The BigCAT: A normative and comparative investigation of the communication attitude of nonstuttering and stuttering adults

Abstract

The purpose of this investigation was to provide normative and comparative data for the BigCAT, the adult form of the Communication Attitude Test, a sub-test of the Behavior Assessment Battery. The BigCAT, a 35-item self-report test of speech-associated attitude was administered to 96 adults who stutter (PWS) and 216 adults who do not (PWNS). The difference in the extent to which the two groups of participants reported a negative attitude toward their speech and speech ability, as measured by the BigCAT, was statistically significant. Moreover, the overlap in the scores of the PWS and PWNS was minimal, and the effect size attributable to group membership was very large. The BigCAT's high Cronbach Alpha coefficients, together with the fact that each of its items significantly differentiated PWS from PWNS, indicate that the BigCAT is an internally consistent measure of the attitude that they have about their speech. Gender did not have a significant influence on the attitude toward speech or speech ability of either the PWS or PWNS. Overall, the present data suggest that the BigCAT holds promise as an aid to clinical decision making that relates to the assessment and treatment of those who stutter.

Learning outcomes: (1) The reader will learn about the BigCAT, a self-report measure of speech-associated attitude. (2) The reader will be given normative and comparative data that relate to the speech-associated attitude of PWS and PWNS as measured by the BigCAT. This will enable the clinician to use the BigCAT data as a useful source of information in clinical decision making that relates to assessment and treatment. (3) The reader will be informed about the internal reliability and content validity of the BigCAT, a gender-free measure of the speech-associated attitude of PWS and PWNS.

Introduction

Over the years, various clinicians, researchers and theorists have challenged the uni-dimensional view that stuttering is a disorder whose assessment and treatment essentially only requires attention to the particular forms of disfluency that notably interrupt the forward flow of speech (Barber Watson, 1995, Conture, 2001, Cooper, 1979, Cooper, 1984, Guitar, 2006, Manning, 2009, Van Riper, 1982, Williams, 1979, Yaruss and Quesal, 2006). In this regard, it has been pointed out that focusing solely on fluency failures, even when specifically limited to certain forms or amounts, or defined in ways that are “considerably elaborated” (Bloodstein & Bernstein Ratner, 2008, p. 2) is not enough to accurately distinguish stuttering from normal disfluency or to differentiate those who stutter from those who do not. Moreover, as Silverman (2004) has pointed out, to define stuttering uniquely in terms of speech disruptions is insufficient because it does “not allow the differentiation between stuttering and other fluency disorders” (p. 11).

Fluency specialists have long noted that, being one who stutters involves more than the presence of speech disruption (Johnson et al., 1956, Sheehan, 1970, Travis, 1957, Van Riper, 1982). From this point of view, stuttering is best seen as a multi-dimensional disorder in which both speech-associated attitudinal and affective reactions, and the coping behaviors of avoidance and escape are vital components (Barber, 1981, Barber Watson, 1988, Barber Watson, 1995, Brutten and Shoemaker, 1967, Brutten and Vanryckeghem, 2003a, Brutten and Vanryckeghem, 2003b, Brutten and Vanryckeghem, 2007a, Conture, 2001, Cooper, 1979, Guitar, 1976, Guitar, 2006, Manning, 1999, Riley, 1994, Smith and Kelly, 1997, Yaruss and Quesal, 2006). This framework was emphasized by Cooper who has said that though “observable speech dysfluencies … [are] an essential element in labeling one a stutterer… the label does not apply unless the dysfluencies are accompanied by feelings, attitudes, and other behaviors characteristic of the stuttering syndrome” (Cooper, 1999, p.10). That is to say, dysfluencies are necessary but not sufficient to fully define the disorder that is stuttering or to make apparent the range of behaviors that characterize one who stutters (Brutten & Vanryckeghem, 2007a).

The recognition that covert attitudinal, affective and behavioral variables all play a significant role in the particular fluency disorder that is stuttering is inherently made clear by the fact that clinicians now commonly refer to the person who stutters (PWS). In part, this is consistent with the position that the disorder that is stuttering relates to more than the presence and frequency of particular forms of disfluency. This change in focus has served to broaden the meaningfulness of the elements that characterize the stutterer to include personal reactions that are not directly observable. In part, too, the change has highlighted the fact that the covert reactions of PWS can serve as secondary causal factors in the development of stuttering and affect the likelihood of improvement (Andrews and Cutler, 1974, Brutten and Vanryckeghem, 2007a, Guitar, 1976, Mildon Stewart, 1982, Neale and Liebert, 1986, Ryan, 1979).

The view that covert reactions can serve to more fully characterize a PWS has led speech-language pathologists to seek ways to augment their clinical observations of the frequency and severity of stuttering moments. To explore the intrinsic features of stuttering (Conture, 2001, Manning, 1999), ones that are experiential in nature (Perkins, 1990) rather than directly observable, clinicians have turned increasingly to the development and use of standardized self-report procedures. These test instruments have provided clinicians with a more extensive understanding of the PWS and stuttering, one that includes a “view from within” (Brutten & Vanryckeghem, 2007a).

