
D O C T O R O F P H I L O S O P H Y
Dean
Date Jan.u&r.yA. . l . 9 . 6 . 6 .
DISSERTATION COMMITTEE
fChairman
ACKNOWLEDGEMENTS
The writer wishes to express his sincere gratitude
to the many individuals and groups who rendered invaluable
assistance and made this study possible, and especially to
Dr. Herbert Poponoe, Chairman of the Committee on Research
Studies of the Los Angeles City Schools, and the other mem
bers of the committee for consideration and approval of the
project, and to Miss Miriam Keslar, Supervisor of Elemen
tary Speech and Hearing in the Los Angeles City Schools,
and the other members of the Elementary Speech and Hearing
staff for cooperation and assistance in gathering the data.
TABLE OP CONTENTS
Page
ACKNOWLEDGMENTS...........................................ii
LIST OF T A B L E S ........................................ v
Chapter
I. THE PROBLEM.................................... 1
Statement of the Problem
Importance of the Study
Uniqueness of the Study
Organization of the Remainder of the
Dissertation
II. REVIEW OF THE LITERATURE.................... 7
Chronological Review of Incidence Studies
Definitions of Stuttering Used
Techniques Used to Identify Stutterers
Characteristics Attributed to Stuttering
Characteristics Attributed to Stutterers
Family Situation and Socio-Economic Status
School Speech Therapists
III. METHODS, TECHNIQUES, AND PROCEDURES ......... 34
Population Surveyed
Identification of Suspected Stutterers
Letters and Forms Used
Accuracy Check and Coordination
Handling of the Data
Chapter
IV. RESULTS
Page
43
Overall Incidence and Incidence by Sex
and by Grade
Characteristics Attributed to the Stuttering
Characteristics Attributed to the Stutterers
Family Situation and Socio-Economic Status
School Speech Therapists
V. DISCUSSION.................................. 92
Overall Incidence and Incidence by Sex
and by Grade
Characteristics Attributed to the Stuttering
Characteristics Attributed to the Stutterers
Family Situation and Socio-Economic Status
School Speech Therapists
VI. SUMMARY AND IMPLICATIONS FOR FURTHER
RESEARCH 117
Summary
Implications for Further Research
APPENDIX 133
REFERENCES
144
LIST OF TABLES
N
Table - Page
1. Per Cent Incidence of Stuttering by Grade
Level........................................... 16
2. Sex Ratio by G r a d e ..............................17
3. Incidence of Stutterers..........................45
4. Incidence by School Grade ..................... 47
5. Stutterers by School Grade ................... 48
6. Primary-Secondary Classification by Grade . . . 50
7. Mild-Severe Classification by Grade .......... 51
8. Severity by Grade ..........................53
9. Repetitions by G r a d e ............................ 56
10. Prolongations by G r a d e ..........................57
11. Blocks by Grade...................................58
12. Movements by G r a d e .............................. 59
13. Stops by G r a d e ...................................60
14. Summary: Characteristics by Grade ............. 61
15. Age at Onset of Stuttering......................64
16. Other Speech Problems of Stutterers............. 66
v
vi
Table Page
17. Handedness of Stutterers........................66
18. Intelligence Tests and Scores ................. 68
19. Personality Traits ............................ 69
20. Social and Emotional Adjustment, Work Habits
and Academic Progress ........................ 71
21. Speech Progress................................... 71
22. Speech Class Attendance by Grade ............. 73
23. Other Stutterers in Family ................... 75
24. Family Position of Stutterers ...........76
25. Family Size of Stutterers........................ 78
26. Home Conditions of Stutterers....................79
27. Family Income................. 81
28. Head of Household Education......................83
29. Population Density ............................ 84
30. Ethnic Composition of Neighborhood............. 85
31. Student Population of Therapist ............... 88
32. Incidence and Sex of Therapist ............... 89
33. Incidence and Therapists........................ 90
34. Incidence and School Size........................ 91
CHAPTER I
THE PROBLEM
There is a continuing need for current, descriptive
data regarding speech and hearing problems, especially in
the public schools where most speech and hearing problems
are diagnosed and treated. The work group (64) that
studied the results of the National Survey of Public School
Speech and Hearing Services stressed the need for systemat
ic accumulation of data, either descriptive or comparative,
pertaining to a specifically identified problem, such as
stuttering, concerning speech among elementary school chil
dren. The work group also stressed the need for develop
ment of criteria for selection of primary grade children
for inclusion in remedial programs. The group observed
that the public schools provide a fertile field for
research.
The Los Angeles City Elementary School System
presents an unusual opportunity for obtaining descriptive
1
2
data on speech problems, especially those with low inci
dence. All schools in the system are regularly serviced by
a full-time staff of qualified speech clinicians. Children
in the schools are routinely surveyed by the clinicians to
identify speech problems. The school system has one of the
nation's largest elementary school populations, about one-
third of a million children. The system covers perhaps the
largest geographic area of any, encompassing many differ
ent socioeconomic and racial groups. Administrators and
staff members in the system are cooperatively interested in
research studies and surveys that provide information to
assist them in dealing with speech and hearing problems.
Statement of the Problem
The main purpose of this study was to determine the
incidence of stuttering, by sex and by grade, among chil
dren in the Los Angeles City Elementary Schools. The
secondary purpose was to obtain information about the fol
lowing correlative aspects:
A. Characteristics attributed to the Stuttering
1. Primary-secondary classification
2. Mild-severe classification
3. Scalar judgments of severity
4. Relative frequency of occurrence of
a. Repetitions
b. Prolongations
c. Blocks
d. Movements
e. Stops
B. Characteristics attributed to the Stutterers
1. Age at onset
2. Other speech problems
3. Laterality
4. Intelligence
5. Personality traits
6. Social and emotional adjustment
7. Academic progress and work habits
8. Speech progress
9. Speech class attendance
C. Family Situation and Socio-Economic Status
1. Other stutterers in family
2. Family position, including twinning
3. Family size
4. Home conditions
5. Family income and parent occupation
6. Head of household education
4
7. Population density of neighborhood
8. Ethnic composition of neighborhood
D. School Speech Therapists
1 '. Student population of therapist
2. Incidence and sex of therapist
3. Incidence and therapists
4. Incidence and school size
Importance of the Study
Stuttering is one of the more important disorders
of speech to study in the public schools because of:
(1) the .relatively little current descriptive data avail-
able regarding incidence by grade, sex, and other important
factors, as the review of the literature will show; (2) the
diverse criteria of stuttering used in obtaining what data
are available, as Milisen (55) has concluded after review
ing the literature on stuttering incidence for his chapter
in Travis' Handbook on Speech Pathology; and (3) the long
period of time since the last large study of stuttering in
the public schools, as the last comprehensive study (92) of
stuttering incidence among Los Angeles public school chil
dren was in 1930 for the White House Conference on Child
Health and Protection, and that study provided no data
regarding correlative factors.
Uniqueness of the Study
This investigation of stuttering differed from
others in that (1) all children suspected of being stut
terers were evaluated by certain, specified criteria;
(2) the nature of the stuttering of each child was des
cribed in comparable terms: the presence or absence of
given characteristics, their relative frequency of occur
rence if present, and the severity of the stuttering;
(3) those who evaluated the stutterers or suspected stut
terers were experienced, trained observers; and (4) cor
relative data on stutterers was obtained in order to deter
mine relationships between such data and stuttering inci
dence .
Organization of the Remainder of the
Dissertation
The remaining portion of this dissertation is
organized as follows:
Chapter II: a review of the literature relating to
the problem of this study.
Chapter III: a discussion of the methods, tech
niques, and procedures used to gather the data.
6
Chapter IVs a presentation of the data in tabular
and narrative form.
Chapter V: a discussion of the results of the study
in terms of the purpose of this investigation.
Chapter Vis a summary of the study and a citation
of conclusions and implications which may be drawn from the
data.
CHAPTER II
REVIEW OF THE LITERATURE
There have been several investigators who have
reported on stuttering incidence among school children.
Not all the studies were specifically concerned with deter
mining incidence? rather, they were concerned with the role
of correlative factors in stuttering. In some studies,
incidence was determined from samples of children; in
others, from a census of the total school populations in
given areas. The definitions of stuttering and the methods
used to identify stutterers varied widely among the inves
tigators. It is not surprising that the results of the
studies also varied widely and were seldom directly compar
able.
Chronological Review of
Incidence Studies
The earliest reported study related to stuttering
incidence, according to Root (67), occurred in 1893 when
8
Hartwell obtained a small amount of data about stutterers
in the public schools of Boston. The next study was not
until eighteen years later: in 1911, Conradi (24) surveyed
87,444 school children in six American cities to obtain
information about the intellectual progress of stutterers.
The studies that followed are presented below in chrono
logical order:
1914: Tucker (82) reported a study of incidence
among 3,010 pupils in ten graded elementary
schools in New England.
1916: Wallin (86) conducted a census of 89,057
pupils to determine stuttering incidence in
the city schools of St. Louis.
Blanton (7) conducted a survey of speech
defects among 4,860 pupils in the public and
parochial schools of Madison, Wisconsin.
1926: Root (67) surveyed speech defectives among
14,072 children in the public elementary
schools of South Dakota.
1928: McDowell (51) reported stuttering incidence
among 7,138 children in a study of the edu
cational and emotional adjustment of stut
tering children.
1930:
1936:
1937:
1940:
1942:
West, Travis, and Camp gathered data on
stuttering incidence for the White House
Conference Report (92). This was the larg
est study of incidence that has been
reported. School children in 40 major
cities in the United States were surveyed
for speech defects, including 213,603 in the
elementary schools of Los Angeles.
Louttit and Halls (49) reported on a survey
of speech defects among public school chil
dren of Indiana.
Travis, Johnson, and Shover (81) reported on
stuttering incidence among 4,827 children in
the public schools of East Chicago, Indiana,
using data obtained from a study of the
relations of bilingualism to stuttering.
McAllister (50) reported stuttering inci
dence figures for an English school popula
tion.
Burdin (20) reported on a survey of speech
defectives among 3,602 children in the
Indianapolis primary grades.
Mills and Streit (57) surveyed speech
1946:
1955:
1956:
1958:
1960:
defectives among 4,685 pupils in the Holy
oke, Massachusetts schools.
Schindler (69) reported stuttering incidence
in a study of educational adjustments of
22,976 stuttering and non-stuttering school
children in Iowa.
Schreiber (70) reported on the incidence^of
stuttering among children in Westphalia,
Germany.
Morgenstern (61) gave incidence of stutter
ing for 29,499 sixth and seventh grade chil
dren in Scotland obtained from a study of
socio-economic factors in stuttering.
Shames and Beams (74) obtained incidence of
stuttering for ages 3 to 80 in a study of
incidence primarily in the older age groups.
Adler (1) reported on a comparative study of
the incidence of White and Negro stutterers
in twenty Tennessee counties.
Lambert (47) obtained incidence of stutter
ing in the second, third, fifth, and sixth
grades among parochial school children in
Los Angeles.
11
These are the major incidence studies that have
been conducted over the years. There have been a few
others, but they involved very small samples or were done
in isolated areas. For example, Aron (3) has reported on
the nature and incidence of stuttering among a group of
Bantu school-going children.
Definitions of Stuttering Used
Definitions of stuttering used in the incidence
studies varied widely, and frequently none were included
in the report. Often definitions appeared quite complex.
For example,^McDowell requested teachers to identify stut
terers based on the following definition:
an intermittent inability to produce voiced sounds
accompanied by severe cramps of the diaphragm, larynx,
tongue, or all three of these speech organs. (51:202)
McDowell, herself, felt that these diagnostic criteria were
questionable.
The following definition was used in the question
naire sent to boards of education for the 1930 White House
Conference survey:
Stuttering (sometimes called stammering). A disturb
ance in the rhythm of speech, an intermittent block
ing, from which, if the conversational situation is
favorable, the child may at times be quite free. This
blocking may be in the muscles of the face, lips,
tongue, or jaw; in the throat or larynx; in the
12
respiratory muscles; or it may be a mere hesitation in
the initiation of sounds or their repetition when
initiated. (92s351)
No mention is made in the survey of what was done with this
somewhat lengthy definition by ^Ehe boards of education.
The report did not say whether those who actually iden
tified the stutterers (teachers or principals) used the
definition.
Blanton (7) gave no definition and, in addition,
he had two assistants who apparently independently iden
tified the stutterers. Wallin (86) also gave no defini
tion and noted possible flaws in his diagnostic procedure
when he found only 5 of 12 reported stutterers to meet his
own criteria for stuttering. Burdin (20) cited no criteria
of stuttering and did not report who did the diagnosing.
Mills and Streit said nothing about using either a defini
tion or criteria of stuttering and used ten different
examiners to identify stutterers.
Schindler (69) defined stuttering in terms of
community agreement with respect to diagnosis; that is, a
child was classified as a stutterer if he was so regarded
by his parents or teachers prior to the survey. Morgen-
stern (61) used a lay definition to discover stutter-
suspects but then had the diagnosis confirmed by qualified
13
speech therapists.
Aron used Van Riper's rather lengthy definition:
. . . the disorder characterized by blockings, pro
longations, or repetitions or words, syllables, sounds,
or mouth postures, all of which (together with the
contortions of devices used to avoid, postpone, dis
guise, start, or release the speech abnoramlity) pro
duce interruptions and breaks in the rhythmic flow of
speech. (85:342)
Other researchers, such as Shames and Beams (74),
made no mention of a definition or criteria used and did
not report who did the diagnosing.
Techniques Used to Identify Stutterers
The main techniques used by investigators to iden
tify stutterers have involved referrals, questionnaires,
and personal surveys.
In the referral technique, stutterers are identi
fied by persons who are not trained speech therapists, such
as teachers or clergymen. The referral technique was used
by Aron (3), McDowell (51), Morgenstern (61), and Schindler
(69) to identify stutterers in their incidence studies.
In the questionnaire technique, forms which require
information about suspected stutterers are mailed or given
to persons to complete. Again, the ones responding to the
questionnaire are ordinarily not trained in speech prob-
14
lems. The questionnaire technique was used by Wallin (86) ,
Burdin (20), Root (67), and Shames and Beams (74). In both
