Communicative and psychological dimensions of the KiddyCAT

Abstract

Purpose

The purpose of the present study was to investigate the underlying constructs of the Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (KiddyCAT; Vanryckeghem & Brutten, 2007), especially those related to awareness of stuttering and negative speech-associated attitudes.

Method

Participants were 114 preschool-age children who stutter (CWS; n = 52; 15 females) and children who do not stutter (CWNS; n = 62; 31 females). Their scores on the KiddyCAT were assessed to determine whether they differed with respect to talker group (CWS vs. CWNS), chronological age, younger versus older age groups, and gender. A categorical data principal components factor analysis (CATPCA) assessed the quantity and quality of the KiddyCAT dimensions.

Results

Findings indicated that preschool-age CWS scored significantly higher than CWNS on the KiddyCAT, regardless of age or gender. Additionally, the extraction of a single factor from the CATPCA indicated that one dimension—speech difficulty—appears to underlie the KiddyCAT items.

Conclusions

As reported by its test developers, the KiddyCAT differentiates between CWS and CWNS. Furthermore, one factor, which appears related to participants’ attitudes towards speech difficulty, underlies the questionnaire. Findings were taken to suggest that children's responses to the KiddyCAT are related to their perception that speech is difficult, which, for CWS, may be associated with relatively frequent experiences with their speaking difficulties (i.e., stuttering).

Learning outcomes: After reading this article, the reader will be able to: (1) Better understand the concepts of attitude and awareness; (2) compare historical views with more recent empirical findings regarding preschool-age CWS’ attitudes/awareness towards their stuttering; (3) describe the underlying dimension of the KiddyCAT questionnaire; (4) interpret KiddyCAT results and describe implications of those results.

Introduction

Investigators have provided various theoretical explanations for the concepts of “attitude” and “awareness.” Eagly and Chaiken define attitude as one's “propensity to evaluate a particular entity with some degree of favorability or unfavorability” (p. 583).¹ Similarly, Petty, Briñol, and DeMarree, (2007) posit that “attitudes commonly refer to people's evaluations of a wide variety of objects, issues, and people, including the self” (p. 658). According to Eagly and Chaiken (2007), an individual must first be (un)consciously aware of the “attitude object”—or in the present study, stuttering—prior to forming an attitude towards said object. Applying the above considerations to preschool-age children who stutter (CWS), it would be necessary for these children to be aware of their speaking abilities prior to negatively evaluating their stuttering. Furthermore, it is likely that children's awareness of their stuttering might contribute to the formation of negative attitudes towards their speaking abilities.

Although awareness of stuttering and the emergence of speech-associated attitudes in CWS have long been discussed (e.g., Bluemel, 1932, Johnson, 1942), the quantity and quality of children's awareness of their stuttering remain unclear. Some have stated that there is an essential lack of awareness in the early stage of childhood stuttering (e.g., Bluemel, 1932), while others have suggested that awareness may appear sooner for some children, in varying degrees (e.g., Bloodstein, 1960, Yairi and Ambrose, 2005). Yairi and Ambrose (2005) also observed that at the onset of stuttering, “many [children] continue on as before, giving little or no evidence of awareness of it” (p. 270). Bloodstein (1960) noted that “young stutterers [who may be] aware of their blocks…are, by and large, unconcerned about them” (p. 236). Such observations have seemingly led other investigators to focus the study of awareness and attitudes on grade school-age children and older individuals who stutter (e.g., Andrew and Cutler, 1974, Brutten and Dunham, 1989, Erickson, 1969, Yaruss and Quesal, 2008).

Investigators who have explored preschool-age CWS’ awareness of stuttering have shown that children as young as two years of age might exhibit some degree of awareness of stuttered versus fluent speech patterns (Ezrati-Vinacour et al., 2001, Grinager Ambrose and Yairi, 1994). For example, Grinager Ambrose and Yairi (1994) explored awareness of stuttering in 2–6 year-old children who do and do not stutter, matched for age and gender, over the course of two years. Each child was presented with a video recording of identical puppets, differing solely with respect to fluency (i.e., one puppet exhibited fluent speech, while the other exhibited stuttered disfluencies consisting of sound repetitions). In a subsequent awareness task (i.e., “point to the puppet that talks the way you do”), children from both groups were found to accurately identify their speech patterns (i.e., fluent versus stuttered) with those of the puppets’. In other words, these findings suggest that children as young as 2 years of age might be aware of their speech fluency.

In another study of preschoolers’ development of fluency awareness (Ezrati-Vinacour et al., 2001), typically fluent 3–7 year-old children were presented with two physically identical puppets, with one exhibiting fluent speech and the other exhibiting stuttered disfluencies (i.e., sound/syllable and monosyllablic word repetitions, blocks, and prolongations). Participants engaged in a number of awareness tasks using these puppets, including fluency discrimination (i.e., “Do the puppets talk in the same way?”), identification (i.e., “Which puppet talks like you?”), labeling (what is this type of speech called?), and evaluation (“Is this talking good or not good?”). Findings indicated that children who do not stutter (CWNS), as young as 3 or 4 years old, are apparently aware of stuttering.