Self-report measures that tap into the attitudinal, emotional and/or coping elements that are part of the disorder that is stuttering have been abundant and varied over the years (Ammons and Johnson, 1944, Barber, 1981, Barber Watson, 1988, Brown and Hull, 1942, Johnson, 1952, Shumak, 1955, Woolf, 1967). However, the meaning of some of these test procedures’ results are confounded because both the total score and/or sub-scale scores cut across a mixture of various reactive and behavioral elements (e.g. Lanyon, 1967, Yaruss and Quesal, 2006).

Avoiding the difficulty that can be created by a self-report assessment procedure that is constructed of a molar mix of different reactive and behavioral elements has led to the development of tests and batteries that separately explore the affective, coping and attitudinal reactions that are part of the stuttering disorder and the impact that each of these elements have on a PWS (Barber Watson, 1995, Brutten and Vanryckeghem, 2003a, Brutten and Vanryckeghem, 2003b, Brutten and Vanryckeghem, 2007a). Probably the first of its kind, at least with respect to attitude, was the 39-item Communication Attitude Scale (Erickson, 1969). This scale, which was later refined by Andrews & Cutler (1974) to increase its discriminative power and clinical utility, led to the development of the Erickson S-24. Their research with the S-24 showed that, on average, the attitude that the PWS they sampled had about their speech and speech ability (Mean = 19.22, SD = 4.24) differed by essentially two standard deviations from that of the average PWNS in their control group (Mean = 9.14, SD = 5.38). These findings, and the data from the Andrews & Cutler (1974) investigation which indicated that the S-24 was sensitive to attitude change that resulted from therapy, led to the scale's use in a number of subsequent studies (Guitar, 1976, Guitar and Bass, 1978, Lewis, 1997, Silverman, 1980, Mildon Stewart, 1982). The frequent use of the S-24 in various investigations also reflected the fact that no other normed self-report test procedure was available for singularly assessing the attitude of adult PWS toward their speech and speech ability. However, recently conducted research has brought attention to some of the seeming limitations of the S-24 (Brutten & Vanryckeghem, 2003b). This research evidenced that the responses of PWS to four of its items (1, 6, 9 and 15) failed to correlate with their respondents’ total score. In addition, Brutten and Vanryckeghem noted that item 9 (I am a good mixer) was linguistically out of date and confusing to a number of respondents. These findings, and the need for an un-confounded cognition-based measure of speech-associated attitude set the stage for the present study. Specifically, this investigation was designed to norm and comparatively evaluate the BigCAT (Brutten & Vanryckeghem, 2007b), a tool that has clinically shown promise as a means of assessing the attitude of PWS and PWNS relative to their speech and speech ability.

The BigCAT, like the KiddyCAT and CAT, is an age-specific measure of communicative attitude. Each is a sub-test of the multi-dimensional Behavior Assessment Battery (Brutten & Vanryckeghem, 2007a) that serves to separately evaluate the affective, coping and attitudinal reactions of those whose speech is problematic. The KiddyCAT (Vanryckeghem & Brutten, 2007), designed for use with preschoolers and kindergartners, and the CAT, for assessing the speech-associated attitude of school-age children, have received considerable clinical and research attention (Bernardini et al., 2009, Brutten and Dunham, 1989, Brutten and Vanryckeghem, 2003a, Brutten and Vanryckeghem, 2007a, De Nil and Brutten, 1990, De Nil and Brutten, 1991, Jaksic Jelcic and Brestovci, 2000, Johannisson et al., 2009, Vanryckeghem and Brutten, 1992, Vanryckeghem and Brutten, 1997, Vanryckeghem and Brutten, 2007, Vanryckeghem et al., 2005, Vanryckeghem and Mukati, 2006). However, the BigCAT has, up until now, not been formally researched in order to determine if the attitude of adult PWS and PWNS about their speech differs to a statistically significant extent.

The BigCAT (Brutten & Vanryckeghem, 2007b) was developed as a means of comparing the attitude that adults who stutter and those who do not have about their speech and speech ability. Its 35 items are based on a review of and selection from a carefully compiled list of belief-based statements that PWS have frequently and consistently made about their speech during assessment and treatment sessions that span decades. As one would expect, the BigCAT contains some items that, in one form or another, are found in other test procedures that relate to communicative attitude. However, none of the BigCAT statements make reference to either speech-related affect or coping behaviors of avoidance and escape.

The BigCAT is a trait test whose items cut across speech situations to determine what an individual currently thinks about his or her speech and speaking ability. It is a test procedure that complements both the Speech Situation Checklist (Brutten, 1973, Brutten, 1975, Brutten, 1981, Brutten and Janssen, 1981, Brutten and Vanryckeghem, 2007c), which considers a respondent's self-reported affective reaction and speech disruption in various speech settings, and the Behavior Checklist (Brutten, 1973, Brutten, 1975, Brutten and Vanryckeghem, 2007d, Vanryckeghem et al., 2004), which examines the coping behaviors that one uses as a result of the anticipation or occasion of speech difficulty. Together, these three self-report tests make up the Behavior Assessment Battery (BAB).