the referral and questionnaire techniques, the accuracy^
with which stutterers are identified would seem to depend
on the definition of stuttering and on how it is used by
untrained persons.
In the personal survey technique, the investigator
or their representatives personally evaluate the stutter
ers. It is not always clear from the report of the studies
whether the investigators themselves screened both stut
terers and non-stutterers or whether they simply evaluated
referred stutterers. The personal survey technique was
used by Blanton (7), Lambert (47), and Travis, Johnson, and
Shover (81).
Both the questionnaire and personal survey tech
nique was used in the White House Conference (92) survey:
questionnaires were sent to the boards of education of all
cities having a population of 10,000 or more; the committee
itself conducted a personal survey of Madison, Wisconsin.
A combination of referral, by teachers, and per
sonal survey techniques was used by Mills and Streit (57).
In other studies, no technique of identifying
stutterers was reported; for example, those by Tucker (82),
15
Conradi (24), Hartwell (39), and Adler (1).
Results of Incidence Studies
The results of incidence studies, as noted before,
have been quite variable. Table 1 shows the results of
some studies which are most relevant to the present one:
those in which there was some information about stuttering
incidence by grade level.
It is difficult to conclude anything about inci
dence by grade level from the figures in Table 1. The
most informative data are probably those from the White
House Conference study. They show an increase in incidence
from the first to fourth grade, then a decrease in the
fifth and sixth grades. Overall incidence seems to be
somewhat less than the often-cited "1 per cent" of the
population.
The results of all incidence studies indicate that
there is more stuttering among boys than among girls. In
1946 Schuell (71) reviewed past investigations of stutter
ing in relationship to sex differences and found ratios
ranging from two to ten males to one female, varying with
age, educational status, and methods used to obtain
samples. More recently, Milisen (55) reviewed reports of
TABLE 1
PER CENT INCIDENCE OF STUTTERING BY GRADE LEVEL
Grade
Root
(1916)
White House Conference*
(1930)
Burdin
(1940)
Mills and Streit
(1942)
Schindler
(1946)
1 1.10 .27 .48 1.50 .55
2 .70 .39 1.66 4.30 .31
3 .60 .41 1.13 2.50 .56
4 1.80 .49 1.59 1 - .43
5 2.10 .42 - -
.62
6 1.60 .37
- -
.71
*Los Angeles only: These percentages were computed from the frequencies reported by the
White House Conference, using grade population figures for 1930 obtained from the Los
Angeles Board of Education.
17
sex ratios and found them to range from 2.2 to 1 to 5.3 to
1. Milisen made the observation, based on the data from
the White House Conference study and from the data of the
Blanton study, that
The marked increase in cases of stuttering in the
middle elementary grades . . . was largely due to the
great increase in incidence of stuttering among boys.
The incidence among girls remained relatively constant.
(55:255)
Table 2 shows the ratio of male to female stutterers in
grades 1 through 6 found in the White House Conference
study.
TABLE 2
SEX RATIO BY GRADE
Total Study Los Angeles Only
Grade Boys Girls Ratio Boys Girls Ratio
First 623 203 3.1 55 18 3.1
Second 839 244 3.3 59 22 2.7
Third 966 265 3.6 73 19 3.8
Fourth 1052 253 4.2 73 22 3.3
Fifth 1172 271 4.3 59 14 4.2
Sixth 1095 255 4.3 45 19 2.4
Ratio reports since Milisen have also varied, but
always more boys than girls were found to be stutterers.
18
For example, Aron (3) reported a ratio of 3.28 to 1; and
Morgenstern (61), a ratio of 4.4 to 1.
Characteristics Attributed to
Stuttering
Primary-Secondary Classification
The concept of primary and secondary stages in the
development of stuttering was advanced by Bluemel (13) in
1932. Prototypes of this concept are to be found in his
writings dating back to 1913 (12). Although the concept
gained wide currency, dissatisfaction with it gradually
took place. In 1942 Johnson (41) noted that it was diffi
cult to distinguish primary stuttering from "normal non
fluency." In 1953 Glasner and Vermilyea (36) demonstrated
that in spite of the popularity of the term "primary
stuttering" there was considerable confusion among speech
clinicians about what it meant. In 1954 Van Riper (85)
introduced the term "transitional stuttering" to cover
those stutterers that seemed to have features of both types.
In 1957 Bluemel (14), apparently dissatisfied with his
concept, revised his definition of primary stuttering to
include "spasm" or blocking and emphasized that in the
secondary stage the secondary aspects merely add to the
primary qualities; they do not displace them. In 1961
Bloodstein (11) concluded from his investigations that two
distinct stages of the kind usually referred to as primary
and secondary stuttering do not appear to exist and that
the concept should be discarded. There have been no
studies, apparently, relating primary and secondary class
ifications to severity of stuttering as rated by clini
cians .
Scalar Judgments of Severity
Scalar judgments of the severity of stuttering have
proven practicable. Lewis and Sherman (48), and Sherman
(76) used the psychological scaling method of equal-
appearing intervals for obtaining measures of the severity
of stuttering for short speech samples. In another study,
Sherman and McDermott (77) found that satisfactory reliable
mean scale values of severity of individual moments of
stuttering can be derived from the responses of a single
observer. The investigators pointed out that the method
may be used both as a diagnostic tool and as a measure of
speech progress.
20
Relative Frequency of Occurrence
of Specific Characteristics
Repetitions appear to be the most frequently ob
served stuttering characteristic. Aron (3) found that a
large group of the younger children in her study consist
ently used repetitions more often than any other charac
teristic. Bloodstein (10) observed repetitions at every
age level studied and found them to be a dominating fea
ture of stuttering until the age of six or seven years.
Bloodstein also noted that after the age of seven, and
sometimes much earlier, repetitions were observed in con
junction with blockages and prolongations. The incidence
of movements were less pronounced. Egland (33) reported
repetitions as the most common reactions found; prolonga
tions ranked second in frequency. Davis (28) found that
children thought of as stutterers had a higher number of
repetitions than the others. Wingate (94), after review
ing research findings on speech characteristics of chil
dren, concluded that certain kinds of fluency irregulari
ties, particularly sound and syllable repetitions and
prolongations, are found much more frequently in children
identified as stutterers. Wingate generalized that stut
tering is identified primarily on the basis of sound and
21
syllable repetitions. The occurrence of stuttering charac
teristics, from most frequently observed to least frequent
ly observed, appears to be in this orders repetitions,
prolongations, blocks, movements, stops.
\
Characteristics Attributed to
Stutterers
Age at Onset
Although accurate information regarding age at
onset of stuttering has been difficult to obtain, the
average age at onset reportedly falls in early childhood
as Van Riper (85) has observed. Berry (5, 6) found the
average age at onset to be 4.8 years among 500 stuttering
children. Johnson (41) reported the peak age at onset to
be around three for the majority of stutterers he studied.
Aron (3) found that the majority of stutterers in her study
associated their entrance into school with the onset of
their stuttering. Apparently most stutterers begin stut
tering before beginning school but often associate such a
memorable event with the onset of their stuttering when
asked to recall the age stuttering began.
Other Speech Problems
Speech problems other than stuttering have been
22
reported to frequently accompany stuttering. For example,
Schindler (69) found a significant number of stutterers to
have speech problems other than stuttering. Forty-nine
per cent of the stutterers she studied made some type of
articulation error as compared with 15 per cent of the
control group. Although not statistically significant, a
greater number of voice problems also was found among the
stutterers. Other investigators have also reported what
appears to be a high percentage of other speech problems
present among stutterers. As Schindler has pointed out,
however, what is thought to be other speech problems may
be integral features of the stuttering pattern and not
actually independent aspects.
Laterality
Laterality, especially handedness, has been report
ed by Bryngelson (15, 16, 17, 18, 19), Milisen and Johnson
(56), Quinan (66), Travis (79, 80), and Van Riper (84) to
have an important relationship to stuttering. However,
other investigators, such as Daniels (25), Heltman (40),
Johnson (41), Spadino (78), and Van Dusen (83), have
presented contradictory evidence. Bryngelson has presented
the most convincing evidence in support of the theory that
23
handedness is an etiological factor in stuttering. He ^
interviewed 700 stutterers (15), and compared 152 stut
terers with 152 non-stutterers (16, 17, 19) and found much
more ambidexterity and shift of handedness among the
stutterers. However, he used more females than males in
his matched groups and this may have biased his results.
Aron (3), for example, found no significant difference
between the male stutterers and male non-stutterers as
regards to change of handedness or left handedness but did
find a significant difference among the female groups,
where 23.8 per cent of the female stutterers were left
handed as compared to 2.3 per cent of the female non
stutterers .
Daniels (25) has presented equally convincing evi
dence contradictory to handedness being a factor in the
etiology of stuttering. In a survey of 1,594 university
students and further interviewing and testing of 154
stutterers, left-handed persons, ambidextrous persons, and
persons whose handedness had been shifted, he found little
or no relationship between handedness and stuttering.
There seems to be no satisfactory explanation for the two
groups of findings being so different. It apparently still
remains to be seen conclusively whether stutterers differ
24
significantly from the general population figure of 4.0
per cent (4) for left-handedness.
Intelligence
Intelligence studies of child stutterers have
found normal distributions, but with means somewhat below
the mean of the average range. Travis (79) reported a
normal distribution of intelligence ranging from IQ's of
60 to 139 for 73 children who stuttered. McDowell (51)
obtained a mean of 99.1 on the Stanford-Binet Intelligence
Test for a group of 61 stuttering children. West (88)
cited a median of 96.5 for the 1930 White House Conference
Report. Berry (6) reported a mean IQ of 99.0 for the 166
stutterers she studied. Schindler (69) found a mean of
94.9 on the Otis as compared to 99.5 of her survey popula
tion (22,976) and 100.1 for her control group. Although
these means are below the mean of the average range, child
stutterers do not appear to differ greatly from the average
in intelligence.
Personality Traits
Considerable research on the personality of the
child stutterer has been conducted. An extensive review
of this research, covering a 25-year period through
December, 1957, has been made by Goodstein (37), who con
cluded that there was little evidence to indicate that the
stuttering child has a particular pattern of personality.
Goodstein cited as evidence for his conclusion such stud
ies as those by Darley (26, 27), Burleson (21), and
McDowell (51), which found no significant personality dif
ferences between stutterers and non-stutterers on various
tests. Adler (1), in a later and less extensive review of
personality studies of stutterers also concluded, as had
Sheehan (75) from a review of projective studies of stut
tering, that the data indicate that there is no one per
sonality pattern common to all stutterers, but that many
stutterers have some type of personality problem. West
(89) claims to find a trait among stutterers he terms
"moral perfectionism." Bloodstein (9) notes among stut
terers a high incidence of such traits as "perfectionism,"
"high aspirations," "sensitiveness," "dependence," "fear
fulness, " "insecurity," and "poor tolerance for frustra
tion." Thus it appears from the conflicting research
results that the relation of personality traits to inci
dence of stuttering is still unresolved.
Emotional and Social Adjustment
Considerable research has also been conducted on
the adjustment of the child stutterer. Goodstein (37), in
his review of the research on the personality and adjust
ment of the child stutterer also concluded that there was
little evidence to indicate that the stuttering child is
neurotic or severely maladjusted. In addition to citing
non-significant findings of personality studies, Goodstein
cited conflicting results of Rorschach and other projective
tests studies,— such as those by Meltzer (52, 53, 54),
Wilson (93), Christensen (23), and Krugman (45). Glasner
(35), Moncur (60), and others, however, have concluded from
their studies that stuttering children show more symptoms
of nervousness and maladjustments than do non-stuttering
children.
Work Habits and Academic Achievement
The academic progress of stutterers has been
reported to be below average. Root (67) found a retarda
tion in school progress of 8.55 months for stutterers.
Schindler (69) found the stutterers in her study to be
retarded scholastically on the average approximately one-
half year. Aron (3) found an even greater scholastic
27
retardation of from one year to two years, seven months for
the stutterers as compared to the non-stutterers in her
study. The investigations did not reveal what caused the
retardation. Aron noted that it has been postulated that
the stuttering child is often unable to concentrate on his
work and is prone to be emotionally threatened by the de
mands made in the class.
Family Situation and Socio-Economic
Status
Other Stutterers in Family
As early as 1943, West (90) noted that, according
to reports in the literature, stuttering tends to run in
families; that is, children who stutter more often have
parents and other family members who stutter than do non
stutterers. Some years earlier West, Nelson, and Berry
(91) studied 204 families of stutterers and found stutter
ing in 50 per cent of the families for several generations.
In addition, Wepman (87) had matched a group of 250 stut
terers with 250 non-stutterers for age, sex, and other
variables and found stuttering in 63.8 per cent of the
families of stutterers as compared to only 15.6 per cent in
families of the matched group. Nelson (62) had also
28
reported the same results. Freund (34) had discovered
stuttering among 74 per cent of the relatives of the stut
terers he investigated. Johnson (41) found stuttering to
have occurred four times as often in families of stutterers
as in families of non-stutterers. Recently, however, Aron
(3) noted that her information obtained from stutterers
about stuttering in their families was inaccurate, in that
a number of the stutterers whose parents were interviewed
reported there was no stuttering in their families, but the
parents reported its existence. Nevertheless, it appears
relatively conclusive that there is a higher percentage of
stuttering among families of stutterers than among families
of non-stutterers.
Family Position. Including Twinning
The relation of the stutterer's position in the
family to stuttering incidence appears unclear. Rotter
(68) found significantly more only children and fewer
middle children among 522 stutterers as compared with a
non-stuttering population. Morgenstern (61), however,
noted no significant difference from expected distributions
among 230 11-year-old stutterers in: (a) number of sib
lings? (b) number of older siblings? (c) number of younger
29
siblings; (d) number of first-born; (e) number of last-
born; and (f) number of only-children.
Several years ago Berry (4) noted the possibility
of a common denominator in twinning and stuttering. In a
study of 250 twins she found 1 twin in 11 to be a stutter
er, or approximately 10 per cent. Graf (38) studied 552
