Elsevier

Journal of Fluency Disorders

Volume 42, December 2014, Pages 13-20
Journal of Fluency Disorders

Short communication
Extraversion and communication attitude in people who stutter: A preliminary study

https://doi.org/10.1016/j.jfludis.2014.08.001Get rights and content

Highlights

  • The personality trait extraversion is correlated with the communication attitude in people who stutter.

  • Extraversion correlated with a more positive communication attitude in people who stutter.

  • Introversion correlated with a more negative communication attitude in people who stutter.

  • The Erickson's Communication Attitude Scale (S-24) is sensitive to a person's degree of extraversion.

  • The use of a personality test is recommended in multidimensional diagnosis of stuttering.

Abstract

Purpose

The aim of the study was to determine the correlation between the personality trait extraversion and the communication attitude in people who stutter (PWS).

Method

Thirty PWS completed Erickson's Communication Attitude Scale (S-24) (Andrews & Cutler, 1974) as well as a Dutch adaptation of the extraversion scale of the NEO Five-Factor Inventory (Hoekstra, Ormel, & Fruyt, 1996).

Results

The communication attitude scores correlated significantly with the extraversion scores: PWS with a more negative communication attitude were more introvert and PWS with a more positive attitude were more extravert.

Conclusion

This result suggests that the S-24 is not only sensitive to communication attitude in relation to speech impairment, but also to the respondent's degree of extraversion. Consequently, assessment of communication attitude needs to be re-thought so as to take personality factors into account.

Educational

Objectives

Readers should be able to: (a) describe the difference between temperament and personality; (b) describe what the S-24 Communication Attitude Scale measures in PWS; (c) describe how the personality trait extraversion may influence the communication attitude in PWS; (d) describe how the extraversion scale is correlated to the communication attitude scale according to the authors of this article.

Introduction

In many stuttering therapy models, both personality and temperament are seen as factors that co-determine the development of stuttering. Well-known examples of such models are the Demands and Capacities Model (Starkweather, 1987), the Dynamic multifactorial model (Smith, 1999), The Nine-component model (Riley & Riley, 1980) and the Erasmus four-component model (Stournaras, Bazen, Bezemer, & Borselen, 1980). Several authors studied the influence of temperament or personality factors on stuttering (Bloodstein & Bernstein Ratner, 2007, Chap. 7; Conture, 1990, Guitar, 2006, Chap. 1). Temperament and personality are closely related, but are not the same. Temperament is described as a congenital and stable construct, which does not change in the course of life, while personality is the result of the interaction between environmental influences during childhood and the stable temperament (Anderson et al., 2003, Caspi, 1998, Costa and McCrae, 2001). Cloninger, Svrakic, and Przybeck (1993) describes personality as the result of temperament and character, where character traits are more conscious, less automatic and more influenced by environment.

Regarding the emergence of stuttering in children, temperament has been argued to be a critical factor in many studies (Guitar, 2006, Chap. 1; Kagan et al., 1987, Kefalianos et al., 2012). Because the present study focused on adults, the relationship between personality and stuttering was studied. Studies comparing personality profiles of people who stutter (PWS) and people who do not stutter (PNS) have generally not found consistent results. Several studies showed that PWS are not different in their personality characteristics from PNS (for detailed review, see Bloodstein & Bernstein Ratner, 2007, Chap. 7; Manning and Beck, 2011, Manning and Beck, 2013). Other studies however, show specific personality differences between PNS and PWS (Bleek et al., 2011, Iverach et al., 2010). For example, Iverach et al. (2010), using the five-factor model of personality, found that PWS are characterized by higher Neuroticism, and lower Agreeableness and Conscientiousness, than PNS. Bleek et al. (2011) replicated this study with a better matched control group. Their findings also showed higher Neuroticism in PWS, but, in contrast to Iverach et al. (2010), they found higher Agreeableness and Conscientiousness in PWS, compared to PNS. Montag, Bleek, Faber and Reuter (2012) investigated the influence of a certain gene (DRD2 C957 polymorphism) on neuroticism in PWS. One of the variants of this gene is associated with higher neuroticism. Another case-control study had associated this gene with a vulnerability for developing speech disorders, such as stuttering (Lan et al., 2009). Thus, this type of gene is associated with neuroticism in PWS and therefore emphasizes the relation between neuroticism and stuttering. However it is not clear whether neuroticism is the cause or the consequence of stuttering.