The above findings seem to suggest that at least some preschool-age children are aware of stuttering, whether it is present in their own or others’ speech. Thus, given Eagly and Chaiken's (2007) theory of awareness and attitude formation (i.e., one must first be aware of an object/entity prior to forming attitudes towards that object/entity), one reasonable means to begin studying the association between awareness, attitudes, and stuttering in CWS is by empirical assessment of their speech-related attitudes.Vanryckeghem and Brutten (1997) investigated speech-associated attitudes of 6–13 year-old CWS and CWNS (n = 55 per talker group), and reported that CWS, as young as 6 years of age, exhibit significantly more negative attitudes towards their speech than CWNS. Therefore, Vanryckeghem, Brutten, and Hernandez (2005) hypothesized that negative speech-associated attitudes would appear earlier (i.e., preschool-age children, younger than age 6).

To date, however, there have been few reported studies of preschool-age CWS’ attitudes beyond anecdotal/parental reports or observations (e.g., Gillam et al., 2009, Johnson, 1942). Although parental reports are often the primary source of information regarding their preschoolers’ speech-associated attitudes, Vanryckeghem (1995) reported weak correlations between parents’ and their school-aged children's scores on the Communication Attitude Test (CAT; Brutten, 1985, De Nil and Brutten, 1991). Vanryckeghem and Brutten (2007) interpreted this result as parental perceptions of their children's attitudes toward speech “reflect[ing] their own attitude about their offspring's speech disorder, rather than…that of their children” (p. 3). Given these findings, it seemed appropriate to explore other means for assessing attitudes of young children who stutter.Hence, Vanryckeghem and Brutten developed the Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (KiddyCAT; Vanryckeghem and Brutten, 2007, Vanryckeghem et al., 2005). The KiddyCAT is a twelve-item, yes/no response questionnaire, designed to obtain 3–6 year old children's self-reported “cognitive data about the belief system”—interpreted as “attitudes”—regarding their speech abilities (Vanryckeghem & Brutten, 2007). A higher score (out of 12) on the KiddyCAT suggests greater negative attitudes towards one's speech.

In their study of the KiddyCAT, Vanryckeghem et al. (2005) reported that preschool-age CWS scored significantly higher on the KiddyCAT than their peers who do not stutter. Based on these results, the test developers speculated that CWS are more likely to demonstrate negative attitudes toward their speaking abilities than preschool-age CWNS, and that the KiddyCAT has the potential to “validly distinguish between” the groups (Vanryckeghem & Brutten, 2007). They further postulated that “attitude is inextricably tied to awareness. This suggests that the negative belief that CWS have about their speech is related to an internally and/or externally derived awareness of reactions to the way they talk” (p. 314).

To the present authors’ knowledge, the KiddyCAT is currently the only assessment tool of its kind, developed specifically for preschool-age children known or suspected to be stuttering. Given its utility, this instrument is becoming more widely used by researchers and clinicians to assess preschool-age CWS’ attitudes toward talking, beyond parental reports. Therefore, it seems important to better understand what dimensions are embedded in the test items to help us more comprehensively interpret KiddyCAT results. At present, however, our understanding of the underlying dimensions is less than fully developed. For instance, although the test was based on the notions of awareness and attitude as “reactive aspects” of stuttering (Vanryckeghem & Brutten, 2007), and attitude as an extension of beliefs (Vanryckeghem and Brutten, 2007, Vanryckeghem et al., 2005), there are no studies showing how these concepts might be linked to KiddyCAT test items.

The purpose of the present study was, therefore, to assess CWS’ and CWNS’ KiddyCAT responses to better understand the possible contributions of communicative and psychological processes to childhood stuttering. This was accomplished by the collection of KiddyCAT responses of preschool-age CWS and CWNS, and applying a categorical data principal components factor analysis (CATPCA). Factor loadings were thought to help clarify some of the underlying constructs of the KiddyCAT and possibly reveal differentiating response tendencies of CWS when compared to CWNS.

We formulated three testable hypotheses. Our first hypothesis was that, overall, CWS will score higher on the KiddyCAT, indicating more negative speech-related attitudes, than CWNS. Our second hypothesis was that multiple factors will be extracted from the KiddyCAT test items. That is, each factor may reflect or be associated with the child's perception of a different facet related to his/her speech-language planning or production. For example, the KiddyCAT item “Do people like how you talk?” may target awareness of social/communicative situations, whereas the item “Do words sometimes get stuck in your mouth?” may target awareness of speech production. Our third hypothesis was that preschool-age CWS and CWNS would respond differently to the underlying test dimensions of the KiddyCAT, as indicated by differences within each of the talker groups’ individual factors (e.g., in terms of the number and/or type of items retained). Empirical support or refutation of these hypotheses should further our understanding of possible communicative or psychological processes that underlie children's reponses to the KiddyCAT.