pairs of twins from a public §uchool population and found
the incidence among them to be 1.9 per cent. Nelson et al.
(63) studied 200 twin pairs and found stuttering among 20
per cent of the total 200 pairs.
Family Size
The relation of family size to incidence of stut
tering has received relatively little attention by research
ers, and then only somewhat indirectly. As reviewed
previously, Rotter (68) found more "only" children than
expected, thus a smaller family, among the 522 stutterers
he studied. Morgenstern (61) , * however, as stated pre
viously, found no significant difference in number of only
children, or in family size, among the 230 11-year-old
stutterers in his study. In other words, Morgenstern saw
the number of siblings a stutterer has as having had no
part in the child's becoming a stutterer.
30
Home Conditions
Home conditions, including such factors as parental
domination, parental attitudes, and parental standards,
have received considerable attention by various investiga
tors. Wingate (95) recently discussed many of these
studies, relative to reviewing investigations of the imme
diate environment of stutterers. For example, Moncur (58,
59, 60), Glasner (35), Johnson (42), Darley (26), and
Despert (29, 30, 31) reported parents of stutterers to be
domineering, perfectionistic, over-anxious, critical, over-
protective, and high in their standards for their children.
LaFollette (46) found the parents of her stutterer group to
be more submissive than the parents of non-stutterers.
Duncan (32) and Schultz (75) found the parents of stutter
ers to lack affection. Kinstler (43, 44) recently reported
experimental results indicating that mothers of stutterers
reject their children more than they accept them, and do
this on a covert basis. Wingate concluded that there is
fairly impressive agreement among investigators that there
are conditions in the immediate environmental background of
stutterers which might be described as emotionally unsatis
factory or conducive to maladjustment.
31
Family Income and Parent Occupation
Relatively little information has been reported on
the income and occupation of parents of stutterers. How
ever# the small amount of literature on these subjects
suggest that parental occupation may be an important factor
in the incidence of stuttering. Morgenstern (61) found a
significantly high proportion of stutterers whose fathers
were semi-skilled manual weekly wage-earners. He inter
preted this finding as possibly due to a high valuation on
fluency that one might expect from a class he assumed to be
striving for higher status. Schindler (69) noted no sig
nificant difference between the means of her occupational
groups. However, one-third of the stutterers and only
one-sixth of the non-stutterers were in the highest three
occupational levels.
Population Density of Neighborhood
Only one study, Morgenstern's (61), gave data on
dwelling and population density relative to stuttering
incidence. He found stuttering incidence to be negatively
correlated with crowded housing. A significantly high
proportion of his stutterers come from areas having homes
of fewer than one person per room or one and less than
32
two per room, while the more crowded homes produced a
significantly low proportion of stutterers. However, he
found no significant difference between the means of any
two of the three incidences for the areas he studied.
Thus, he concluded that population density has no signifi
cant effect on incidence of stuttering.
Ethnic Composition of Neighborhood
Ethnic factors in incidence of stuttering have re
ceived some attention by researchers. Adler (1) reports
finding no indications relevant to a difference in inci
dence between white and Negro stutterers in the school
population of twenty Tennessee counties. Travis, Johnson,
and Shover (81) surveyed 4,827 children ranging from 4 to
17 years of age in the public schools of East Chicago,
Indiana, of which 2,399 spoke English only while 2,322 were
bilinguals. Significantly more stutterers were found among
the bilinguals than among those speaking only English
(2.80 and 1.80 respectively). However, the investigators
speculated that factors other than the bilingualism, such
as economic insecurity and emotional instability found in
many "foreign" homes, or confusion arising from being
placed in a strange and new environment, may have accounted
33
for part or all of the difference detected. Thus it
appears that the role of ethnic factors in incidence of
stuttering is still unknown.
Sex of the Therapist
Possible differences between the sexes in diagnos
ing stuttering appears to have received little attention by
investigators. However, Bloodstein and Smith (8), in an
investigation concerned with the cause of the sex ratio in
stuttering, had 44 college students, consisting of 22 males
and 22 females, listen to 30 fifteen-second tape-recorded
samples of the spontaneous speech of four- to six-year-old
non-stuttering children and judge whether or not each
sample belonged to a 'btutterer" or a "non-stutterer." He
found that the males tended to make more diagnoses of
stuttering than did the females. Thus it seems that the
sex of the diagnostician may be an important factor to
consider in incidence studies of stuttering.
CHAPTER III
METHODS, TECHNIQUES, AND PROCEDURES
In the spring of 1962, the entire elementary
school population of the Los Angeles City Schools was can
vassed for suspected stutterers by a combination of the
therapist-survey and teacher-referral methods. The
"stutterer-suspects" were further evaluated by elementary
system speech and hearing specialists, commonly called
"speech therapists" in the elementary system. Each thera
pist used the same definition of stuttering and completed
a check list of characteristics of the stuttering according
to specified criteria, in evaluating the suspects. Various
forms for correlative data were completed for each child
identified as a stutterer. The population surveyed and the
specific techniques and procedures used will be discussed in
this chapter.
Population Surveyed
The population of the Los Angeles City Elementary
34
Schools, at the time of this survey, was 318,056 children
in 413 schools, ranging in size from 176 to 1,893. This
included all grades from kindergarten through the sixth
grade. All children attending the schools during this
period were included in the survey. The estimates of
stuttering incidences were based on the total populations
of children enrolled.
Identification of Suspected Stutterers
Identification of suspected stutterers was made in
two ways: (1) by speech therapists who had already iden
tified many of them in regular screening procedures, and
(2) by classroom teachers who were specifically asked to
refer any child they suspected of being a stutterer.
Specifically, "Information on Children Who Stut
ter" letters (see Appendix for all letters and forms used)
were sent to the elementary speech and hearing therapists
by the Elementary Speech and Hearing Supervisor requesting
them to take another look for children who stutter and to
complete an attached form, "Report on Children Who Stutter
giving each child's name, grade, sex, and certain other
information.
In addition, the therapists were gathered together
36
in the presence of the author, by the Elementary Speech and
Hearing Supervisor and requested to: (1) contact each
teacher by note and in person asking them to refer all
suspected stutterers until the end of the spring semester;
(2) complete a check list of characteristics of the stut
tering according to specified criteria and check list
instructions given to them, and (3) complete a "Pupil's
Record" on each stutterer.
Suspected stutterers identified by the above means
were personally evaluated by the elementary system speech
therapists. There were 53 therapists, 44 women and 9 men,
who did the evaluating. Each therapist held, in addition
to the regular teaching credential issued by the State of
California, a special credential in the area of speech and
hearing. The Los Angeles City School System also requires
a therapist to qualify on a personnel examination in speech
for placement on an eligibility list.
The therapists evaluated those suspected stutterers
in the schools to which they were regularly assigned. No
therapist was assigned to more than eight schools, and some
were assigned fewer than that number. The total number of
children in the schools assigned to a therapist ranged from
fewer than 4,000 to more than 9,000; the average was 6,200.
37
Letters and Forms Used
Letters to Principals
Letters were sent to the elementary system princi
pals by the Elementary Speech and Hearing Supervisor in
forming them that the Committee on Research Studies of the
Los Angeles City Schools had approved a research study on
the incidence of stuttering among children in the Los
Angeles City Elementary Schools. The principals were
appraised of their part in the study and their participa
tion and cooperation were solicited. (See Appendix, page
135 for this letter.)
v •
Letters to Teachers
Letters, which included a questionnaire, were sent
to the elementary system teachers informing them that the
speech therapists needed the names of children the teachers
would like to have checked for a stuttering or an articula
tion problem. (The latter was included at the request of
the Elementary Speech and Hearing Supervisor and may have
been of value in finding more stutterers if any teachers
tended to confuse the two problems.) Information concerning
the therapy status of each child listed was also requested.
38
(See Appendix, page 134 for this letter.)
Letters to Speech Therapists
"Information on children who stutter" letters were
sent to the speech and hearing therapists by the Elementary
Speech and Hearing Supervisor informing them of the study
and asking them to take another look in their schools for
children who (1) stutter and are enrolled in speech class;
(2) stutter and are not enrolled in speech class, and
(3) stutter and are in private therapy. (See Appendix,
page 133 for this letter.)
"Report on Children Who Stutter" Form
The therapists were also asked to complete a form
"Report on Children Who Stutter." This form contained
spaces for each child's name, school, grade, sex, birth-
date, type of stuttering (primary or secondary), severity
of stuttering (mild or severe), and therapy status (in
speech class, not in speech class, in private therapy).
(See Appendix, page 136 for this form.)
Criteria and Check List
Instructions Form
The Criteria and Check List Instructions Form
included the following definition of stuttering which all
39
therapists were instructed to use in evaluating the sus
pected stutterers:
Stuttering is characterized by repetitions, pro
longations, or blocks of speech.
Repetitions: Instances where sounds, syllables, or
words are repeated.
Prolongations: Instances where some aspect of speech
is maintained for a longer period of
time than is usual.
Blocks: Instances where the child is unable to
proceed witfi speech.
Further, repetitions, prolongations, or blocks may
be accompanied by body or head movements or facial
grimaces. Some stutterers may stop speaking entirely
if blocks or repetitions occur. The severity of stut
tering is known to vary considerably from person to
person and within the same person from time to time.
Instructions were given for completing the accom
panying check list of characteristics of the stuttering,
for rating stutterers on a severity scale, and for making
additional observations about each stutterer that the
therapist thought was relevant and important. (See
Appendix, page 137 for this form.)
Characteristic Check List Form
The characteristic Check List provided space for
checking whether each of these characteristics— repeti
tions, prolongations, blocks, movements, stops entirely—
40
was present, and for checking the frequency of occurrence
of the characteristic on a five-category scale. The scale
categories ranged from "occasionally or infrequently" to
"on nearly every speech attempt."
A seven-category scale was' provided for rating the
severity of stuttering. Three anchor statements were given
with the scale: top, "This child is a severe stutterer";
middle, "This child is a moderate stutterer"; bottom, "This
child is a mild stutterer." The therapists were instructed
to compare each child with all stutterers they had known.
In addition, space was provided for any special
observations the therapist wished to make about the child
or the stuttering. (See Appendix, page 338 for this form.)
Pupil's Record Form
In addition to the cumulative record maintained by
the Los Angeles City Schools on each child, the Speech
Correction Section of the Division of Elementary Education
keeps a record on each child as to the type of speech
defect, cause of speech defect, handedness, family history,
home conditions, record of physical examinations, report
of psychological examinations, personality traits, report
of progress, and various other information. Much of the
41
correlative data on stuttering used in this study were
obtained from the Pupil's Record. (See Appendix, page
139 for this form.) ■ —
Accuracy Check and Coordination
The author instructed the therapists in the admin
istration of the characteristic check list. Throughout
the data-gathering phase the author maintained close con
tact with the therapists, giving them support and guidance.
To see that the therapists were administering the charac
teristic check lists accurately, the author spot-checked
therapists while they administered check lists. Addition
ally, correlative data were obtained by the author himself,
from teachers, clerical staff, and other school personnel
Handling of the Data
The data obtained from the characteristic check
lists, pupil's record forms, and other sources were trans
ferred to master data sheets, coded, and punched on IBM
cards for analysis. The analysis- plan called for the
cross-tabulation of stuttering incidence by sex, grade
level, and other factors. Having this information on IBM
cards greatly facilitated the analysis. An IBM-101
counter-sorter-printer machine was used for the data
processing.
CHAPTER IV
RESULTS
The results presented in this chapter are based on
318,056 elementary school children, the total number’ * '
enrolled in the Los Angeles Elementary School System at the
time of the survey. The total number of stutterers iden
tified in that group was 1958. Complete information was
not available for all stutterers for correlative data
analyses. In some cases, Pupil's Record Forms were not
available or were not completed, usually because the
therapist did not have the required information. In other
cases, therapists simply did not complete information forms
or made invalid responses that made the forms unusuable.
The percentage bases for the different analyses vary con
siderably. For example, the base for "Other Family Members
^This number excludes 12,048 children enrolled in
special physically handicapped, mentally retarded, and
social adjustment schools.
43
44
Who Also Stutter," was 1139; that is, this information was
available for only 1139 of the 1958 identified stutterers,
and not for the remaining 819.
In each of the analyses that follow, the base for
each percentage is identified. It seems reasonable to
assume, in most cases, that the omissions are random in
character and not related to particular information. In
the example above, there is no reason to suspect that the
missing 819 stutterers would distribute differently on the
other-stutterers-in-family question than did the 1139
about whom the information was available.
Overall Incidence and Incidence by
Sex and by Grade
Overall Incidence
The overall incidence of stuttering among Los
Angeles elementary school children was .62 per cent. Inci
dence among males (1.00 per cent) was about 4.5 times that
among females (0.22 per cent). Table 3 shows the numbers
on which these incidence figures are based.
The overall incidence value is close to incidence
percentages reported by Blanton (.72), Schindler (.55), and
the White House Conference (.70 for ages 5 to 21). It is
45
TABLE 3
INCIDENCE OF STUTTERERS
Sex Population
No.
Stutterers
%
Stutterers
Male 161,507 1614 1.00
Female 156,549 344 0.22
TOTAL 318,056 1958 0.62
lower than percentages reported by Mills and Streit (1.50),
Morgenstern (1.02), Root,_(1.20) and Travis et al. (1.80).
The differences in the incidence percentages are more like