Differences in personality might lead to interindividual differences between PWS, e.g. in stuttering severity, or in their emotional and cognitive reactions to stuttering. Bleek et al. (2012) investigated such interindividual differences in personality between PWS. They investigated the adverse impact of stuttering on a person's life. One hundred twelve PWS completed both the NEO Five-Factor Inventory (Costa & McCrae, 1992) and the Overall Assessment of the Speaker's Experience of Stuttering (OASES) (Yaruss & Quasal, 2006). They found a strong positive correlation between scores on the Neuroticism scale and scores on the OASES, and a negative correlation between Extraversion scores and the OASES scores. These results indicate that high Neuroticism, i.e., a tendency to experience negative emotional states (Costa and McCrae, 1992, Hoekstra et al., 1996), as well as low Extraversion (the tendency to be enthusiastic, assertive and gregarious), are associated with a more adverse impact of stuttering on PWS’ everyday life than low Neuroticism and high Extraversion.

In the light of the findings of Bleek et al. (2012) it is possible that personality traits such as extraversion also interact with the attitude towards communication in PWS. An extravert person is assertive, active and more talkative and will possibly have a more positive attitude towards communication than a more introvert person, who is more quiet, reserved and introspective (Costa and McCrae, 1992, Hoekstra et al., 1996). Since communication attitude is considered an important aspect of stuttering and is given a prominent place in stuttering interventions, it seems relevant to investigate how this trait interacts with a person's degree of extraversion.

Many studies have shown that PWS have a more negative attitude towards communication than PNS. PWS avoid speaking and avoid situations where speaking is expected (Bloodstein & Bernstein Ratner, 2007, Chap. 7). Quesal and Shank (1978) showed that people with voice or articulation difficulties have a more negative communication attitude than unaffected speakers, but PWS were found to have significantly stronger negative attitudes than people with voice or articulation difficulties. Cox, Seider, and Kidd (1984) established that PWS scored more negatively on communication attitude than recovered PWS, non-stuttering relatives, and typically fluent comparison speakers. These results suggest that stuttering correlates with a negative communication attitude. However, the direction of causation between communication attitude and stuttering remains unclear; a negative attitude can be a risk factor in stuttering, but it can also be a consequence (Brutten & Vanryckeghem, 2003). Brutten and Vanryckeghem (2003) suggest that PWS develop negative communication attitudes in response to their stuttering and to the negative reactions from their environment to their stuttering. These negative experiences lead to negative emotions and thoughts, which are often the reason for avoiding particular speech situations or particular words.

In all studies mentioned here, communication attitude was measured with the same instrument, namely the Erickson's Communication Attitude Scale (generally known as ‘S-24’; Andrews & Cutler, 1974), which is also used in the current study. It is a questionnaire that measures the ideas and beliefs of PWS regarding different kinds of situations where oral communication is required. A negative attitude refers to more negative ideas and beliefs in respect to oral communication (Andrews & Cutler, 1974). The S-24 is one of the best-known diagnostic instruments in stuttering treatment and research. Langevin and Kully (2003) emphasize the importance of S-24 results for the indication of the direction for general treatment. For example, PWS with a low score on the S-24, referring to a positive communication attitude, may need less of the cognitive-behavioural component of treatment, comparing to PWS with a high score on the S-24. The questionnaire is also used as an instrument to evaluate treatment success. It can be used to measure the effect of stuttering treatment on the communication attitude of PWS; Irani, Gabel, Daniels, and Hughes (2012) concluded that the communication attitude of PWS became more positive as a result of their stuttering therapy.

It appears that the studies mentioned above were done on the premise that the S-24 (Andrews & Cutler, 1974) is specifically sensitive to the communication attitude in connection to stuttering. This premise, however, has to the best of our knowledge not been verified. Thus, it is conceivable that communication attitude differences reported in the literature are related to factors independent of stuttering, for instance personality. Brutten and Vanryckeghem (2003) suggested that stuttering severity is sufficient to explain differences in communication attitude among PWS. A discriminant analysis based on their normative data showed that 87.5% of their PWS norm group was discriminated correctly. From the PNS subgroup 91.61% was discriminated correctly. The reason why 12.5% of PWS and 8.39% of PNS is not identified as such, remains unclear, but this result indicates that stuttering severity can not be the only factor underlying interindividual differences between PWS. Such variations may also be influenced by personality differences (which, in turn, may impact communication attitude). With respect to coping strategies in daily situations extraversion is a relevant personality trait. People who are more extraverted experience a less adverse impact of stuttering on their everyday life (Bleek et al., 2012). Since communication is an important element of daily life situations, the communication attitude of PWS possibly also interacts with extraversion. As mentioned above, extravert persons are more assertive, active and more talkative. A more positive attitude towards communication as compared to introvert people may be a consequence. The present study focused on the relation between extraversion and communication attitude, as the two constructs appear to overlap in their denotation.