ly the result of differences in methods of identifying and
evaluating stutterers than of actual differences in the
incidence of stuttering. Even though incidence figures
vary among investigators, the percentage of stutterers in
the general population seems to have been remarkably con
stant over the years— close to the often-cited "1 per cent"
figure. Stuttering incidence apparently has not increased,
but neither has it decreased.
Incidence by Sex
The male-female ratio among stutterers obtained in
this study generally confirms the results of other inves
tigators. There are more male stutterers than female, and
the ratios reported vary from 2 to 1 to 10 to 1. The
results here (4.5 to 1) are in close agreement with Mor—
genstern (4.4 to 1), Mills and Streit (5.0 to 1), and
West (4.0 to 1).
Incidence by Grade
The percentage of children who were judged to stut
ter increased from .49 per cent of kindergarten to about
.75 per cent of fourth and fifth graders. There was a
sharp drop in incidence to .64 per cent among sixth grade
children. Table 4 shows the number and percentage of
reported stutterers, by sex, in each grade. Note that the
drop in overall incidence from the fifth to the sixth grade
is due entirely to the drop in incidence among males. The
male-female ratio for the sixth grade stutterers is about
3.8 to 1, somewhat below the overall ratio of 4.5 to 1.
Note also that the male-female ratio for kindergarten is
about 4 to 1. This increases to the maximum ratio for the
third grade, nearly 5.4 to 1, then decreases to the sixth
grade 3.8 to 1. These data suggest that females who are
stutterers begin stuttering at an older age than males,
and perhaps, that their stuttering is more resistant to
therapy or spontaneous recovery.
47
TABLE 4
INCIDENCE BY SCHOOL GRADE
Grade
Male Stutterers
No. %
Female
No.
Stutterers
%
Total Stutterers
No. %
Kind. 204 0.77 48 0.19 252 0.49
First 205 0.79 44 0.18 249 0.50
Second 214 0.87 40 0.17 254 0.54
Third 268 1.18 50 0.22 318 0.71
Fourth 270 1.24 57 0.27 327 0.76
Fifth 256 1.24 54 0.26 310 0.75
Sixth 197 0.99 51 0.26 248 0.64
Total -1614 1.00 344 0.22 1958 0.62
48
Table 5 shows the percentage of reported stutterers
in each grade of the total number of stutterers. About
one-half of the stutterers were in the third/ fourth, and
fifth grades.
TABLE 5
STUTTERERS BY SCHOOL GRADE
Grade No. Stutterers % Stutterers
Kind. 252 12.9
First 249 12.7
Second 254 13.0
Third 318 16.2
Fourth 327 16.7
Fifth 310 15.8
Sixth 248 12.7
The higher incidences observed for these grades
agrees with the results of the White House Conference Study
(as well as the sharp drop in incidence for sixth graders).
But it seems unlikely that there are actually fewer stut
terers in the lower grades; for example, 76 per cent of
these Los Angeles stutterers were reported to have first
stuttered at the age of five or less. The main reason for
"lower" incidence among younger children probably lies in
a reluctance to diagnose them as stutterers. Parents,
49
teachers, and speech therapists, alike, probably adopt a
"wait-and-see" attitude with very young children. For
example, only about 40 per cent of kindergarten and first
grade children are in school speech classes, compared with
about 60 per cent of the older stutterers.
Characteristics Attributed to the
Stuttering
Primary-Secondary Classification
Table 6 shows the percentages, by grade, of stut
terers who were classified as "secondary." (This informa
tion was obtained from the Pupil's Record Form.) A rela
tively high proportion of kindergarten stutterers were
classified as secondary (28.9%); then, following about a
10 per cent drop in first graders, there is an increase in
reports of secondary stuttering to the sixth grade. A much
higher percentage of the older stutterers— fourth, fifth,
and sixth graders— are considered to be secondary stutter
ers by the therapists.
Mild-Severe Classification
The mild-severe classifications, by grade, shown
in Table 7 were also obtained from the Pupil's Record Form.
The kindergarten stutterers and the older stutterers were
50
TABLE 6
PRIMARY-SECONDARY CLASSIFICATION BY GRADE
Grade
No.
Stutterers Primary Secondary
%
Secondary
Kind. 218 155 63 28.9
First 208 169 39 18.8
Second 221 165 56 26.7
Third 283 200 83 29.3
Fourth 282 168 114 40.4
Fifth 266 139 127 47.8
Sixth 214 112 102 47.7
Total* 1692 1108 584 34.4
Classification not available for 266 stutterers.
51
MILD-SEVERE
TABLE 7
CLASSIFICATION BY GRADE
Grade No. Stutterers Mild Severe % Severe
Kind. 211 128 83 39.3
First 212 148 64 30.2
Second 222 164 57 25.8
Third 285 209 76 26.6
Fourth 278 190 88 31.6
Fifth 271 181 91 33.6
Sixth 218 142 76 34.9
Total* 1697 1162 535 32.6
*Classification not available for 261 stutterers.
52
judged to be the more severe stutterers. A much higher
proportion of the kindergarten stutterers as compared with
stutterers in the middle grades were deemed "severe" stut
terers, supporting the notion that very young children have
to manifest relatively severe symptoms to be classified
"stutterers."
Scalar Judgments of Severity
In addition to the mild-severe classification
already made on the Pupil's Record Form, judgments of the
severity of stuttering were also made by the therapists
on a seven-category scale. For the analysis, the cate
gories on the scale were assigned numerical values from 1
to 7, ranging from "mild" to "severe." The data were
analyzed, by grade, in terms of the mean scale values and
the percentage of stutterers judged to be "very severe,"
those in the top two categories of the scale (categories 6
and 7). The therapists tended not to use the extreme cate
gories of the scale, so both categories 6 and 7 were used
for this analysis. The results are shown in Table 8.
The difference in the means among the grades is not
substantial, but it is evident that the mean scale values
are higher for the kindergarten and sixth grades. The
53
TABLE 8
SEVERITY BY GRADE
(SEVERITY SCALE)
Grade No. Stutterers Mean % Verv Severe*
Kind. 220 3.4 23.2
First 218 3.1 16.1
Second 234 3.2 19.7
Third 281 3.0 13.5
Fourth 305 3.2 15.4
Fifth 294 3.2 16.3
Sixth 223 3.4 22.4
Total** 1775 3.2 17.7
*Per cent judged in categories 6 and 7 of severity scale.
**Judgments not available for 183 stutterers.
54
reason for the mean differences observed is evident in the
percentages of those judged "very severe." A considerably
higher proportion of kindergarten and sixth grade stutter
ers, than of the other grades, are judged to be "very
severe." The high proportion of "very severe" judgments
for kindergarten stutterers was not due to a difference in
judgments of therapists. No particular therapist or group
of therapists contributed an unusual number of "very
severe" judgments. The sixth graders, children who have
probably been stutterers for a long time, are likely, in
fact, to be more severe stutterers.
Relative Frequency of Occurrence
of Characteristics
The speech therapists were requested to report on
the presence or absence of given characteristics of stut
tering and on the relative frequency of each characteris
tic. Such information was available for about 95 per cent
of the identified stutterers. The characteristics were
repetitions, prolongations, blocks, movements, and stops.
The data were analyzed, by grade, in terms of the percen-
tage of stutterers in which the characteristic was observed
and the mean frequency the characteristic was observed
"very frequently" (on "most" or "nearly all" speech
55
attempts, categories 4 and 5 of the frequency scale).
Judgments of characteristics, like those of severity, were
made during a period in which the therapist personally
observed the stuttering child.
Tables 9 through 13 shows the results of the char
acteristic judgments; Table 14 shows a summary of the per
centages, by grade, of stutterers who were judged to mani
fest a given characteristic.
First of all, the mean frequency of occurrence of
characteristics does not differentiate much between the
grades. For example, the mean frequency of repetitions
(Table 9) varies from 2.5 (third, fourth, and fifth grades)
to 2.7 (kindergarten, second, and sixth). But the per
centage "very frequent" is quite different, a substantially
higher percentage for the first three grades and the sixth.
Perhaps the most striking result of the frequency
of occurrence data lies in the comparisons of the sixth
grade and kindergarten stutterers. These characteristics
were reported to occur "very frequently" among sixth grade
stutterers: prolongations (26.0%), blocks (28.9%), move
ments (27.7%), stops (23.5%). The same characteristics
among kindergarten stutterers: prolongations (18.2%),
blocks (20.0%), movements (11.9%), stops (27.0%).
56
TABLE 9
REPETITIONS BY GRADE
Grade
No.
Stutterers No. %
Mean
Frecruency
% Very
Frequent^
Kind. 233 197 84.6 2.7 25.9
First 230 204 88.7 2.6 24.5
Second 238 212 89.1 2.7 25.0
Third 303 259 85.5 2.5 17.8
Fourth 315 280 88.8 2.5 17.8
Fifth 301 273 90.7 2.5 19.8
Sixth 235 209 89.0 2.6 23.0
Total^ 1855 1634 88.2 2.6 21.6
♦Per cent judged in categories 4 and 5 of the frequency
scale.
♦♦Characteristic not reported on for 103 stutterers.
57
TABLE 10
PROLONGATIONS BY GRADE
Grade
No.
Stutterers No. %
Mean
Freauencv
% Very
Freauent*
Kind. 233 137 58.8 2.6 18.2
First 230 111 48.3 2.4 17.1
Second 238 114 47.9 2.5 20.2
Third 303 160 52.8 2.5 16.2
Fourth 315 163 51.7 2.4 16.6
Fifth 301 160 53.2 2.4 13.1
Sixth 234 123 52.6 2.6 26.0
Total** 1854 968 52.2 2.5 17.4
*Per cent judged in categories 4 and 5 of the frequency
scale.
**Characteristic not reported on for 104 stutterers.
58
TABLE 11
BLOCKS BY GRADE
Grade
No.
Stutterers No. %
Mean
Freauencv
% Very
Freauent*
Kind. 233 115 49.4 2.4 20.0
First 230 85 36.9 2.3 20.0
Second 238 85 35.7 2.4 16.4
Third 303 126 41.6 2.4 14.3
Fourth 315 132 41.9 2.4 15.2
Fifth 30-1 143 47.5 2.3 12.6
Sixth 235 114 48.5 2.7 28.9
Total** 1855 800 43.1 2.4 17.9
*Per cent judged in categories 4 and 5 of frequency scale.
**Characteristic not reported on for 103 stutterers.
59
TABLE 12
MOVEMENTS BY GRADE
Grade
No.
Stutterers No. %
Mean
Frequency
% Very
Frequent*
Kind. 232 42 18.1 2.3 11.9
First 230 39 16.9 2.4 20.5
Second 238 48 20.2 2.5 20.8
Third 303 61 20.1 2.5 24.6
Fourth 315 87 27 .6 2.2 15.0
Fifth 301 81 26.9 2.4 18.5
Sixth 235 65 27.6 2.5 27.7
Total** 1854 423 22.8 2.4 19.8
*Per cent judged in categories 4 and 5 of frequency scale.
**Characteristic not reported on for 104 stutterers.
60
TABLE 13
STOPS BY GRADE
Grade
No.
Stut terers No. %
Mean
Frecruencv
% Very
Freauent
Kind. 233 37 15.9 2.6 27.0
First 229 19 8.7 2.4 15.8
Second 337 29 8.6 1.8 3.4
Third 303 49 16.2 2.2 10.2
Fourth 314 51 16.2 2.4 21.5
Fifth 301 62 20.6 2.3 16.1
Sixth 235 51 21.7 2.4 23.5
Total** 1852 298 16.1 2.3 17.4
*Per cent judged in categories 4 and 5 of frequency scale.
**Characteristic not reported on for 106 stutterers.
TABLE 14
SUMMARY: CHARACTERISTICS BY GRADE
(Percentage of Characteristics Present)
Grade Repetitions Prolongations Blocks Movements Stops
Kindergarten 84.6 58.8 49.4 18.1 15.9
First 88.7 48.3 36.9 16.9 8.7
Second 89.1 47.9 35.7 20.2 8.6
Third 85.5 52.8 41.6 20.1 16.2
Fourth 88.8 51.7 41.9 27.6 16.2
Fifth 90.7 53.2 47.5 26.9 20.6
Sixth 89.0 52.6 48.5 27.6 21.7
Total 88.2 52.2 43.1 22.8 16.1
a\
H
6 2
The sixth grade stutterers, the older stutterers,
had a relatively high frequency of reported occurrence of
all characteristics. Kindergarteners, the younger stutter
ers, had a relatively high frequency of reported occurrence
of repetitions, prolongations, and blocks; but very low
frequency of movements and very high of stops. These
results suggest that the older stutterer is more likely to
display a wider variety of characteristics, perhaps that
he is "substituting" characteristics. The relatively high
reported occurrence of "very frequent" stops for kinder
garten stutterers probably indicates that this symptom is
important in the diagnosis of stuttering, at least at that
age level.
Table 14, the summary of the presence of character
istics, shows clearly (there are no inversions) that the
order of characteristics of stuttering is (1) repetitions,
(2) prolongations, (3) blocks, (4) movements, (5) stops;
and that this order holds up by grade or age of the
stutterer.
Characteristics Attributed to the
Stutterers
The characteristics attributed to the stutterers
that are considered in this section are the age at
63
stuttering onset, other speech problems, laterality, intel
ligence, personality, social and emotional adjustment, work
habits and academic progress, speech progress, and speech
therapy. Most of the information was obtained from the
Pupil1s Record Form; some from remarks written by the
therapist on the special recording forms provided.
It should be emphasized that the information about
the personality traits and the social and emotional adjust
ment of the stutterers was based on judgments of the
therapists. The therapists were certainly not thoroughly
nor uniformly trained to make such judgments. The results
must be interpreted in light of that fact.
Age at Onset
Information about the age when stuttering was first
observed was available on 230 stutterers. Table 15 shows
these data: the mean age at onset was 4.5 years; the
median, 3.6 years. Some 76 per cent of stutterers began
stuttering at the age of five or younger. Aron had report
ed that stuttering onset coincided with entrance into
school. Apparently, average onset is at a much earlier
age.
64
TABLE 15
AGE AT ONSET OF STUTTERING
Onset Age
(in Years) No. %
2 21 9.1
3
61 26.5
4 55 23.9
5 38 16.5
6 31 13.5
7 13 5.7
8 4 1.7
9 3 1.3
10 2 0.9
11 2 0.9
TOTAL 230
Mean Age at Onset = 4.5
Median Age at Onset = 3.6
65
Other Speech Problems
Table 16 shows the percentage of other speech prob
lems diagnosed among the 1224 stutterers reported on by
the therapists. The most frequent speech problem in addi
tion to stuttering was substitutionss about 20 per cent of
the stutterers also had this problem. Many stutterers
(12.3%) reportedly had a combination of speech problems.
Forty per cent of the stutterers were judged to have an
additional speech problem.
Laterality
About 4.0 per cent of the general population is
left handed (4). Table 17 shows that among the stutterers
in the Los Angeles elementary schools handedness is not
apparently related to stuttering. The 4.9 per cent of
left-handed stutterers is possibly somewhat of an over
estimate: very likely, therapists may not report handedness
on the Pupil's Record Form when there is no particular
reason to do so; that is, when the stutterer is right
handed.
Intelligence
Stutterers in the Los Angeles elementary sOhools,
like other students, are exposed to a variety of measures
66
TABLE 16
OTHER SPEECH PROBLEMS OF STUTTERERS
Problem No. Stutterers %
Substitutions 248 20.2
Combination 151 12.3
Lisp 49 4.0
Infantile Speech 19 1.6
Foreign Accent 17 1.4
Voice 6 0.5
No other problem 734 60.0
TOTAL 1224
TABLE 17
HANDEDNESS OF STUTTERERS
Handedness No. Stutterers %
Right Handed 1073 95.1
Left Handed 55 4.9
TOTAL 1128
67
of intelligence. No fewer than nine different tests of
intelligence were administered to the stutterers at one
time or another. The most frequently administered test was
the Kuhlmann-Andersony it was given to about 37 per cent
of the stutterers. Table 18 shows the kind of test admin
istered to the stutterers and the distribution of test
scores. Both the distribution and the mean test score of
99.3 indicate that intelligence is not a differentiating
measure of stuttering.
Personality Traits
There were a wide variety of adjectives used by the
therapists to describe the personalities of the stutterers.
Table 19 represents an attempt to classify these adjectives,
the descriptions of the stutterers, into "favorable" and
"unfavorable" personality traits. The kind of adjectives
classified as favorable were "cooperative," "friendly,"
"sweet," "lovable," "likable," "outgoing," "happy," "depend
able, " and other synonyms indicating a pleasing personality.
Those classified as unfavorable were "hostile," "lordly,"
"emotional," "withdrawn," "unstable," "irresponsible," and
others indicating an unpleasant personality. The unclass-
ifiable ones were those stutterers who had both favorable
68
TABLE 18
INTELLIGENCE TESTS AND SCORES
Test Name No. Stutterers %
Kuhlmann-Anderson 508 36.9
Detroit First Grade 337 24.5
Stanford-Binet 205 14.9
California Mental Maturity 107 7.8
Public School Primary 64 4.6
Detroit Primary 36 2.6
P intner-Cunningham 19 1.4
Leiter 6 0.4
Wechsler-Children 4 0.3
Test not identified 91 6.6
TOTAL 1377
Test Score No. Stutterers %
60-69 31 2.2
70-79 121 8.8
80-89 255 18.5
90-99 319 23.2
100-109 334 24.3
110-119 182 13.2
120-129 85 6.2
130-139 32 2.3
140-149 10 0.7
150-159 8 0.6
TOTAL 1377
Mean = 99.3
69
TABLE 19
PERSONALITY TRAITS
Trait Classification No. Stutterers
%
Favorable Trait 473 54.1
Unfavorable Trait 387 44.2
Unclassifiable 15 1.7
TOTAL 875
and unfavorable traits reported. It is interesting that
these were less than 2 per cent of all the stutterers (45%)
about whom some comment was made by the therapists.
Apparently, many stutterers~have well-defined "favorable"
or "unfavorable" personality traits.
Table 19 shows that about 44 per cent of the stut
terers who were commented on had unfavorable personality
traits reported. According to the therapists, and the
classification, this fairly large percentage had no re
deeming characteristics. Nothing favorable was said about
them. On the other hand, about 55 per cent had favorable
traits reported. Nothing unfavorable was said about them.
70
Social and Emotional Adjustment,
Work Habits and Academic Progress
The therapists were requested to make any comments
they wished about the stutterers on the special recording
forms for this study. In addition they may have already
made some comments on the Pupil's Record Form. Table 20
shows the results of a classification of some comments on
639 stutterers, about 33 per cent of the total number. In
interpreting this table, it should be kept in mind that,
very likely negative comments are more apt to be made by
the therapists. Thus, almost 50 per cent of the stutterers
commented on were judged to display unfavorable emotional
adjustment. (This is about 16 per cent of all stutterers.)
And about 21 per cent of the stutterers were judged to have
unfavorable academic progress (only about 7 per cent of the
total— probably considerably less than what one would find
among the non-stuttering school population).
Speech Progress
Table 21 shows an interesting result. The speech
progress of about 29 per cent of the stutterers was report
ed by the therapists. Nearly all the stutterers were
reported to be improved, less than 2 per cent becoming
worse. The incidence facts seem to contradict this: the
71
TABLE 20
SOCIAL AND EMOTIONAL ADJUSTMENT, WORK HABITS
AND ACADEMIC PROGRESS
No. Stutterers % *
Social Adjustment
Favorable 282 44.1
Unfavorable 285 44.6
Emotional Adjustment
Favorable 79 . 12.4
Unfavorable 316 49.5
Work Habits
Favorable 111 17.4
Unfavorable 43 6.7
Academic Procrress
Favorable 97 15.2
Unfavorable 136 21.3
*The percentage base is 639 stutterers therapists commented
on.
TABLE 21
SPEECH PROGRESS
Progress No. Stutterers %
Improvement noted 537 94.4
No improvement noted 25 4.3
Stuttering becoming worse 7 1.2
TOTAL 569
72
age at onset and the increase in incidence up to the fifth
grade. More likely, the therapists are doing some wishful
thinking. The need for objective criteria of "improvement"
is evident.
Speech Class Attendance
Attendance in a school speech class increases
fairly systematically from kindergarten to the sixth grade.
The younger reported stutterers (kindergarten and first
grade) tend not to be in a speech class. This is probably
because of the "wait-and-see" attitude discussed earlier.
Table 22 shows that speech class attendance ranges from
about 40 per cent for kindergarten to about 68 per cent
for the fifth grade stutterers. The higher attendance
figures for the older grades may simply reflect limited
facilities for stuttering children. The older stutterers
are undoubtedly considered to be the ones more in need of
therapy.
Family Situation and Socio-Economic
Status
In this section, the correlative data considered
are other stutterers in the family, family position of
stutterers, family size, and home conditions; and socio-
73
TABLE 22
SPEECH CLASS ATTENDANCE BY GRADE
No.
Grade Stutterers
Not in
Speech Class
In School
Speech Class
% In
Speech Class
Kind. 229 137 92 40.2
First 222 126 96 43.2
Second 231 93 138 59.7
Third 292 122 170 58.2
Fourth 305 111 194 63.6
Fifth 285 92 193 67.7
Sixth 227 79 148 65.2
Total*
r
1791 760 1031 57.6
*Speech class attendance not available for 167 stutterers.
74
c<
economic data such as family income, education, population
density, and ethnic characteristics.
Other Stutterers in Family
The incidence of stuttering among other family
members was reported on for about 58 per cent of the stut
terers. About 15 per cent of these reported that some
other family member also stuttered. Table 23 shows that
more than half of these (8%) were siblings. It is evident
that the probability of stuttering in the family of a
stutterer is higher than for the general population.
Family Position of Stutterer
Table 24 shows that family position has no appar
ent relation to stuttering incidence. The general popula
tion data are based on a study of a sample, with corres
ponding error of measurement, so possibly the "only child"
discrepancy is not significantly different. Rotter (68),
who did the study, actually found significantly more only
children among stutterers, a result contradicted by this
study.
It is interesting to note that the reported inci
dence among twins is about 9 per cent (4 twins of 45 had
twins who also stuttered), which seems to agree with
75
TABLE 23
OTHER STUTTERERS IN FAMILY
Other Stutterers No. Stutterers %
Sibling 91 8.0
Father 33 2.9
Mother 25 2.2
Combination 17 1.5
TOTAL OTHER STUTTERERS 166 14.6
No other stutterer 973 85.4
Total 1139
76
TABLE 24
FAMILY POSITION OF STUTTERERS
Stutterer is No. Stutterers % Gen. Pop. % **
Oldest Child 345 24.4 26
Middle Child 493 34.9 36
Youngest Child 389 27.5 26
Only Child 88 6.2 12
Twin 45 3.2
Position not reported 54 3.8
TOTAL 1414
Stutterer has
Twin Brother 34 2.4
Twin Sister 15 1.1
Total Twins* 49 3.5
Other Sibling 1369 96.5
TOTAL 1418
*Four stutterers had a twin who also stuttered and is
included in total number.
**Rotter
77
Berry's (4) reported 10 per cent. But this must be inter
preted in the light of the results for siblings reported in
the previous sections 8 per cent of stutterer's siblings
also reportedly stuttered. There is no evidence in this
study that twinning is related to stuttering.
Family Size of Stutterer
Table 25 shows the reported family size for about
78 per cent of the stutterers. The median family size was
4.8 people. According to the 1960 census, the Los Angeles
city average of 4.2 people for households with at least one
child. Therefore, the conclusion seems to be that Los
Angeles stutterers tend to come from larger than average
families.
Home Conditions of Stutterers
The data shown in Table 26 represent some specific
home conditions commented on by the therapists. About 33
per cent of the stutterers come from a broken home: due to
divorce, separation, or other causes. Only about 24 per
cent of all women 14 years and older in Los Angeles are
separated, divorced, or widowed, according to the 1960
census. Therefore, there appears to be more broken homes
among stutterer's families than normal. About 25 per cent
78
TABLE 25
FAMILY SIZE OF STUTTERERS
No. in Familv No. Stutterers %
Two 40 2.7
Three 109 7.3
Four 346 23.0
Five 358 23.8
Six 246 16.4
Seven 135 9.0
Eight 90 6.0
Nine 49 3.3
Ten or more 130 8.6
TOTAL 1503
Median Family Size = 4.8
79
TABLE 26
HOME CONDITIONS OF STUTTERERS
Condition No. Stutterers %
Familv Cohesion
Both parents at home 641 66.7
Divorce, Separation 281 29.2
Child not with parents 39 4.1
TOTAL 961 100.0
Mother at home 732 75.1
Mother works 243 24.9
TOTAL 975 100.0
Familv Life
Problems in home 545 90.7
Normal home life 56 9.3
TOTAL 601 100.0
of the mothers work. This compares to the census figure of
20 per cent married women who work.
There is a very high reported percentage of
family problems among stutterers (family problems include
such things as a domineering parent, a hostile parent,
generally unsettled home life). Even if it is assumed that
the therapists only record negative things, the percentage
of stutterers of the total number with family problems
reported is about 28 per cent. This is a substantial num
ber of stutterers whose home life is sufficiently bad to be
noted and recorded by the therapists.
Familv Income
Table 27 shows the distribution of median family
incomes for census tracts in which about 85 per cent of
the stutterers lived. These data were taken from the 1960
census for Los Angeles City. The median of $5,860 for
stutterers' families is well below that of $7,800 for the
general population. Perhaps one reason for the lower in
come level is that the occupation of about 11 per cent of
the stutterer's head of household is laborer, compared to
about 4 per cent for the general Los Angeles work force.
81
TABLE 27
FAMILY INCOME
Median Income
(Dollars) No. Stutterers %
0- 1,999 2 0.1
2,000- 2,999 37 2.2
3,000- 3,999 101 6.1
4,000- 5,999 734 44.5
6,000- 7,999 497 30.1
8,000- 9,999 175 10.6
10,000-11,999 65 3.9
12,000-14,999 19 1.2
15,000 + 21 1.3
TOTAL 1651
Median = $5,860
82
Head of Household Education
The data in Table 28 are also taken from the 1960
census. The median education of the stutterer's head of
household is 10.8 years, compared to 11.1 years for the
general population. Stutterer's families seem also to
have somewhat lower educational levels.
Population Density
Table 29 shows the percentage of single-unit
dwellings in census tracts where stutterers live. The
data represent an attempt to determine whether population
density is related to stuttering incidence. Apparently it
is not: based on these figures, about 71 per cent of the
stutterers live in single-unit dwellings, compared to about
60 per cent for the general population. The higher per
centage for stutterer's families may be related to their
larger family size.
Ethnic Composition of Neighborhood
The data in Table 30 represent an attempt to
determine if there is a differential incidence of stutter
ing among two minority groups: Negro and Mexican-American.
The race of the stutterers was not identified by the thera
pists (nor requested); the data in the table are from the
83
TABLE 28
HEAD OF HOUSEHOLD EDUCATION
Median Education
(Years Completed)_____________No. Stutterers______________%
0 - 7.9 45 2.7
8.0 - 8.9 333 20.1
9.0 - 9.9 185 11.2
10.0 -10.4 160 9.6
10.5 -10.9 130 7.8
11.0 -11.4 148 8.9
11.5 -11.9 112 6.8
12.0 -12.4 277 16.7
12.5 -12.9 210 12.7
13.0+ 59 3.6
TOTAL 1659
Median = 10.8
84
TABLE 29
POPULATION DENSITY OP NEIGHBORHOOD
% Single Unit
Dwellina No. Stutterers % Stutterers
0-9 19 1.1
10-19 63 3.8
20-29 67 4.0
30-39 45 2.7
40-49 109 6.6
50-59 101 6.1
60-69 176 10.6
70-79 253 15.2
80-89 353 21.3
90-99 474 28.6
TOTAL 1660
85
TABLE_ 30
ETHNIC COMPOSITION OF NEIGHBORHOOD
% Necrro No. Stutterers % Stutterers
0-9 1079 65.0
10-19 65 3.9
20-29 14 0.8
30-39 52 3.1
40-49 13 0.8
50-59 54 3.3
60-69 103 6.2
70-79 77 4.6
80-89 92 5.5
90-99 112 6.7
TOTAL 1661
Mexican-American
% Mexican
(Based on Surname) No. Stutterers % Stutterers
0-9 951 57.3
10-19 224 13.5
20-29 66 4.0
30-39 137 8.2
40-49 53 3.2
50-59 34 2.0
60-69 70 4.2
70-79 68 4.1
80-89 41 2.5
90-99 17 1.0
TOTAL 1661
86
1960 census for the tracts in which the stutterers lived.
Negroes represent about 7 per cent of the Los Angeles popu
lation; and Mexican-Americans, about 10 per cent.
^ There does seem to be a higher incidence among
Negroes than in the total population. About 7 per cent of
stutterers live in tracts that are almost entirely Negro
(90-99%), which is about the proportional representation.
There are undoubtedly other Negro stutterers from the areas
that have lower proportions of Negro inhabitants. If it is
assumed that the numbers of Negro and non-Negro stutterers
in each tract are proportional, a weighted average for only
the tracts with 60 per cent or more Negroes shows that
about 18 per cent of the stutterers are Negroes (i.e., 65
per cent times 6.2 per cent plus 75 per cent times 4.6 per
cent, etc.). This is much higher than would be expected
from the population representation of Negroes.
The Mexican-American minority, on the other hand,
seems to have a lower incidence of stuttering: only 1 per
cent of the stutterers live in the almost entirely Mexican-
American tracts. However, this seems less clear a conclu
sion than that for the Negroes: the Mexican-American
minority is not as segregated as is the Negro.
87
School Speech Therapists
In this section, the relation of the speech thera
pist to stuttering incidence reported is considered.
First, the total number of children that a thera
pist surveys, or is responsible for surveying, varies con
siderably. Table 31 shows this variation; the median
number of children per therapist is about 6,200.
Second, incidence varies by the sex of the thera
pist. Table 32 shows that incidence reported by the male
therapists was about 2.5 times that of female therapists.
Third, incidence varies considerably among thera
pists, without regard to sex. Table 33 shows a variation
in incidence from less than 0.19 per cent to more than
1.75 per cent. The low and the high figure were, respec
tively, from a female and a male therapist.
Finally, incidence varies by school size. Table 34
shows that the smaller schools (less than 399 students) had
a much higher reported incidence than the larger schools
(more than 1400 students). The reason for this may be that
therapists can do a more thorough survey job in the small
schools and are, perhaps, spread too thin in the larger
ones.
88
TABLE 31
STUDENT POPULATION OF THERAPIST*
No. Children No. Therapists
3,999-under 1
4,000—4,999 14
5,000-5,999 9
6,000-6,999 13
7,000-7,999 8
8,000-8,999 2
9,000-9,999 1
TOTAL 53
Median = 6,200
*The number of schools per therapist ranged from 6 to 8.
89
TABLE 32
INCIDENCE AND SEX OF THERAPIST
Sex of
Therapist No.
Average, No.
Stutterers Identified % Stutterers*
Female 44 33 0.37
Male 9 56 0.94
Total 53
*The percentage bases are the respective school populations
surveyed by the male and female therapists.
TABLE 33
INCIDENCE AND THERAPISTS
% Stuttering Incidence________________________No. Therapists
.00- .19 7
.20- .39 11
.40- .59 14
.60- .79 7
.80- .99 8
1.00-1.24 1
1.25-1.49 2
1.50-1.74 1
1.75-1.99 1
TOTAL 53
91
TABLE 34
INCIDENCE AND SCHOOL SIZE
School Size
No.
Schools
Total
Population
NO.
Stutterers
%
Stutterers
399-under 34 10,775 78 0.72
400-799 193 116,640 722 0.62
800-1099 120 108,526 686 0.63
1100-1399 50 57,144 364 0.64
1400-over 16 24,971 108 0.43
Totals* 413 318,056 1958 0.62
*Less handicapped schools.
CHAPTER V
DISCUSSION
The results of this investigation add substantial
weight to many well-established facts, confirm or contra
dict certain previous indications, and provide some new
and perhaps surprising findings. Such well-documented
facts as an overall incidence of approximately 1 per cent
and a sex ratio of about 4 or 5 to 1 favoring males was
given added emphasis. Indications of an increase in inci
dence among boys by grade, while incidence among girls re
mains relatively constant, as observed in the 1930 White
House Conference survey, was confirmed. Perhaps the most
surprising and unexpected finding was that of male thera
pists making many more diagnoses of stuttering on the
average than did female therapists. These and other re
sults, as they relate to the literature reviewed, are dis
cussed in this chapter.
92
93
Overall Incidence, and Incidence by
Sex and by Grade
Overall Incidence
The overall incidence obtained, although somewhat
below the 1 per cent figure around which incidence per
centages have varied, is remarkably close to the consensus
of the authorities as reflected in their estimate for the
Midcentury White House Conference report (2). The actual
incidence is probably somewhat higher than what was found,
as some difficulties in detection apparently existed,
especially in the larger schools. (This factor will be
discussed later.) As previously pointed out, differences
in incidence percentages also depend on differences in
methods of identifying and evaluating stutterers. The con
stancy of incidence over the years studied suggests
(1) that constant causal factors, physiological or psycho
logical, or both, are operating, and (2) that much of the
work that has been done regarding the prevention and treat
ment of stuttering has been relatively ineffective.
Incidence by Sex
The overall male-female ratio result of 4.5 to 1
agrees remarkably well with previous ratio reports, such as
those of Morgenstern (61) and the 1930 White House Confer
ence, and adds weight to the overwhelming evidence that