Recent research has established that individual personality profiles can be reliably differentiated on the basis of five dimensions (Cox, Borger, Taylor, Fuentes & Ross, 1999). This is the so-called Five Factor Model (FFM) of personality, which was originally proposed by Fiske (1949). The dimensions are Openness, Conscientiousness, Extraversion, Agreeableness, and Neuroticism. In stuttering research, neuroticism and extraversion appeared to have the strongest correlation with stuttering (Bleek et al., 2012, Montag et al., 2012, Yaruss and Quasal, 2006). In this study extraversion is the dimension of interest. Extraversion – Introversion is a contrast based on sociability, excitability, dominance, assertiveness and emotional expressiveness. Extraverts are more assertive, active and talkative than introverts. They enjoy excitement, are positive-minded, energetic and optimistic. They are alert and focused on their environment. Introverts, on the other hand, are detached, more independent and thoughtful, and they appreciate being alone. They are more focused on their own feelings and thoughts than on their environment (Costa & McCrae, 1992).

Thus, an introvert person may talk less than an extravert person–and may like talking less (Costa & McCrae, 1992). Regarding stuttering, it has so far not been established if there is a difference between introvert PWS and extravert PWS considering their communication attitude. It would, however, seem important to do so, with the aim to determine to what degree communication attitude in PWS co-varies with personality traits. This would seem relevant for a careful interpretation of the S-24 results (Andrews & Cutler, 1974) of PWS, and, consequently for the determination of therapy goals that are reasonable. In the end this could lead to a more positive outcome of the intervention.

It should be noted that there is no a priori reason to suspect that PWS are, on average, different from PNS with respect to the distribution of extraversion scores. As stated before, studies comparing the personality profiles of PWS and PNS have generally not found consistent results (Bleek et al., 2011, Iverach et al., 2010, Manning and Beck, 2011, Manning and Beck, 2013). Thus, we expect to see a distribution of extraversion scores in PWS that is similar to what is found in the population at large.

The aim of the present study was to determine if and to what extent communication attitude scores co-vary with the personality dimension extraversion. The purpose was to better understand the influences of personality aspects in PWS to further improve their stuttering treatment. A preliminary question to answer, before we could answer our main research question, was:

  • Is the distribution on the extraversion-introversion scale amongst PWS different from that in the general population?

The expectation was to find no differences from the general population in this respect, because stuttering does not influence personality directly. Our main research question was:

  • Is there a significant correlation between extraversion and the S-24 (Andrews & Cutler, 1974)?

It was expected that the extraversion scores and the S-24 scores are correlated. A positive communication attitude was expected to predict a high score on extraversion and a negative communication attitude was expected to predict a low score on extraversion.

Section snippets

Participants

The present study used data of 30 PWS (23 men; 7 women). These 30 were a subset of 79 PWS who were taken in at the Erasmus University Medical Center (EMC) for stuttering treatment from 2007 up to 2010. All of these people were chronic PWS and visited the EMC on their own initiative; their ages at the time of the intake ranged from 16 to 65 years. The educational level of the participants varied from high (University) to low (in the Netherlands: VMBO, i.e. basic vocational training). In March

Extraversion amongst PWS as compared to the general population

The mean extraversion score in the current sample of PWS was 156.4, with a standard deviation (SD) of 24.7. The mean extraversion score obtained in a random sample of 672 individuals considered representative for the Dutch population is 152 (SD = 19; Hoekstra et al., 1996). This norm group was not screened for stuttering or other speech/language difficulties. A t-test shows that these means do not differ significantly (t = 0.96, p = 0.35, two-tailed). Thus, there is no reason to suspect that the

Discussion

The question addressed in this study is if communication attitude in PWS co-varies with extraversion. It is important to address this question because the S-24 (Andrews & Cutler, 1974), which is widely used in the assessment of PWS, measures communication attitude, and it has so far not been established if personality is possibly an interacting factor. In this study the mean extraversion score of the participants was equal to that of the general population, as was hypothesized. This indicates

Financial Disclosures

Lottie-Willianne Stipdonk, Frank Wijnen, Jan Bouwen and Arno Lieftink did not disclose any relevant financial relationships used in support of the research reported in this article.

Non-Financial Disclosures

Lottie-Willianne Stipdonk, Frank Wijnen, Jan Bouwen and Arno Lieftink did not disclose any relevant non-financial relationships used in support of the research reported in this article.

Acknowledgements

The authors express their sincere appreciation to the participants of the present study; their contribution was invaluable.

Lottie Stipdonk is currently working at the Ear-Nose-Throat department of the Erasmus Medical Centre in Rotterdam as a clinical language, speech and hearing pathologist and as a clinical researcher. She earned her master's degree from Utrecht University and graduated on the subject of the current article.

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