more males than females stutter. As observed by Milisen
(55), however, there is some variation in the reported ratio
by grade, and the results of this study show that varia
tion. The variation in the ratio apparently is due to an
increase in incidence of stuttering among boys, as the
reported incidence among girls remains relatively constant.
This seems to indicate, as previously suggested, that girl
stutterers begin stuttering at an older age than boys and,
possibly, that their stuttering is more persistent.
Incidence by Grade
The general agreement with the results of the 1930
White House Conference study (92) regarding an increase in
reported incidence by grade to about the sixth grade, sug
gests that this is a fairly constant finding. As pointed
out in the presentation of the results, it is unlikely that
there is actually that much increase in incidence by grade
or age, but rather, that much of the increase is due to
some reluctance in diagnosing the younger child as a stut
terer and also to the greater chance that the older stut
terer has been well identified. The falling off of
incidence at about the sixth grade suggests that either
stuttering has actually decreased because of therapy or
maturation, or that they are no longer in contact with the
therapist. It is probably an actual decrease in stuttering
incidence, because it is well established that there are
relatively fewer older stutterers in the population. An
interesting aspect about the decrease in reported incidence
from the fifth to the sixth grades, as Milisen (55) has
pointed out, is the fact that it is due entirely to a drop
in incidence among males. The incidence among females
apparently remains relatively constant from about the
fourth grade. It is unclear if this is because a greater
resistance to therapy among females or whether they actual
ly start stuttering at a later age.
Characteristics Attributed to the
Stuttering
Primary-Secondary Classification
The increase in diagnoses of secondary stuttering
to the sixth grade, shown in Table 6, corresponds to the
traditional view that stuttering progresses from a primary
to a secondary stage in development as the stutterer grows
older and the longer the stuttering problem exists. To
96
what extent, if any, this view affected the therapists'
diagnoses cannot be determined from the data. The rela
tively high proportion of kindergarten stutterers classi
fied as secondary is the surprising finding and confirms
Bloodstein's (10) more limited observations of a large
number of secondary or associated features at the earliest
age levels. A contributory factor to consider, however,
regarding the high incidence of secondary stuttering’ diag
noses made among the kindergarten children would be the
general tendency not to diagnose a young child as a stut
terer unless the characteristics of the stuttering are
relatively severe or pronounced. The high incidence of
secondary diagnoses among kindergarten children and the
parallel relation of the primary-secondary classification
system to a mild-severe classification system (to be dis
cussed next) lends weight to the growing contention, such
as Bloodstein's (11), that the primary-secondary classifi
cation system is of questionable value.
Mild-Severe Classification
The miId-severe diagnoses, shown in Table 7, gen
erally parallel the primary-secondary findings and, as
previously pointed out, support the notion that very young
97
children have to manifest relatively severe characteristics
of stuttering to be classified as stutterers. The mild-
severe classification system seemed to result in less con
fusion than the primary-secondary classification system,
apparently due to less difficulty in making a distinction
between mild and severe, as compared to distinguishing be
tween the ambiguous primary and secondary designations.
Frequently, the therapists commented to the investigator
that they were having trouble deciding between primary and
secondary stuttering, as Glasner and Vermilyea (36) had
discovered. In addition, a therapist often classified 'one
stutterer as secondary and mild, and the next one as
primary and severe. Although the mild-severe classifica
tion system seemed easier than the primary-secondary one,
the use of only a two-category system proved to be of
limited value in delineating the severity of stuttering.
Scalar Judgments of Severity
Scalar judgments of severity on a seven-category
scale proved feasible and rendered rather valuable results.
Again, as shown in Table 8, a relatively high proportion
of kindergarten stutterers were judged to be severe. In
fact, a higher proportion of kindergarten and sixth grade
stutterers than of the in-between grades were judged to be
severe. As noted before, kindergarten children apparently
have to be relatively severe stutterers to be even classi
fied as stutterers. The sixth grade stutterers, who have
probably been stutterers for a long time, are, apparently,
in fact more severe stutterers. This seven-point scale
obviously differentiated among stutterers better than did
the two-point mild-severe classification. The scale would
also appear to be more useful in assessing whether stutter
ing has changed as a result of therapy. A nine-point scale,
such as Sherman (76) used, extending from one, for least
severe stuttering, to nine, for most severe stuttering,
might be of even more value if diagnosticians can make the
necessary discriminations among stutterers.
Relative Frequency of Occurrence
of Specific Characteristics
Repetitions were by far the most frequent charac
teristic observed. They were seen at all grade levels, as
shown in Table 9, and appear to be the most significant
characteristic in identifying stuttering. In fact, it is
questionable whether a diagnosis of stuttering would be
made without their presence. They may undergo various
changes as the stuttering problem progresses, as Bloodstein
99
(10) has observed, but apparently still form an important
aspect of the stuttering pattern at the highest grade level
studied. They were observed in nearly 90 per cent of the
sixth grade stutterers. Although there may be some diffi
culty in differentiating between a normal and an abnormal
amount of repetition, excessive repetition apparently is
the most frequent basis for making the diagnosis of stut-
tering, as Wingate (94) has contended.
Prolongations, the so-called "tonic" characteristic
of stuttering, were also observed at all grade levels
studied, as Bloodstein (10) also found. But contrary to
Bloodsteijn' s findings, prolongations apparently were not
judged to be the most typical characteristic of stuttering,
as they ranked a poor second to repetitions in reported
frequency. However, the outstanding fact about these char
acteristics of stuttering is the relatively high frequency
with which they are reported to appear among the youngest
stutterers. In any case, prolongations appear to be an
important characteristic of stuttering, and rank with repe
titions as one of the two most frequent characteristics
reported. It seems, therefore, as Wingate (94) has con
tended, that stuttering is identified primarily on the basis
of repetitions and prolongations, and only somewhat
100
secondarily in terms of other characteristics, such as
blocks, movements, and stops.
Blocks, movements, and stops, in that descending
frequency order, as shown in Table 14, were observed less
frequently than repetitions and prolongations, but were
also seen at all grade levels. A striking aspect of blocks
and stops is their relatively high frequency of occurrence
at the kindergarten level; movements were seen at a very
low frequency among kindergarteners. The relatively high
occurrence of stops observed among kindergarten stutterers,
shown in Table 13, apparently indicates that these charac
teristics are important in the diagnosis of stuttering at
this level. The high frequency with which blocks, move
ments, and stops are seen at the older age levels suggests
that for the most part they are secondary or substituted
characteristics.
Perhaps the most striking aspect of the frequency
of occurrence data lies in the comparison of the sixth
grade and kindergarten stutterers. The kindergarten stut
terers paralleled, although at a lower frequency, the sixth
grade stutterers in the percentage of all characteristics,
except movements, occurring "very frequently." As pointed
out, kindergarteners, the younger stutterers, had a rela
101
tively high frequency of occurrence of repetitions, pro
longations, stops, and blocks reported; but a very low
frequency of movements. The sixth grade stutterers, the
older stutterers, had a relatively high reported frequency
of occurrence of all characteristics. These results sug
gest that the older stutterer is more likely to display a
wider variety of characteristics, as is generally believed,
and perhaps --that he is substituting or associating charac
teristics .
Characteristics Attributed to the
Stutterers
Acre at Onset
Onset of stuttering apparently occurs at an early
age for most stutterers, as Van Riper (85) has observed.
The average age at onset of 4.5 years found in this study,
as shown in Table 15, is very close to what Berry (6)
found (4.8 years). Johnson's (41) observation that most
stutterers start at about 3 years of age is probably fairly
accurate. Aron (3) and others have noted that it is ex
tremely difficult to detect the actual beginning of stut
tering. But it may well be that most stuttering has its
beginnings during the transition from one word responses to
102
meaningful speech, which occurs sometime near 3 years of
age.
Other Speech Problems
The finding that 40 per cent of the stutterers had
an additional speech problem reported is somewhat lower
than the 49 per cent observed by Schindler (69), but still
an apparently significant occurrence of other speech prob
lems among stutterers. As Schindler found, most of these
additional problems involved articulation errors. However,
there was not a large number of voice problems present
among stutterers in this study, as she had found in hers.
Although it is possible, as she pointed out, that some of
the misarticulations may have been integral features of the
stuttering pattern and not significant as independent dis
orders, the fact remains that the percentages of additional
problems reported in both studies were quite high.
Laterality
Handedness does not appear to be related to inci
dence of stuttering among this population. The finding
that 4.9 per cent of the stutterers were left handed is
somewhat higher than the 4.5 per cent for the general
population reported by Berry (4); but also it is probably
103
somewhat of an over-estimate: very likely, some therapists
do not report handedness on the Pupil's Record when the
stutterer is right handed, as there is only a blank space
to indicate those that are left handed. The data do not
reveal whether or not there was any previous change of
handedness. However, these results would appear to contra
dict Bryngelson's findings that stutterers are less likely
to be left handed than non-stutterers.
Intelligence
Both the distribution of the IQ score and the mean
test score of 99.3, as shown in Table 18, indicate that
intelligence is not related to stuttering. Although the
mean is slightly below the mean of the average range, from
90 to 109, as McDowell (51), West (88), and Schindler (69)
also found, the difference is not significant nor does it
suggest that stutterers are below average in intelligence.
Nor do the results support West's and Schindler's findings
of a plurality among the 90-99 group, as most of the stut
terers in the present study were in the 100-109 group. In
addition, the results contradict the belief that stutterers
have to be rather intelligent to have the problem: about 11
per cent of the stutterers had IQ scores below 80.
104
Personality Traits
The percentage (44 per cent) of stutterers reported
with only unfavorable personality traits, no favorable ones,
seems very high (as Adler [1] had also observed), but it is
difficult to affirm with any certainty because of the lack
of comparative data. On the other hand, more than half
(54 per cent) of the stutterers were reported to have only
favorable personality traits. Thus, it appears that the
majority of the stutterers were judged by the therapists to
have predominantly favorable traits. An interesting aspect
of the findings is that less than 2 per cent were reported
to have both favorable and unfavorable traits. Apparently,
most stutterers have well-defined favorable or unfavorable
personality traits; but as Adler (1), Goodstein (37), and
Sheehan (75) have concluded from their review of the re
search, no particular pattern of personality appears to dif
ferentiate stutterers from the general population.
Social and Emotional Adjustment
The stutterers commented on regarding their social
adjustment apparently do not exhibit a predominantly favor
able or unfavorable adjustment, as they are evenly split on
the per cent of favorable and unfavorable comments made.
105
The percentage (44 per cent) judged to have an unfavorable
social adjustment reported seems high, but this may be
because of, in part, the likelihood that unfavorable social
adjustment is more apt to come to the attention of the
therapist. Although, very likely, negative comments about
the emotional adjustment of stutterers are also apt to be
made by therapists, the percentage (49.5 per cent) of stut
terers commented on as displaying unfavorable emotional
adjustment seems high— especially in relation to the low
percentage (12.4 per cent) reported on as having favorable
emotional adjustment. This low figure for favorable emo
tional adjustment is also interesting in view of the much
higher figure for favorable social adjustment (44 per
cent).
Work Habits and Academic Progress
Of the stutterers commented on, more were judged to
have favorable than unfavorable work habits, but more were
also judged as making unfavorable than favorable academic
progress. However, the 21 per cent (only about 7 per cent
of the total number of stutterers) judged as making unfav
orable academic progress is probably less than is the case
among the non-stuttering school population. It is surely
106
less than the percentage of non-stutterers (33 per cent)
that Schindler (69) found to be retarded scholastically.
No real evidence was obtained in the present study for
scholastic standing, however, either to support or refute
Schindler's, or Aron's (3), report of significant scholas
tic retardation among stutterers.
Speech Progress
The overwhelming majority of stutterers reported as
being "improved" seems contradicted by the incidence facts
of an early age of onset, an increase in incidence up to
the fifth grade, and an increase in severity as the problem
progresses. More likely, the therapists are biased by the
stutterers being in therapy, feeling that if the stutterers
are getting therapy they are bound to be improved. In
addition, the therapists could be using some other criteria
for evaluating improvement than what they used for judging
the severity of the characteristics. In any case, the
need for common criteria of severity and improvement seems
evident.
Speech Class Attendance
The systematic increase in attendance in a school
speech therapy class indicates that the older the stutterer
107
and the longer he has the problem, the more likely he is to
be in a speech class. Attendance, then, seems to be re
lated to the severity of the stuttering, although kinder
garten appears to be an exception to this because of the
general tendency not to work directly with the very young
stutterer. It is interesting to note that no more than 68
per cent of the stutterers, at even the highest grade
level, are in a speech therapy class, though the older stut
terers are undoubtedly considered to be the ones more in
need of speech class therapy. Evidently, other factors,
such as limited facilities, limited therapist time, and
priority given to other speech problems, play a part in
determining the number of stutterers at all grade levels
attending a speech class.
Family Situation and Socio-Economic
Status
Other Stutterers in Family
The percentage of stutterers reported as having
some other family member who also stuttered is much lower
than the percentages found by Wepman (87), Nelson et al.
(63), Johnson (41), Freund (34), and West, et al. (91).-—
This perhaps was because of the reliance in this study only
108
on reported instances, not on actual investigation data,
and primarily only on instances among parents and siblings.
The source of the reports in the present study was not
clearr it would probably be of some importance to know, in
view of the fact that Aron (3) found that many of the
stutterers in her study reported there was no stuttering
in their families, whereas their parents often reported its
existence. In any case, it is evident, even from the inci
dence obtained by this study, that the incidence of stut
tering in the family of a stutterer is higher than that for
the general population.
Family Position, Including Twinning
The finding that the stutterer's position in the
family has no apparent relation to incidence of stuttering
confirms Morgenstern1s (61) negative results and contra
dicts Rotter's (68) report of significantly more only chil
dren and fewer middle children among stutterers.
The results regarding twinning, showing no indica
tion that twinning is related to stuttering, seems sur
prising in view of the literature indicating the likelihood
that stuttering occurs relatively more frequently among
twins than non-twins. As pointed out, however, the 10 per
109
cent incidence that Berry (4) found and the 9 per cent
found in this study seems high. But, when considered in
conjunction with the finding that 8 per cent of stutterer's
siblings also reportedly stuttered, there appears to be no
evidence for concluding that there is a significant dif
ference between twins and non-twins relative to stuttering.
Family Size
The finding that the stutterers in this study tend
to come from larger than average families contradicts the
previous report by Rotter (68) regarding more only children
stutterers and the study by Morgenstern (61) showing no
significant difference in family size. Perhaps some other
factor than family size is influencing the incidence of
stuttering in the larger families. However, it remains
that incidence of stuttering apparently does increase with
family size in the Los Angeles area; thus tending to rule
out the possibility that stuttering is due to "pampering"
of an only child such as Rotter has suggested, or to pos
sible increased attention to speech in a smaller family
such as Morgenstern has speculated. The fact that 90 per
cent of the stutterers in this study came from families of
four or more in size seems to fairly well indicate that
stuttering incidence increases with family size.
110
Home Conditions
Conditions in the homes of stutterers apparently
tend to be more undesirable than in the homes of non
stutterers. The findings that there are more broken homes
among stutterers' families, that more of their mothers
work, and that more family problems reportedly exist, such
as a domineering parent, a hostile parent, and an unsettled
home life, suggest that the home conditions are important
in stuttering. The results do nofc reveal which of these
factors is most significant. However, as pointed out, even
if it is assumed that the therapists tend only to record
negative aspects, only 9 per cent reported to have a
"normal" home life seems a significantly low figure. Thus,
the various results of this study appear to lend weight to
the rather impressive findings of previous studies, as re
viewed by Wingate (95), that stutterers tend to come from
unstable home environments.
Family Income and Parent Occupation
The finding of a much lower median income level for
families of stutterers than for the general population,
together with the larger per cent of laborers among heads-
of-households, suggest that stuttering is related to socio-
Ill
economic factors. These findings definitely indicate a
lower socio-economic status for stutterers' families than
is found for the general population, and contradict
Morgenstern's (61) findings of a higher socio-economic
status for stutterers' families.
The lower median education of the stutterer's he.ad
of household and the lower educational levels of the stut
terer's families confirm the general lower socio-economic
level.
Population Density of Neighborhood
Apparently population density of the neighborhood,
or crowded housing, is not positively related to the inci
dence of stuttering. More of the stutterers live in tracts
with single-uriit dwellings than do the general population.
This finding may be related to Morgenstern's (61) results
showing incidence of stuttering to be negatively correlated
with crowded housing; that is, a significantly lower pro
portion of his stutterers came from the more crowded homes.
In the present study the higher percentage for stutterers'
families appear to be related to their larger family size,
as the larger families are more likely to need and live in
single-unit dwellings.
112
Ethnic Composition of the Neighborhood
The results related to ethnic factors seem signifi
cant. Although race data were not obtained directly by the
therapists, the finding that about 7 per cent of the stut
terers came from census tracts almost entirely Negro sug
gests that this percentage would be increased substantially
when the probable Negro stutterers in other tracts are
added to it. These indications are contrary bo what one
would expect on the basis of Adler's (1) negative findings
in this regard. However, the studies are probably not
directly comparable, in that they were done in different
locales, and on a different population with a different
socio-economic structure. Nonetheless, it would be impor
tant to verify the apparent findings of the present study.
Very likely, if a relationship between race and stuttering
is observed, it will be because of the common factors of
socio-economic status and home conditions. The results of
the present study strongly indicate that stutterers tend to
have less than ideal living and home environments. It does
not have to be argued that Negroes have far less than ideal
environments. It would perhaps be surprising if incidence
were not higher among Negroes.
113
School Speech Therapists
Student Population of
the Therapists
The student population that the therapists in this
study were responsible for was considerably greater than
reported by most of the therapists1 in the California Survey
(22), 4000-9000 in Los Angeles, compared with 1000-5000
statewide. In addition, the therapists in the present
study regularly visited from 6 to 8 schools per week as
compared to the 4 to 7 schools per week for most of the
therapists in the statewide study. The greater student
population per therapist and the greater number of schools
visited per week by therapists in the Los Angeles Elemen
tary Schools may suggest that they were covering too much
to be most effective and that, perhaps, this may have
resulted in a lowered overall incidence figure for stut
tering.
Incidence and Sex of
the Therapist
The finding that male therapists identified many
more stutterers on the average than did the female thera
pists seems significant, especially considering that Blood-
stein and Smith (8) had previously noted, in a small study,
114
that their male judges tended to make more diagnoses of
stuttering than did their female judges. The difference
that Bloodstein and Smith found was not as great as the
present finding, however, and may have been due to the fact
that they had lay persons doing the diagnosing. Wingate
(94) has concluded that lay persons identify stuttering
much less frequently than do speech clinicians. A variety
of factors could be responsible for the difference between
the sexes in diagnosing stuttering. For one thing, it may
be that males are less tolerant of fluency irregularities
than females. In any case, this difference could alter
incidence findings considerably, especially in view of the
fact that there is a preponderance of female therapists in
the public schools.
Incidence and Therapists
The incidence variation among therapists seems to
be considerable, and more than one would expect. The data
show a wide variation of about 2.5 per cent, from a low of
less than .19 per cent to a high of more than 1.75 per cent.
Some therapists identified fewer than a half-dozen stutter
ers while other therapists identified more than a hundred.
There seems to be no satisfactory explanation for this
115
variation. It is certainly not accounted for by the total
number of children surveyed. It is true that the very
lowest incidence was reported by a female therapist, and
the very highest by a male; but there was considerable
variation, nonetheless, within sex of the therapist.
These were all qualified, trained therapists, and some of
the therapists showing the widest variation were trained at
the same institution. This is an important difference that
certainly should be studied further.
Incidence and School Size
The finding of a much higher reported incidence of
stuttering for the smaller schools than for the larger
schools was not anticipated from Schindler's (69) negative
findings in this regard. However, most of her larger
schools, the "city" schools, were not as large as were the
larger schools in the present study; thus, her results are
not directly comparable. In the present study the lower
reported incidence from the larger schools appears due to
difficulties in detection of the stutterers. It may be
more difficult, as therapists told the investigator, to
find stutterers in the larger schools because of the in
creased problems involved in such matters as making a
116
personal survey, in communicating with teachers about
stuttering problems, and in receiving referrals from
teachers about suspected stutterers.
1
CHAPTER VI
summary: and implications for
FURTHER RESEARCH
Summary
There is a continuing need for current, descriptive
data regarding speech and hearing problems, especially in
the public schools where the bulk of these problems are
diagnosed and treated. The Los Angeles City public school
system presented an unusual opportunity for obtaining such
data, especially for relatively low incidence speech dis
orders such as stuttering. The primary purpose of the
present study was to determine the overall incidence of
stuttering and incidence by grade and by sex among ele
mentary school children in the Los Angeles system. The
secondary purpose of the study was to obtain information
about correlative factors such as characteristics attrib
uted to the stuttering and the family situatiori'and socio
economic status of the stutterers.
117
118
Literature relevant to incidence studies and the
correlative factors was reviewed and summarized, indicating
an overall incidence of about one per cent with varying
correlative relationships, depending upon the techniques
and criteria of stuttering used. The results of many of
these studies were inconclusive. In addition, many pos
sibly important factors, such as the sex of the diagnosti
cian, had received relatively little attention.
In the present study, the elementary school popu
lation of 318,056 children was surveyed and those suspected
of having a stuttering problem were evaluated by the
school system speech therapists according to specified -
criteria, and reported on regarding the various correlative
factors. Check lists enabled the therapists to rate each
child's stuttering on a severity scale and note the absence
or presence, and frequency of occurrence, of specific
characteristics. Various other forms allowed the thera
pists to provide information about the correlative factors.
The following results were obtained from the study:
A. Incidence:
1. The total number of stutterers identified
was 1958, an overall incidence of 0.62 per
cent, remarkably close to the Midcentury
119
White House Conference estimate of 0.7 per
cent for ages 5 to 21.
2. Incidence varied by grade from 0.49 per
cent in kindergarten to 0.75 per cent in
fifth grade, then dropped to 0.64 per cent
in the sixth grade, fairly similar to the
1930 White House Conference Study results.
3. The overall male to female ratio among the
stutterers was 4.5 to 1, closely agreeing
with the ratio reports from the somewhat
similar studies of Morgenstern (4.4 to 1),
Mills and Streit (5.0 to 1), and West
(4.0 to 1).
B. Characteristics Attributed to the Stuttering:
1. The primary-secondary classifications of
the stutterers showed an increase in the
percentage of secondary classifications
from the first grade (19 per cent) to the
sixth grade (48 per cent); there was a
relatively high percentage of secondary
classifications among kindergarten stut
terers (29 per cent).
2. The percentage of stutterers classified as
120
severe, using only the two categories of
mild and severe, increased slightly from
the first grade (30 per cent) to the sixth
grade (35 per cent); but the highest per
centage was for kindergarten children (39
per cent). Very young children apparently
have to be quite severe stutterers to be
diagnosed as such.
3. Scalar judgments of severity on a seven-
category scale were similar to the mild-
severe classification results, but provided
a more descriptive breakdown for diagnostic
purposes. Kindergarten and sixth grade
stutterers were again judged to be the most
severe stutterers.
4. The characteristics of the stuttering were
observed overall to occur in this order:
repetitions (88 per cent), prolongations
(52 per cent), blocks (43 per cent), move
ments (23 per cent), and stops (16 per
cent). This same order of occurrence was
observed at each grade level: there were
/
no inversions. The reported occurrence of
repetitions varied from the "low" for
kindergarten (85 per cent) to the fifth
grade (91 per cent); prolongations, from
second grade (48 per cent) to kindergarten
(59 per cent); blocks, from second grade
(36 per cent) to kindergarten (49 per cent);
movements, from first grade (17 per cent)
to sixth grade (28 per cent); and stops,
from second-grade (9 per cent) to sixth
grade (22 per cent).
Characteristics Attributed to the Stutterers:
(Information about correlative factors was not
available for all stutterers; the base for each
of the results is shown in parentheses. The
information about personality traits and social
and emotional adjustment was based on the judg
ments of the therapists, essentially untrained
observers in these areas.)
1. The mean age at reported onset of stutter
ing was 4.5 years; the median, 3.6 years.
Some 76 per cent of the stutterers began
stuttering at the age of 5 or younger
About 40 per cent of the stutterers re
portedly had an additional speech problem;
20 per cent of these problems were substi
tutions (N = 1224). This was a lower per
centage of other speech problems for stut
terers than reported in the literature.
Left-handedness reportedly occurred in 4.9
per cent of the stutterers, very close to
the 4.5 per cent for the general population
(N = 1128). Handedness and stuttering
V
incidence are apparently not related.
The mean IQ for the stutterers, as meas
ured by a variety of group and individual
tests, was 99.3. The range was from about
65 to 155 and the distribution was fairly
symmetrical (N = 1377). This result
agreed with that of many investigators who
have found that intelligence and stuttering
are not causally related.
About 44 per cent of the stutterers com
mented on were reported to have only un
favorable personality traits, no favorable
ones. This was about 20 per cent of the
123
total number of stutterers (N = 875). On
the other hand, more than half (54 per
cent) of the stutterers were reported to
have only favorable personality traits.
Thus the majority of the stutterers were
judged by the therapists to have predomi
nantly favorable traits.
6. Almost 50 per cent of the stutterers com
mented on were reported to have unfavorable
"emotional adjustment"; and about 45 per
cent unfavorable "social adjustment." This
was about 16 per cent and 15 per cent,
respectively of the total (N = 639). Only
about 12 per cent were reported to have a
favorable emotional adjustment, whereas 44
per cent were reported to have a favorable
social adjustment.
7. About 21 per cent of the stutterers com
mented on were reportedly making unfavorable
academic progress. This was about 7 per
cent of the total, probably not a signifi
cant number if the percentage of non
stutterers progressing unfavorably is
124
considered (N = 639).
8. The stuttering of about 94 per cent of the
stutterers was reported to have improved
(N = 569). This result seems inconsistent
with the observations of mean onset age
and increased incidence with age. Some
firm criteria of "improvement" are needed.
9. Speech class attendance of the stutterers
increased fairly systematically from kinder
garten (40 per cent) to the sixth grade
(65 per cent) (N = 1791).
Family Situation and Socio-Economic Status:
1. About 15 per cent of the stutterers re
portedly had other stutterers in their
immediate families. Eight per cent of
these other stutterers were siblings
(N = 1139). Incidence among family members
of the stutterers is higher than in the
general population.
2. Neither family position nor twinning among
the stutterers revealed any apparent re
lationships to incidence- of stuttering
(N = 1418).
The median family size of the stutterers
was 4.8, larger than the average of 4.2
people for households with at least one
child (1960 census data) (N = 1503).
A high percentage of "unfavorable" home
conditions was reported. About 33 per cent
of the stutterers came from broken homes,
compared with 24 per cent broken homes in
the population (N = 975). About 25 per
cent had working mothers, compared with 20
per cent in the population (N = 975) and
about 90 per cent were reported to have
"home problems" of various other types
(N = 601).
The median family income for census tracts
in which the stutterers lived was $5,860,
well below the median of $7,800 for the
population, and the occupation of about 11
per cent of the stutterers' heads of house
hold was laborer, compared with 4 per cent
for the population (N = 1651).
The median education of the heads of house
hold for census tracts in which the stut-
126
terers lived was 10.8 years, somewhat below
the 11.1 years for the general population
(N = 1659).
7. About 71 per cent of the stutterers lived
in census tracts predominantly made up of
single-unit dwellings, above the 60 per
cent for the population (N = 936).
8. About 7 per cent of the stutterers lived
in census tracts almost entirely Negro
(90-99 per cent), whereas only 1 per cent
lived in the almost entirely Mexican-
American tracts (N = 1661). Apparently,
incidence is higher among Negroes than
among Mexican-Americans.
E. School Speech Therapists:
1. The total student population a therapist
was responsible for ranged from under
4,000 to above 9,000, with a median of
about 6,200 children. Los Angeles speech
therapists see many more children than do
their counterparts in the rest of the
states the state average is 1000 to 5000
children per therapist.
127
2. Stuttering incidence reported by male
therapists was about 2.5 times that of
female therapists. Most of the therapists
in this study were female. Incidence may
be higher than was observed.
3. Incidence varied among therapists (from less
than 0.19 per cent to more than 1.75 per
cent. This large variability suggests,
again, that incidence may be higher than
observed.
4. Reported incidence in the smaller schools
(fewer than 399 students) was .72 per cent;
reported incidence in the larger schools
(more than 1400 students) was .62 per cent
— about a 16 per cent difference. This
variation is probably because of the dif
ferential work load of the therapists,
those in larger schools see many more
children.
Implications for Further Research
In view of the apparent hesitancy on the part of
the therapists to identify a child as a stutterer at the
kindergarten level, a study should be done among the kinder
garten children, and among pre-school children, to more
accurately determine the actual incidence in this young
age group. This study should not be a complete survey,
where the initial identification of stutterers is usually
made by untrained observers. Rather, a larger sample of
children should be selected from the population, and each
child given a detailed evaluation of his speech by an ade
quately trained speech therapist. Standardized criteria
should be us^d in this evaluation, and the evaluators
should be trained to follow the same procedures. The
result would be a sampling estimate of stuttering incidence
that would probably be more accurate than that from a com
plete survey, such as was done in the present study. It
seems apparent that many stutterers were missed, not diag
nosed as such, in the population of this study.
Considering the unexpected finding that the male
therapists identified many more stutterers on the average
than did the female therapists, a study should be done to
clarify this finding and discover the variables involved.
This could be done by having groups of male and female
therapists observe questionable cases and evaluate them
independently. Each would use the same criteria and make
129
judgments about severity and the characteristics of the
stuttering. This would provide a basis for comparing the
two groups on whether a diagnosis of stuttering was made
and on the judged nature of the stuttering.
There was a wide range among therapists in the
incidence of stuttering reported. The reasons for this
should be investigated. Was it because of differences in
training, because of differences in criteria^used, or per
haps because of the different work loads of the therapists?
A related question concerns the tendency of thera
pists to rate the stuttering of a child in therapy as
"improved." Children in therapy should be rated at period
ic intervals, using standardized criteria of stuttering, to
determine the effectiveness of the therapy. To provide a
control, a comparable group of stutterers not in therapy
should also be rated, using the same criteria, over the
same time period.
The indications of ethnic differences should also
be investigated further, to see if there are significant
differences and, if verified, to determine the factors
responsible for the differences. This is a difficult area
to investigate, because of social attitudes, but it would
be important to find out if ethnic background is related
130
to stuttering incidence. If a relationship were observed,
it would be very likely because of socio-economic factors
and home conditions rather than because of racial or in
herent differences.
A study should be made of the apparent strong rela
tionship between socio-economic factors and stuttering. In
the present study, socio-economic information was obtained
from general census data, not from the families of individ
ual stutterers. In another study, samples of families from
various socio-economic levels should be selected, and then
the family members individually evaluated to determine the
incidence of stuttering by levels.
If the observation of higher incidence among lower
socio-economic levels is verified, then additional studies
should be done to identify the specific factors responsible
For example, is it because of the high proportion of broken
homes, a lack of social and familial responsibility, par
ticular home conditions, or a combination of these?
Other problem areas raised by the results of the
present study that should be further investigated concern
the personality patterns, social and emotional adjustment,
and scholastic achievements of the child stutterer. Is he
actually so much different in these areas than the non-
stuttering child?
AP P END IX
Marcfi 13, 1962
To! Elementary Speech and Hearing Therapists
. From: IMiriam Keslar, Supervisor
Elementary Speech and Hearing
Subject: IN E O R JV L A .T IO N ON CHILDREN W HO STUTTER
A study of the incidence of stuttering in the elementary schools of Los Angeles
City is underway.
Your help is requested.
Will you please "take another look" for children in each of your schools
— — Those children who stutter and are enrolled in speech class.
Those children who stutter and are not enrolled in speech class.
— — Those children who stutter'and are in private therapy.
Will you please complete the attached form and return not later than March 30,
or as soon as completed. -
Your help is appreciated, so "thanks" now for your participation.
MK:rr
Enc.
I
LOS ANGELES CITY SCHOOLS
SPECIAL EDUCATION BRANCH
SPEECH AND HEARING SECTION
Teacher’s N a m e _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Grade
The speech and. hearing therapist needs the following information concerning
children in this school. Please complete this questionnaire and return it to
the office by_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ .
i —1
I would like the following students checked for speech (list names below):
ARTICULATION STUTTERING
W e would also like further information in the area of stuttering. Of the stuttering
children listed above:
a. How many are enrolled in speech class? -
b. How many are receiving private help ? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
c. How many are not receiving help from either source? __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Elem. Sp. and Hearing — 4/62
A p r i l 1 2 , 1 9 6 2
TO:
Fr in cipal
Miriam Keslar, Supervisor
Elementary Speech and Hearing
APPROVED RESEARCH STUDY OF THE INCIDENCE OF
STUTTERING AMONG CHILDREN IN THE ELEMENTARY
SCHOOLS
The Committee on Research Studies has approved a research study on
the incidence of stuttering among children in the Eos Angeles City
Elementary Schools.
Mr. Leo Carroll, a doctoral candidate in the Speech Department of
the University of Southern California, is conducting the research.
Dr. Herbert Popenoe, Chairman of the Committee on Research Studies,
has requested that Mr. Carroll work closely with the Supervisor of
Elementary Speeoh and Hearing, speech correction teachers, and
principals and classroom teachers in the schools.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ , your speech correction teacher,
will he prepared to discuss with you the extent of school cooperation
required. This will include a report of the number of children with
the stuttering problem.
a. Those enrolled in speech class
b. Those in school but not in speech class
c. Those in school who are having private therapy.
Your interest and cooperation with this study will be greatly appreciated.
FROM:
£ SUBJECT:
MK:rr
I
a
m
n
I
8 ?
P a
&S
8 0
iR
Grade
Sex
Birthdate
Primary
Stuttering
Seoondaiy
Stuttering
Mild
*
Severe
-
In
Speech Class
Not in
Speech Class
In Private
Therapy
I
CRITERIA AND CHECK LIST INSTRUCTIONS
Critarla
Please use the following definition in judging whether or not a
given child is a stutterer. The underlined symptoms are the ones we
want you to pay special attention to. You will use these to describe
the behavior of a child you identify as a stutterer.
Stuttering is characterized by repetitions. prolongations. or
blocks of speech■
Repetitions! Instances where sounds, syllables, or words are
repeated.
Prolongations: Instances where some aspect of speech is main
tained for a longer period of time than is usual.
Blocks: Instances where the child is unable to proceed
with speech.
Repetitions, prolongations, or blocks may be accompanied by body
or head movements or facial grimaces. Some stutterers may stop
sneaki ng entirely if blocks or repetitions occur. The severity of
stuttering is known to vary considerably from person to person and
within the same person from time to time.
Check List Instructions
Please complete the symptom check list for each child who you
identify as a stutterer. Indicate whether a given symptom repetitions,
prolongations, blocks, movements, stops speaking entirely is present
or absent and the frequency of occurrence. The determination of
frequency will necessarily be based on your own observations.
We would like also to obtain your Judgment of the severity of
stuttering for each child. This Judgment will represent your overall
impression of how severe a stuttering problem the child has. There
are seven scale positions. Try to compare each child with all
stutterers you have encountered. Assign the child the scale position
you think best describes the relative severity of his stuttering.
Space is provided for any notes or observations you may wish to
make. You may use this space to explain your Judgments about
symptoms and their frequency of occurrence and your Judgments of
severity. Please also note any behavior associated with the stutter
ing that you think relevant and Important, something you may have
observed yourself or has been reported to you by parents, teachers,
or other people; for example, "This child stutters only when address
ing the class as a group, never when in face—to—face conversation.”
If the behavior has been'reported to you, please indicate the source:
SYMPTOM CHECK ElST
Child’s Nan e_
iix am ins I * _____
OJ
co
Svanton
Repetitions
Prolongations
Blocks
UoTenents
Stops entirely
* 1 .
2 .
3 .
4 .
5 .
(Check each symptom)
Pres ent Abs en t
(Circle Appropriate number*)
Frequency
1
1
1
1
1
2
2
2
2
2
3
3
3
3
3
4
4
4
4
4
5
5
5
5
5
Occasionally, infrequently
On some speech attempts
On about half of the speech attempts
On most speech attempts
On nearly every speech attempt
On the basis of your experience with stutterers. Indicate on
the scale below how you would describe this child.
This child is a severe stutterer
This child is a moderate stutterer
This child is a mi IdS stutterer
i
Special Notes.
(Use other side, if necessary)
FORM 27.901 B M 9*97
LOS ANGELES CITY SCHOOLS
DIVISION OF ELEMENTARY EDUCATION
SPEECH CORRECTION SECTION
PUPIL'S RECORD
To be filled out by teacher and treated as confidential.
Sex.................. Nationality......................
Date of Birth...........................................
Occupation of Parent............................
.Telephone.................................................
Name.................. .
Place of Birth....
Name of Parent.
Address...............
School Grade Speech Teacher Room Number
Date of Enrollment Days Present Days Absent
TYPE OF SPEECH DEFECT
Stuttering
Severe........ ...........................................................
SUBSTITUTIONS
Mild.......................................................................'
Defects of Enunciation
Lisping...................................................................
Infantile Speech..................................................
(Baby Talk)
Foreign Accent....................................................
Age a t onset............................................................
139
CAUSE OF SPEECH DEFECT
(Date all notations)
1 Speech defect in father's family..
Heredity j
( Speech defect in mother's family.
!
Physical injury...............................
Shock................................................
Imitation......................................................................
Defective development of the nervous system......
Accompanied by mental retardation..................
Not accompanied by mental retardation...........
Deafness. .............................................................
Paralysis.......................................................................
Cleft Palate................................................................
Left-handed.................................................................
Family History........................................................... .
Home Conditions.
Remarks..
140
RECORD OP PHYSICAL EXAMINATION
(COPY FROM SCHOOL HEALTH CARD)
Symbols— A N"d Attention, grade urgency 1, 2, 3, or 4
1—Slight A—Received attention S—Slight defect
2—Moderate
3—Severe F—Further examination needed
4 —Urgent
Date of
Examination
Name of
Examiner
Nutrition Eyes Ears Nose & Throat
Wgt. Hgt.
Vision
Lids
Hearing
Dis
charge
Ton
sils
Ade
noids
R I R L
■
Teeth Heart
Lungs
Orthopedic
Ner
vous
System
Speech Skin Hair
Endo
crine
Misc.
De
cay
Clean
ing
Gums
Ortho
dontia
Or
ganic
Funct
ional
Chest
Pos
ture
Feet
-
REPORT OF PSYCHOLOGICAL EXAMINATION
Date C. A. M. A. Serial No. Type of Test Dlag.
S
141
PERSONALITY TRAITS
REPORT OP PROGRESS
(Date all notationi)
142
R E FE R E N C E S
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Asset Metadata

Creator Carroll, Leo Sylvester (author)

Core Title An Investigation Of The Incidence Of Stuttering Among Elementary School Children In The Los Angeles City Schools

Degree Doctor of Philosophy

Degree Program Speech

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag OAI-PMH Harvest,Speech Communication

Language English

Contributor Digitized by ProQuest (provenance)

Advisor Perkins, William H. (committee chair), Backer, Carl L. (committee member), McDonagh, Edward C. (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c18-199265

Unique identifier UC11359828

Identifier 6605473.pdf (filename),usctheses-c18-199265 (legacy record id)

Legacy Identifier 6605473.pdf

Dmrecord 199265

Document Type Dissertation

Rights Carroll, Leo Sylvester

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA