_______________________________________________________________

_______________________________________________________________

Report Information from ProQuest

February 24 2014 06:18 _______________________________________________________________

24 February 2014

ProQuest

Table of contents
1. MMPI-2/A ASSESSED PERSONALITY DIFFERENCES IN PEOPLE WHO DO, AND DO NOT, STUTTER........................................................................................................................................................

24 February 2014

ii

ProQuest

Document 1 of 1

MMPI-2/A ASSESSED PERSONALITY DIFFERENCES IN PEOPLE WHO DO, AND DO NOT, STUTTER
Author: Treon, Martin; Dempster, Lloyd; Blaesing, Karen ProQuest document link Full text: Headnote The Minnesota Multiphasic Personality Inventory (MMPI-2 and MMPI-A) was administered to 60 subjects who stutter (SWS) and to 60 matched subjects who do not stutter (SWNS). Computer scored results indicate a statistically significant (p = .017) greater average tendency toward psychosocial-emotional disorder in SWS than in SWNS. Also, mean T-scores in 24 of the 93 scales/subscales assessed were statistically significantly higher for SWS than for SWNS, especially in personality characteristics related to schizophrenia, depression, healthy concerns-somatic complaints, psychasthenia, anxiety-fearfulness, and self-doubt/self-depreciation. Overall, these findings tend to support the tendency toward psychopathology (TTP) pole of the etiologic bipolar stuttering threshold hypothesis (Treon, 1995, 2002). In accord with this hypothesis, average MMPI-2/A T-scores for SWS were within the normal range of psychosocial-emotional functioning. Headnote Keywords: stuttering, stutterers This study was an attempt to empirically test a specific hypothesis (i.e., the tendency toward psychosocialemotional disorder pole of the bipolar stuttering threshold hypothesis) in relation to its possible role in developmental stuttering etiology. By way of background, there exists a long and rich history of theory formulation and empirical study of possible etiologic, maintaining, and/or precipitating stuttering behavior factors dating from the early part of the twentieth century to the present time. This theoretic formulation and experimental research history and its etiologic implications for stuttering have been documented, reviewed and summarized by - among others - Bloodstein (1995), Conture (2001), Gregory (2003), Guitar (1998), Manning, (2001), and Silverman (2004). All of these authors, by either implication or direct assertion, appear to agree (with minor exceptions) that in relation to tendency toward psychosocialemotional disorder and personality profile, adult people who stutter (PWS) do not, on average, greatly (if at all) differ from adult people who do not stutter (PWNS). They also appear to be in general agreement that the preponderance of empirical evidence reviewed in their respective overviews suggests that, on average, PWS fall within the normal range of psychosocial-emotional functioning and adjustment, that is to say they do not - on average - have clinically defined neurotic, borderline, or psychotic psychopathology. However, Bloodstein, in his concluding remarks concerning the data he reviewed, sees justification for saying that at least adult PWS on average ". . . are not quite as well adjusted as are typical normal speakers." (p. 236), and tend to have lower self-esteem and greater risk aversion than do PWNS. In agreement with Bloodstein's comment above, Dahlstrom and Craven (1952), in a study using the original MMPI with one hundred matched college students who did - and did not - stutter, found that the stuttering students were, on average, slightly less well adjusted, and most resembled students who had applied for counseling with personal problems. Finally, the above six authors, by either implication or direct assertion, appear to agree that - overall - the empirical evidence relevant to psychosocial-emotional disorder (psychopathology) as a major factor in the etiology of stuttering is often contradictory, inconclusive and, in short, not substantially supported. Psychosocial-emotional disorder is generally considered to emerge developmentally from an individual's primarily genetically based temperamentreactivity tendencies (Bates, 1989) interacting with his or her environmental, especially early environmental, experiences (American Psychiatric Association, 2000; National Institute of Mental Health, 2003). Over the past seventy-five or so years there have occurred many and varied 24 February 2014 Page 1 of 17 ProQuest

formulations, speculations and hypotheses asserting a psychopathology role in stuttering etiology (Bloodstein, 1995; Van Riper, 1971). Many of the psychological factors presented in these formulations are broad conceptual variables that are not easily empirically defined and observed (e.g., repression, unconscious self, sublimation, ego, id, superego, oral or anal fixation). Others are somewhat more apparent and observable in manifestation (e.g., paranoia, anxiety, depression, hostility, anger) and are thus easier to study empirically. Experimentally examining such psychosocial-emotional personality-centered variables, Boland (1953), using the original version of the MMPI, Craig (1990), Craig, Hancock, Tran, and Craig (2003), Ezrati-Vinacour and Levin (2004), Fitzgerald, Djurdjic, and Maguin (1992), Gabel, Colcord, and Petrosino (2002), Greiner, Fitzgerald, Cooke, and Djurdjic (1985), Guitar (2003), Pukacova (1974), Santostefano (1960), and Zeltzer (1982), have all found significantly higher levels of trait anxiety in adult PWS compared to adult PWNS. Kraaimaat, Jansseen, and Van Dam-Baggen (1991), Mahr and Torosian (1999), and Stein, Baird, and Walker (1996) found that PWS compared to PWNS had higher levels of social anxiety. Others have found no significant differences in trait anxiety between PWS and PWNS (Andrews &Harris, 1964; Cox, Seider, &Kidd, 1984; Craig &Hancock, 1996; Miller &Watson, 1992; Molt &Guilford, 1979; Oliver, 1981; Peters &Hulstijn, 1984; Quarrington, 1953; Zenner &Shepherd, 1980). Along similar lines, Santostefano found that PWS had significantly higher levels of paranoia and depression than did matched PWNS. Again, others have found no significant differences between PWS and PWNS in paranoia and depression (Miller &Watson; Quarrington). Guitar (2003), comparing 14 adult people who do - and do not - stutter, found that the PWS scored significantly higher in the standardized Taylor-Johnson Temperament Assessment on the trait "nervous"(the descriptors for this trait are "tense" and "excitable") and also evidenced a greater eyeblink magnitude of acoustic startle response than did PWNS. In reference to this latter finding, Snidman and Kagan (1994) found that children behaviorally determined to have more emotionally reactive temperaments had greater magnitude of acoustic startle response than did less temperamentally reactive children. More recent studies involving temperament-reactivity differences between children who do - and do not - stutter are especially significant in relation to the hypothesis considered in this study. Such temperament-reactivity differences in young children are generally considered to be primarily genetically based. Given this substantial genetic basis, it is reasonable to suppose that such differences will continue to manifest themselves in various developmental forms in adolescent and adult life (i.e., will manifest themselves in MMPI-Adolescent and MMPIAdult responses and assessment). Published and unpublished research findings indicate that children who stutter (CWS) versus children who do not stutter (CWNS) tend to significantly differ in certain temperamental and reactivity personality tendencies. In general, CWS compared to CWNS tend to be significantly more temperamentally sensitive and emotionally reactive, as well as more fearful, cautious and reserved (Anderson, Pellowski, &Conture, 2001; Embrechts, Ebben, Franke, &van de Poel, 2000; LaSaIIe, 1999; Oyler, 1996, 1999). CWS compared with CWNS tend to be more behaviorally inhibited, socially withdrawn, and more reactive to their environment as well as more gradual in adapting to changes in that environment (Anderson, Pellowski, &Conture, 2001; Wakaba, 1998). CWS versus CWNS appear to be more anxious, introverted and withdrawn (Fowlie &Cooper, 1978; Glasner, 1949). Anderson, Pellowski, Conture, and Kelly (2003) found that CWS compared with CWNS were: (1) slower to adapt to new environmental circumstances, situations and people (i.e., slower to adapt to novelty), (2) less distractible or more vigilant, perhaps hypervigilant, when engaged in a task, and (3) tended to be irregular and less predictable in bodily and daily physiologic functions (i.e., in biologic functions like elimination patterns, hunger, sleep). Note that Embrechts et al. (2000) found that CWS tended to be less able to maintain attention, were more inattentive or distractible, than CWNS. In either case the commonality of focusing-attention problems may differentiate CWS from CWNS. PURPOSE AND RATIONALE In a broad sense, one of the important purposes of this study was to look at possible psychosocial-emotional 24 February 2014 Page 2 of 17 ProQuest

disorder factors in developmental stuttering through the eyes of the revised (updated and restandardized) Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and MMPI-A (Adolescent); (Butcher, Dahlstrom, Graham, &Tellegen, 1989, 1992; Butcher, Graham, BenPorath, Tellegen, Dahlstrom, &Kaemmer, 2001). This restandardization of MMPI-2 and MMPI-A was completed in 1989. It was tested within seven testing sites (Minnesota, Ohio, North Carolina, Washington, Pennsylvania, Virginia, and California) which were chosen for overall representation of U. S. geographical regions. In all, 2,900 participants took part in the original testing project, and this group was ultimately winnowed down to 2,600 (1,138 men and 1,462 women) (Graham, 2000). The MMPI-2/A T-score analyzed in this study has a mean of 50 and a standard deviation of 10. That is, an individual with a T-score of 50 on a particular scale/subscale would have an average or mean score for individuals who fall into that particular test-taker's gender profile as taken from the normative sample. In general, the higher the T-score for an individual on any given MMPI-2/A scale/subscale, the greater is his or her indication of tendency toward psychopathology on that scale/subscale compared to the normative sample (Graham 2000). It has often been asserted in psychology and psychiatry that many, if not most, psychosocial-emotional disorders have their origins and initial emergence in the early developmental years of childhood. In this context, it is also often asserted that the child's environmental experiences in these years play an important role in the etiology of such disorders (American Psychiatric Association, 2000; Kohut, 1971; Millon, 1996). Incidentally, this is the same developmental period during which stuttering typically initially emerges (Wingate, 2002). It is also quite widely acknowledged that such early rooted and emergent psychosocial-emotional disorders often persist and variously manifest themselves into adolescence and adulthood (American Psychiatric Association, 2000; Kohut, 1971; Millon, 1996; Saul, 1977). Assuming the basic validity of MMPI-2/A assessment outcomes, it is thus reasonable to suppose that at least certain adolescent or adult individuals MMPI-2/A assessed psychosocial-emotional disorder issues and patterns substantially reflect the same, or closely related, issues and patterns of disorder that originated and emerged in the early developmental period of their childhood. This premise then is an important etiologic inferential basis for this experimental study of developmental stuttering. The further question of whether or not such disorder issues and patterns are a cause or an effect (or both) of stuttering will be addressed later in the paper in light of the findings of this study. More specifically, however, the primary purpose of this study was to empirically test the tendency-towardpsychopathology pole of the etiologic four-factor bipolar stuttering threshold hypothesis (Treon, 1995, 2002). In turn, this hypothesis is an integral aspect of the more encompassing etiologic fourfactor bipolar psychopathology and neurolinguipathology-based linguistic and paralinguistic processing deficit syndrome hypothesis (i.e., the PNB-LPPD syndrome hypothesis; Treon, 2002), of which stuttering behavior is but one sign and symptom. Both of these hypotheses propose that, on average, PWS have a modestly greater tendency toward psychosocial-emotional disorder (toward psychopathology) of various kinds than do PWNS. Both hypotheses assert that this average difference between PWS and PWNS is real (statistically significant), but not large in magnitude. Both hypotheses also assert that this greater tendency toward psychosocial-emotional disorder in PWS is: (1) developmentally early in origin (predominantly in the preschool years), and (2) a central etiologic factor in the emergence of the problem of developmental stuttering (Treon, 1995, 2002). Finally, both hypotheses propose that there exists a wide range of diverse psychosocial-emotional disorder tendency types (and combinations) that can play an etiologic role in the tendency-toward-psychopathology pole of these hypotheses. According to the four-factor bipolar PNB-LPPD syndrome hypothesis, stuttering behavior is one sign and symptom in the phenotypic spectrum of a child who has an above average degree of tendency toward psychosocial-emotional disorder and/or (most often "and") an above average degree of tendency toward neurolinguistic disorder (i.e., neurolinguipathology). These two polar etiologic factors are almost always both present to some degree and interacting with one another. In general, if the magnitude of the sum of their 24 February 2014 Page 3 of 17 ProQuest

interaction is sufficient, it will cause manifestation of the PNB-LPPD syndrome in that child (i.e., the extent of the magnitude of this interaction will exceed the perceptual magnitude threshold of the PNB-LPPD syndrome and it will perceptibly manifest itself; Treon, 2002). This study is concerned only with the first tendency-towardpsychopathology pole (called "pole A"). The two factors that together comprise this pole are: (1) early childhood traumatic and disruptive environmental experiences interacting with (2) innate genetically based temperamentreactivity personality tendencies which predispose the child to be vulnerable to such traumatic and disruptive experiences. To widely varying degrees between PNB-LPPD syndrome individuals, this pole A contributes (almost always in interaction with pole B) to the etiology of a variety of linguistic and paralinguistic processing deficits which may involve sensorimotor speech, para-language and language (including pragmatic) deficits and dysfunctions. The tendency toward neurolinguipathology (pole B) is composed of factors three and four. Factor three is an innate genetically based tendency toward neurolinguistic and neuro-paralinguistic processing deficits. Rarely, but sometimes, factor three interacts with factor four which is early environmentally inducedexperienced neuropathology based physical-organic lesions/malformations which negatively affect the normal developmental emergence of such neurolinguistic and neuro-paralinguistic processing functions. Again, to widely varying degrees between PNB-LPPD syndrome individuals, this pole contributes (almost always in interaction with pole A) to the etiology of a variety of linguistic and paralinguistic processing deficits and dysfunctions which may include sensorimotor speech, para-language and language problems. Almost always then, it is the interaction of these two multifactorial etiologic poles together (and more rarely almost exclusively alone) that, when elevated to a critical degree of deficit or dysfunctional severity (i.e., reach perceptible PNB-LPPD syndrome threshold), cause these varied linguistic and paralinguistic problems. These two etiologic poles, usually in interaction, may cause other nonlanguage - and non-paralanguage - related phenotypic spectrum signs and symptoms as well (Treon, 2002). However, stuttering behavior is considered a primary symptom in the phenotypic spectrum of the PNB-LPPD syndrome, but perhaps not the only one (e.g., cluttering may prove to be a primary symptom as well). By primary symptom is meant that the PNB-LPPD syndrome may manifest in a given individual through signs and symptoms other than stuttering (without stuttering), but when stuttering occurs it is always indicative of the presence of this syndrome in that individual. Which is to say that, according to the PNB-LPPD syndrome threshold hypothesis, the overt and manifest presence of this syndrome in an individual is the necessary and sufficient cause of developmental stuttering. Both the bipolar stuttering threshold hypothesis and its more inclusive bipolar PNB-LPPD syndrome hypothesis propose that over all individuals with the PNB-LPPD syndrome (i.e., thus over all PWS) the average etiologic contribution of each of the two poles to this syndrome (and thus to stuttering) is approximately equal. However, to account for the proposed wide variance in relative degree of etiologic contribution of these two poles between PWS (between people with PNB-LPPD syndrome), there are hypothesized to be seven subsyndrome categories of this syndrome for individuals who perceptibly stutter (Treon, 2002). The following subsyndromes designate the relative (proportionate) degree of etiologic contribution of each of these two poles within each subsyndrome: (1) predominantly psychosocial-emotional disorder based and very secondarily neurolinguipathology based PNB-LPPD subsyndrome, (2) primarily psychosocial-emotional disorder based and strongly secondarily neurolinguipathology based PNB-LPPD subsyndrome, (3) predominantly neurolinguipathology based and very secondarily psychosocial-emotional disorder based PNB-LPPD subsyndrome, (4) primarily neurolinguipathology based and strongly secondarily psychosocial-emotional disorder based PNB-LPPD subsyndrome, (5) approximately equally balanced psychosocial-emotional disorder and neurolinguipathology based PNB-LPPD subsyndrome, (6) almost exclusively psychosocial-emotional disorder based PNB-LPPD subsyndrome, and (7) almost exclusively neurolinguipathology based PNB-LPPD subsyndrome. The PNB-LPPD syndrome hypothesis asserts that stuttering is only one expression of a broader linguistic and 24 February 2014 Page 4 of 17 ProQuest

paralinguistic processing deficit. The resultant singly manifesting or variously configured symptom clusters of linguistic and paralinguistic processing dysfunction and disorder are the central and most prominent feature of the PNB-LPPD syndrome. These linguistic and paralinguistic processing deficits, expressed through speech (including stuttering), language, and/or paralanguage disorders, include possible deficits and dysfunctions of sensorimotor speech, prosodie, and language (semantic, syntactic, phonologic, morphologic and/or pragmatic) processing. These speechlanguage and paralanguage processing deficits may be of capacity, efficiency, complexity, organization and/or synchrony. Conceptually, three functional levels of the etiologic four-factor bipolar PNBLPPD syndrome hypothesis are proposed. The first two are etiologic variables and the third is a symptomatic variable. First is the genetically based deep etiologic functional level which is composed of either: ( 1 ) a single function of either one of the two genetically based factors (factors two and three), or more likely, (2) an interaction function of these two factors. This is the foundational etiologic basis of the PNB-LPPD syndrome, and plays a critical originating role in its etiology. second is the environmentally based precipitating etiologic functional level which is composed of either: (1) a single function of either one of the two environmentally based etiologic factors (especially factor one and rarely factor four alone), or rarely - but sometimes - (2) an interaction function of these two environmental factors. This is the mediating etiologic basis of the PNB-LPPD syndrome, and plays a central precipitating role in its etiology. The deep and intermediate functional levels of etiology are considered to function bidirectionally (interactively) with one another and not in a uni-directional manner (Millon, 1996). Within and between these two multifactorial functional levels, depending upon the factors involved, the influence of a given factor in relation to the PNB-LPPD syndrome may be linear or nonlinear in its etiologic effect. For tendency toward psychosocialemotional disorder, a nonlinear influence would indicate that the effect of a relatively mild to moderate genetically based temperamental-reactivity problem and/or environmentally based emotionally traumaticconflictive-dysfunctional problem, interacting with other etiologic factors, may result in an above threshold PNBLPPD syndrome etiologic effect (which would be likely to involve stuttering). The third level is expressed when perceptible linguistic and paralinguistic processing deficits (including stuttering) occur, as they almost always do, in the phenotypic spectrum of this syndrome. This level is the psychosocially learned conceptual, attitudinal, affective, and behavioral reactionary coping and adaptive surface functional level. From very early in its onset, such learning factors may function to maintain, and possibly even elaborate upon and increase, the severity of any speech-language-paralanguage disorder symptoms that may initially emerge. When perceptible stuttering is involved at this surface level, the learned defensive and reactionary coping strategies are thought to evolve over time in an attempt to reduce the psychosocial and communicative stigma associated with such stuttering. Integral to the four-factor bipolar PNB-LPPD syndrome hypothesis is the more specific four-factor bipolar stuttering threshold hypothesis, which, in fact, is the general focus of this study. In particular, it is the tendency toward psychosocial-emotional disorder etiologic pole (pole A) of this bipolar stuttering threshold hypothesis that is being empirically tested here. METHOD In this study, the psychometric instruments used for personality based psychosocial-emotional disorder tendency assessment was the revised MMPI-2 and MMPI-A. The MMPI-2 and MMPI-A have identical T-score criterion norms (e.g., for any given scale or subscale of MMPI-2/A an individual T-score above 64 is generally considered to be a clinically significant indicator of possible psychopathology). In overview, 60 PWS were matched with 60 PWNS on the factors described below. For matching purposes, and prior to taking the MMPI-2 or MMPIA, each of the 120 subjects completed a background questionnaire. The 60 PWS also completed an additional questionnaire focusing on their stuttering problem and the Perception of Stuttering Inventory (Woolf, 1967). One hundred and fourteen of the 120 subjects then completed the 556-item MMPI-2. The remaining 6 subjects completed the 478-item MMPI-A. Each MMPI-2/A item is a short one24 February 2014 Page 5 of 17 ProQuest

sentence statement about the person taking the Inventory. This person is requested to respond by marking his or her answer sheet "T" for true (or mostly true) or "F" for false (or not usually true) as the statement applies to that person (e.g., "No one seems to understand me.") Each subject received a stipend of ten dollars for their participation in the study. All 120 MMPI-2/A outcomes were computer scored through the facilities of the corporation that holds copyright to this personality inventory instrument. All statistical analyses were computed using the SPSS 11.0 for Windows statistical analysis program. Prospective subjects were excluded from the study if their MMPI-2 or MMPI-A results were, for any reason, judged to be invalid according to computer scoring. Three such subjects were excluded from the study on this basis. Finally, the Texas A&M UniversityKingsville Human Subjects Committee approved this study prior to its undertaking, and each subject in the study read and signed an approved informed consent form. BACKGROUND INFORMATION AND MATCHING CRITERIA The majority of both stuttering (SWS) and nonstuttering (SWNS) subjects who volunteered to participate in the study resided in the South Texas area, primarily in and around Corpus Christi and Kingsville, Texas. However, stuttering subject volunteers were sampled from all major geographic areas of the contiguous United States (i.e., New England, Northeast Atlantic, Southeast, Midwest and Western areas of the United States). Twentytwo (36%) of the 60 stuttering subjects were members of the National Stuttering Association (NSA) who resided in various U. S. geographic locations. All 120 subjects were judged to be fluent speakers of American English as observed in face-to-face conversation or via telephone conversation with examiners (or in a few instances, subject's written confirmation to that effect). Also, all subjects were judged to be reading literate based on their reported levels of educational background and their written responses to written questions in the questionnaires. All subjects were judged to be within the normal range of cognitive-academic intelligence based on examiner conversational interaction with subjects and/or their written responses to questions in the questionnaires. All subjects were matched for gender. Fifty-one (85%) of the subject pairs were male while 9 pairs (15%) were female. The 120 subject participants ranged in age between 15 and 78 years with an average age of 39 years. The average age of female subjects (18 in all) was 35 years whereas the average age of male subjects (102 in all) was 40 years. Subjects were divided into three groups for age matching. For subjects 14 to 20 years, each of the nine subject pairs were matched within plus or minus three years of one another. For subjects 21 to 65 years, 40 of the 45 subject pairs (89%) were matched within plus or minus five years of one another. The 5 pairs who did not meet this criterion were within a few years of meeting it. For subjects 66 to 78 years, each of the 6 subject pairs were matched within plus or minus nine years of one another. Over all of the three agematching groups, 55 (92%) of the 60 subject pairs met age-matching criteria. All 60 subject pairs were matched for ethnic or racial background. Twenty-seven pairs (45%) shared EuropeanAmerican ethnic/racial backgrounds. Thirty-one pairs (52%) shared Mexican-American racial/ethnic backgrounds, and 2 pairs (3%) shared African-American racial/ethnic backgrounds. Five partially overlapping matching categories were employed to match educational levels. Subject pairs were matched based on the following criteria: (1) those subjects who completed high school or had some high school education (5 subject pairs), (2) those subjects who completed high school or had very little college education (16 subject pairs), (3) those subjects who completed college at the Bachelor's level or had some college education (19 subject pairs), (4) those subjects who completed college at the Bachelor's level or had some graduate school education (10 subject pairs), and (5) those subjects who completed a Master's or Doctoral level graduate program (4 subject pairs). Fifty-four (90%) of the 60 subject pairs were matched based on these criteria. Based on a 4-category self-report scale of degrees of "social outgoingness" or "extroversion-introversion" (designated from very, to quite, to not very, to not socially outgoing with similar degrees of extroverted to introverted below these designations), 40 (67%) of the 60 subject pairs were matched on the basis of being in either the same or the immediately adjacent but similarly designated (extroverted or introverted) category. 24 February 2014 Page 6 of 17 ProQuest

Based on subject self-response to the question "Do you show or express your emotions easily or readily, or are you emotionally quite reserved and cautious?" 30 (50%) of the 60 subject pairs were matched as being either more or less emotionally expressive. Twenty-nine (48%) of the 60 subject pairs were matched on the basis of their responses to a logic-analysis-reason versus artistic-creativeintuitive tendencies self-report question. All subjects used American English as their primary mode of speech and written communication. Forty-seven (78%) of the 60 subject pairs were matched as regards marital status. Fifty-one (85%) of the 60 subject pairs were matched for parental status. Within the context of the above major matching criteria, specific and systematic efforts were made to match subject pairs on the basis of each of the following additional criteria: similar height and weight, regional geographic area where the person grew up, siblings versus no siblings, mother's and father's educational background, religious affiliation (e.g., Protestant, Jewish, Catholic), leisure time interests-hobbies-activities, academic subjects that interested that person, television shows that person liked to view, how academically strong each felt him or herself to be (4-step scale from very strong to below average), how they viewed themselves politically in a 5-step scale from conservative to middle of the road to liberal, on the basis of the three people in history that they most admired, and on the content basis of one sentence in which each subject "describes and characterizes" his or her own "temperament and personality." To a greater or lesser extent, some of these additional matching criteria were achieved in the process of matching many of the 60 subject pairs. Twenty-five (42%) of the 60 stuttering subjects reported that one or more members of their immediate family (mother, father, sisters, brothers, sons or daughters) currently stutters or had previously stuttered. Twelve (20%) of the 60 stuttering subjects indicated that their father had stuttered, or currently does stutter, while only 5 (8%) said that their mother had stuttered, or currently does stutter. Fifteen (25%) of the 60 stuttering subjects indicated that one or more of their sisters and/or brothers had stuttered, or currently does stutter. Twenty (33%) of the stuttering subjects indicated that a member or members of their extended family (grandparents, aunts, uncles, and/or cousins) had stuttered, or currently does stutter. Conversely, only 3 (5%) of the 60 nonstuttering subjects reported that one or more members of their immediate family currently does stutter, or had previously stuttered. To the best of examiners' knowledge and observation, all subjects had functional hearing for face-toface conversational speech. EXPERIMENTAL CONDITIONS, PROCEDURES AND ASSESSMENTS Prior to taking the MMPI-2/A, each of the 120 subjects completed the written three-page background questionnaire. In addition, each of the 60 stuttering subjects completed: (1) a second three-page questionnaire concerning various aspects of their stuttering problem, and (2) the Perception of Stuttering Inventory (PSI; Woolf, 1967). The PSI is a 60-item self-inventory checklist of an individual's stuttering features, coping behaviors, and characteristics (e.g., "Avoiding the use of the telephone"). One of the questions in the questionnaire for PWS involved completion of a 7-point self-rating severity of stuttering scale. Subjects were asked to circle the item that best described the overall severity level of their stuttering from very mild, mild, moderate, marked, fairly severe, severe to very severe. The number of PSI self-inventory items that stuttering subjects checked ranged from O to 55 out of 60 items. The mean number of PSI items checked was 21.4 with a standard deviation of 14. On the 7-point self-rating stuttering severity scale, 8 subjects (18%) circled very mild, 18 (30%) circled mild, 20 (33%) circled moderate, 9 (15%) circled marked, 5 (8%) circled fairly severe, and none circled severe or very severe. There are 99 possible personality scales or subscales on the MMPI-2 Adult Clinical System - Revised, Interpretative Report form used in this study. The number of scales/subscales actually assessed and commonly shared by different groups of pairs ranged between 93 and 98. Of the 57 subject pairs using MMPI-2, 8 pairs shared 98 scales, 2 pairs shared 95 scales, 44 pairs shared 94 scales, and 3 pairs shared 93 scales. There are 62 possible personality scales or subscales on the MMPI-A Adolescent System Interpretative Report form used 24 February 2014 Page 7 of 17 ProQuest

in this study. All three subject pairs shared all of these sixty-two scales/subscales in their scores. Almost all of the personality scales/subscales on the MMPI-A also occur on the MMPI-2. Only the 93 personality scales/subscales (62 scales/subscales for MMPI-A) that had a full complement of subject pairs were used in analysis of within scale/subscale T-score differences between stuttering and nonstuttering subjects. However, comparisons of overall average T-scores across all scales/subscales between matched subject pairs were calculated using every scale in which each subject pair had shared scores. As noted above, this ranged between 93 and 98 MMPI-2 scales/subscales depending on which of the 57 subject pairs were considered. At the time of this study all of the 60 nonstuttering subjects resided in South Texas (including San Antonio), especially in and around the Corpus Christi and Kingsville areas of South Texas. Thirty-eight (63%) of the stuttering subjects also resided in South Texas at the time of this study. Six stuttering subjects (10%) resided in either North or West Texas and 16 (27%) resided in various areas, as previously noted, throughout the United States. Over a period of two years, eight speech-language pathology (SLP) graduate students worked closely with, and under the supervision and direction of, the authors during the data collection stage of this study. Six of these eight students recruited and matched subjects, administered questionnaires, PSI, and MMPI2 or MMPI-A to 30 stuttering and 30 matched nonstuttering subjects in this study. Each of the six students collected data on 5 stuttering and 5 matched nonstuttering subjects. The remaining two SLP graduate students each recruited and matched 9 nonstuttering subjects to each of 9 stuttering subjects from examiners' previously collected stuttering subject data, and then administered a questionnaire and MMPI-2 to each of these nonstuttering subjects. At every stage of data collection, each of these eight students was conferred with, instructed, and evaluated by Drs. Treon and Blaesing, so as to meet all study protocol criteria. These students recruited stuttering and nonstuttering subjects primarily by word of mouth through their contacts with friends, relatives, and acquaintances (including some SLP friends and acquaintances), in and around the South Texas area, who knew of PWS and PWNS who might be willing to participate in the study. Additionally, these students recruited nonstuttering (and sometimes stuttering subjects) through tables and booths that they set up from time to time in various places of population convergence (e.g., retail stores, church socials, student union building hallways at local colleges). Locally, the authors recruited 7 of their stuttering and all 8 of their nonstuttering subject in ways similar to the SLP students, but also through class announcements, local print media and radio announcements, and printed flyers posted about the campus. One of the stuttering subjects was recruited through the authors' University Speech and Hearing Clinic where he had been seen in stuttering therapy the previous semester. As previously described, the remaining 22 stuttering subjects were recruited by the authors contacting local NSA Chapters throughout the United States. Thirty-six (60%) of the 60 stuttering subjects and all of the nonstuttering subjects were directly met with (face-toface) by various researcher participants in this study and given their required forms and questionnaire(s) to complete. They were then either: (1) administered the MMPI-2 or MMPI-A with the researcher in a nearby location and available for consultation or (2) given the MMPI-2 to complete and directly return to the researcher within a short period of time (typically a day or two). If given the MMPI-2 to complete and promptly return, each subject was also given a special instructions form (i.e., the "Instructions, Check List, and Signature Validation for Taking the MMPI-2" form described below) and the researcher's phone number to contact in case of questions or problems. Twenty-four (40%) of the 60 stuttering subjects were given their forms and questionnaires to complete and administered the MMPI-2 through a mailing protocol. Twenty-two of these 24 subjects were active National Stuttering Association members living throughout the United States. Except for the initial first step described below, the mailing protocol for the 2 subjects who were not NSA members was the same as for the 22 NSA members. 24 February 2014 Page 8 of 17 ProQuest

Initially, SLP researchers made phone calls and sent informational letters about the study to several NSA Chapter Coordinators throughout the United States asking them to describe the study to their members and invite them to contact the researchers if they wished to participate. Prospective subjects who wished to participate were then sent the two questionnaires, PSI, and other required forms to complete. Two to three weeks after this mailing, each participant was sent the MMPI-2 booklet, answer sheet, and "Instructions, Check List, and Signature Validation for Taking the MMPI-2" form to complete. The latter included specific instructions and conditions, check list (e.g., "I carefully read the instructions for taking this Inventory...", "I spent a minimum of one hour reading and responding...", "I completed the MMPI-2 in a quiet and isolated setting... without input or feedback from any other person...") and an attesting signature requirement for taking the MMPI-2. A selfaddressed and stamped envelope was also included for return of all completed data sent to the participant. RESULTS The mean T-score for all 60 stuttering subjects across all MMPI-2/A scales/ subscales in which there occurred a matching nonstuttering subject -score was 52.19 (SD = 6.462) Similarly, the mean -score for all sixty nonstuttering subjects across all scales/subscales was 49.75 (SD = 4.341). Using an analysis of variance (ANOVA) to analyze this difference yields an F-value of 5.904 (df = 1) which is statistically significant at the p = .017 level, well below the .05 level used in this study. The eta squared value in this analysis was .048 (4.8%). Although summing T-scores across all MMPI-2/A scales is a somewhat atypical scoring protocol, it is a valid and useful statistical procedure for purposes of this study. Its application is valid because it is accurate to say that the higher a subject's T-score on any given scale/subscale of MMPI-2/A the greater is that subject's tendency toward psychosocial-emotional disorder in relation to that scale/subscale. Thus it is reasonable to average -scores across all MMPI-2/A scales as a rough measure of a subject's overall tendency toward psychosocialemotional disorder in general. Average standard deviation values in each of the 93 MMPI-2/A scales/ subscales was used as a basis for comparing the degree of -score variance within each of the stuttering versus nonstuttering subject populations across these scales/subscales. Of the 93 scales/subscales with a full complement of subject pairs, 83 (89.3%) of these scales/subscales had higher mean standard deviation values (i.e., greater mean T-score variance) for stuttering than for nonstuttering subjects. The mean standard deviation value for all stuttering subjects across all 93 scales/subscales was 11.79, whereas this mean for all nonstuttering subjects across all scales/subscales was 9.51. Using ANOVA to analyze this difference yields an F- value of 115.419 (df= 1) which is statistically significant below the p = .001 level, well below the .05 level used in this study. Of the 93 (of a possible 99) MMPI-2/A scales/subscales with a full complement of subjects, the mean T-score for stuttering subjects was higher than for nonstuttering subjects in 80 (86%) of these 93 scales/subscales. Conversely, the nonstuttering subjects' mean T-score was higher in 13 (14%) of these 93 scales/subscales. Analysis of variance indicated that the mean T-scores of the 60 stuttering subjects were statistically significantly higher then their 60 nonstuttering controls at or below the .05 level on 24 (25.8%) of the 93 MMPI-2/A scales/subscales (see Table 1). Note that 3 of these 24 scales/subscales are considered to be statistically significant at the 2 decimal place .05 level (Basic Scale paranoia at .053, Supplementary Scale anxiety at .056, and Schizophrenia Subscale lack of ego mastery-cognitive at .055) even though they slightly exceed this level by up to .006 when thep-value is extended to 3 decimal places. ANOVA testing indicated that none of the 13 scales/subscales in which nonstuttering subjects had higher mean -scores than stuttering subjects approached statistical significance at the .05 level. ANOVA significance p-values for these 13 scale/ subscale differences ranged between .103 and .953, and averaged .492.

24 February 2014

Page 9 of 17

ProQuest

Five of the 6 MMPI-2/A Schizophrenia Subscales (Bizarre Sensory Experiences, Social Alienation, Lack of Ego Mastery-Conative, Lack of Ego Mastery-Cognitive, and Emotional Alienation) were statistically significant at or below the .05 level in the direction of higher mean -scores for stuttering versus nonstuttering subjects (see Table 1). Indeed, all differences noted in this and the next paragraph were in the direction of higher mean scores for stuttering versus nonstuttering subjects. Two of the 5 Depression Subscales (Mental Dullness and Subjective Depression) were also significant at or below the .05 level. Five of the 10 Basic Scales Profile: Clinical were also statistically significant at or below the .05 level: Depression, Schizophrenia, Psychasthenia, 24 February 2014 Page 10 of 17 ProQuest

Masculinity-Femininity and Paranoia. Four of the 15 scales under Content Scales Profile were significant at or below the .05 level: Anxiety, Health Concerns, Work Interference, and Family Problems. Of the 5 Hysteria Subscales only Somatic Complaints was significant at or below the .05 level. Under the Content Component Scales, 1 of the 2 Fear Subscales (Generalized Fearfulness) was significant at or below the .05 level. Self-depreciation, one of the three Depression Subscales, was statistically significant at or below the .05 level. General Health Concerns, one of the three Health Concerns Subscales, was also statistically significant at or below the .05 level. Competitive Drive, one of the two Type A Subscales, was significant at or below the .05 level, and Self-doubt, one of the two Low Self-Esteem Subscales, was also significant at or below the .05 level. Finally, under the 2 Negative Treatment Indicators Subscales, Low Motivation was significant at or below the .05 level. The eta squared values for each of the MMPI-2/A scales/subscales of Tables 1 indicate the percentage of variance within the stuttering and nonstuttering subjects' T-score distributions that can be accounted for by the difference between the two groups on that scale or subscale. The following include those MMPI-2/A scales/subscales with the largest eta squared values at or above 3.7 percent. The largest eta squared percentage scores on the Basic Scales Profile: Clinical were for Depression (7.8%), Schizophrenia (7.2%) and Psychasthenia (5.1%). For the Content Scales Profile, eta squared percentages were highest for Anxiety (4.7%), Health Concerns (4.6%), and Work Interference (4%). The highest eta squared percentages in the Depression Subscales were in Mental Dullness (6.4%) and Subjective Depression (4.7%). In the Hysteria Subscales the Somatic Complaints subscale had an eta squared of 4.1 percent. In the Schizophrenia Subscales the highest eta squared percentages were as follows: Bizarre Sensory Experiences (5.1%), Social Alienation (3.9%) and Lack of Ego Mastery-Conative (3.7%). Under Fear Subscales, the eta squared for Generalized Fearfulness was 4%. The eta squared for the Self-depreciation subscale under the Depression Subscales was 5.2%, while under the General Health Concerns Subscales, General Health Concerns was 6.2%. Under the Type A Subscales, Competitive Drive had an eta squared of 4.1%. In the Low Self-esteem Subscales, the Selfdoubt subscale was at 3.7%. Under the Negative Treatment Indicators Subscales, the Low Motivation subscale eta squared was 4.5%. INTERPRETATION AND DISCUSSION One of the central findings of this study is that, averaged across all MMPI2/A scales/subscales, subjects who stutter (SWS) score statistically significantly higher than do matched subjects who do not stutter (SWNS) (p = .017) in overall tendency toward psychosocial-emotional disorders (i.e., overall tendency toward pyschopathology). This finding agrees with the explicit projection of the tendency toward psychopathology pole (Treon, 2002) that: (1) there exists a greater tendency toward such disorder in PWS versus PWNS, and (2) that this tendency is relatively small but statistically significant (i.e., appears to be a real average difference). Another central finding that may help to clarify the nature of the distribution (i.e. range and variability) of this apparent greater average tendency toward psychosocial-emotional disorder in PWS concerns the T-score standard deviation differences found between SWS versus SWNS in this study. The mean standard deviation value for all stuttering subjects was greater than the mean standard deviation value for all nonstutteirng subjects in 83 (89.25%) of the 93 MMPI-2/A scales/subscales sampled. The mean standard deviation value across all 93 scales/subscales was 11.79 for all stuttering subjects versus 9.51 for all nonstuttering subjects. This difference was statistically significant below the p = .001 level. This outcome indicates that stuttering subjects, on average, displayed greater within scale T-score variance than do nonstuttering subjects across these 93 MMPI-2/A scales/subscales. This statistically significant MMPI-2/A finding of greater within-scale variance in tendency toward psychosocial-emotional disorders among stuttering versus nonstuttering subjects can be interpreted as supportive of the tendency toward psychopathology pole hypothesis of the bipolar stuttering threshold hypothesis. Because of the proposed wide variance in degree of etiologic tendency toward psychosocialemotional disorder among PWS (see the previously discussed 7 subsyndromes of the PNB-LPPD syndrome 24 February 2014 Page 11 of 17 ProQuest

hypothesis), it is quite likely that a sample of stuttering subjects, with their extremes of variance in this tendency factor, would display greater variance on this factor than would a comparable sample of nonstuttering subjects. In agreement with the great majority of previous personality inventory studies comparing SWS to SWNS (see Bloodstein, 1995 for a review of such studies), the results of this study, according to MMPI-2/A -score standardization values, suggest that, in general and on average, PWS are not neurotic, borderline, or psychotic (i.e., are not psychopathologic), but rather fall within the normal range of psychosocial-emotional functioning and adjustments. This finding also agrees with specific projections to this effect put forth in relation to the tendency-toward-psychopathology pole of the bipolar stuttering threshold hypothesis (Treon, 2002). In this study, the tendency for SWS to have higher mean -scores than SWNS across the 93 MMPI-2/A scales/subscales examined was very evident. SWS scored higher on mean T-score than SWNS on 80 (86%) of these 93 scales/ subscales. Of the 24 scales/subscales (25.8%) that had statistically significantly higher mean T-scores for SWS versus SWNS, the following tendency toward psychosocial-emotional disorder trends appeared. The 6 most prominent findings in this regard (i.e., prominent by virtue of the number of related scales/subscales involved and/or the levels of statistical significance of those scales/subscales) are in scales/subscales related to schizophrenia, depression, health concerns-somatic complaints, psychasthenia (tendency toward phobia, obsession and compulsion), anxiety-fearfulness, and self-doubt-self-depreciation. Stuttering subjects in this study had statistically significantly higher mean T-scores than nonstuttering subjects did at or below the .05 level in various dimensions of all of these psychological problem areas. This was especially apparent in the areas of schizophrenia and depression. The Depression Scale in the Basic Scales Profile: Clinical section had the highest level of significance at p =.002 of any of the ninety-three scales/subscales studied. In general, these depression findings agree with those of Walnut (1954) in a study using the original MMPI, and of Richardson (1944). The next highest significance level among these 24 scales/subscales was in the Schizophrenia Scale of this same Basic Scale Profile: Clinical at p = .003. Also recall that 5 of the 6 Schizophrenia Subscales had statistically significantly higher mean T-scores for SWS versus SWNS at or below the .05 level. Similarly, 2 of the 5 Depression Subscales are significant well below the .05 level. The greater tendency toward health concerns in the Content Profile Scale (p = .019), general health concerns in the Health Concern Subscales (p = .008) and somatic complaints in the Hysteria Subscales (p = .026) in stuttering versus nonstuttering subjects was quite evident in this data. Also evident was the increased tendency toward phobia, obsession and compulsion (i.e., the Psychasthenia scale; p = .013) in stuttering versus nonstuttering subjects. The findings of this study indicate that the tendency toward Content Scale Profile anxiety (p = .018) and Supplementary Scale Profile anxiety (p = .056) as well as generalized fearfulness in the Fear Subscales (p = .032) were notably higher in stuttering than in nonstuttering subjects. In general, these anxiety findings agree with those of Boland (1953), Craig (1990), Craig et al. (2003), Ezrati-Vinacour and Levin (2004), Fitzgerald et al. (1992), Gabel et al. (2002), Greiner et al. (1985), Guitar (2003), Kraaimaat et al. (1991), Mahr and Torosian (1999), Santostefano, (1960), Stein et al. (1996), and Zeltzer, (1982). Also, self-doubt (p = .039) and self-depreciation (p = .015) mean /"-scores were higher in stuttering than in nonstuttering subjects. In general, these self-doubt and self-esteem related findings agree with those of Perkins (1947). By way of generalization, the most prominent findings among the scale/ subscale outcomes of this study can be interpreted as suggesting that, on average, PWS tend to have personality-based psychological profiles that are more similar to schizophrenia, depression, trait anxiety-generalized fearfulness, and health concerns-somatic complaints profiles than are the profiles of PWNS. Also, PWS appear to have a greater tendency toward phobia-obsessioncompulsion (psychasthenia), self-doubt-self-depreciation, issues and concerns of masculinityfemininity, and paranoia than do PWNS. The paranoia findings of this study agree with those of Walnut (1954) using the original MMPI. Other statistically significant findings in this study suggest that, in general, PWS versus PWNS appear to have 24 February 2014 Page 12 of 17 ProQuest

greater average tendency toward psychosocial-emotional problems concerning work interference (p = .034), family problems (p = .049), low motivation in relation to psychological treatment (p = .023), and strong competitive drive (p = .030). Whether or not any given factor regularly associated with the problem of stuttering is a part of its cause, its effect, or both, has been frequently debated since the beginning of the scientific study of stuttering (Bloodstein, 1995), and probably before. Indeed, it seems reasonable to suppose that the psychosocial-communicative stigma that a person who stutters (or has any other type of pronounced speech or language disorder for that matter) must daily encounter, confront and respond to, has a psychosocial-emotional influence (i.e., has its own psychosocial-emotional "rebound" effect) on that individual. Such an effect could be expected to account for at least some of the statistically significant scale/subscale differences in this study (e.g., perhaps the social anxiety dimension of generalized anxiety). Also, in repeatedly using the .05 level of statistical confidence criterion across these 93 scales/subscales, it is quite possible that perhaps 3, 4 or even 5 of the statistically significant findings of this study may be due to sampling error. However, even granting that these 2 factors operated to the extent suggested above, it does not seem reasonable to the authors that these factors by themselves could fully account for the extent, range, and consistency of direction of the statistically significant tendency toward psychosocial-emotional disorders differences found in this study. For example, a remarkable 24 (25.8%) of the 93 MMPI-2/A scales/subscales statistically significantly differentiated SWS from SWNS in the direction of greater mean T-scores for SWS. And again, the overall (i.e., summed across all sampled scales/ subscales) mean T-score difference in the direction of greater tendency toward psychosocial-emotional disorder in stuttering versus nonstuttering subjects was statistically significant (p = .017), well below the .05 level. In summary, the overall range, direction and magnitude of the statistically significant findings of this study, together with the likelihood that many, if not most, of these tendencies toward psychosocial-emotional disorder have their origins in early childhood, can reasonably be interpreted as generally supportive of the tendency toward psychosocial-emotional disorder pole hypothesis of the etiologic bipolar stuttering threshold hypothesis. Interpreted in this way, the data of this study tend to support the hypothesis that, in general, a child's early traumatic-disruptive experiences interacting with his or her genetically based temperament-reactivity predisposition to be psychologically vulnerable to such traumatic-disruptive experiences (i.e., a child's above average tendency toward psychosocial-emotional disorder) plays a significant role in the etiology of developmental stuttering. References REFERENCES American Psychiatrie Association (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Text revision. Washington, DC: Author. Anderson, J., Pellowski, M., &Conture, E. (2001, November). Temperament characteristics of children who stutter. Paper presented at the annual convention of the American Speech-Language-Hearing Association, New Orleans, LA. Anderson, J., Pellowski, M., Conture, E., &Kelly, E. (2003). Temperamental characteristics of young children who stutter. Journal of Speech, Language, and Hearing Research, 46, 1221-1233. Andrews, G., &Harris, M. (1964). The syndrome of stuttering. Clinics in Developmental Medicine, No. 17. London: Spastic Society Medical Education and Information Unit in association with Wm. Heinemann Medical Books. Bates, J. (1989). Concepts and measures of temperament. In G. Kohnstamm, J. Bates, &M. Rothbart (Eds.), Temperament in childhood (pp. 3-27). New York: Wiley. Bloodstein, O. (1995). A handbook on stuttering (5th ed.). San Diego: Singular Publishing Group. Boland, J. (1953). A comparison of stutterers and non-stutterers on several meanures of anxiety. Speech Monographs, 20, 144 (Abstract). 24 February 2014 Page 13 of 17 ProQuest

Butcher, J., Dahlstrom, W., Graham, J., &Tellegen, A. (1989). Minnesota Multiphasic Personality Inventory - 2. Minneapolis, MN: Regents of the University of Minnesota (Distributed by National Computer Systems, Inc.). Butcher, J., Dahlstrom, W., Graham, J., &Tellegen, A. (1992). Minnesota Multiphasic Personality Inventory -A. Minneapolis, MN: Regents of the University of Minnesota (distributed by National Computer Systems, Inc.). Butcher, J., Graham, J., Ben-Porath, Y., Tellegen, A., Dahlstrom, W., &Kaemmer, B. (2001). MMPl2 (Minnesota Multiphasic Personality Inventory - 2): Manual for administration, scoring, and interpretation. Revised Edition. University of Minnesota Press: Minneapolis. Conture, E. (2001). Stuttering: Its nature, diagnosis, and treatment. Boston: Allyn &Bacon. Cox, N., Seider, R., &Kidd, K. (1984). Some environmental factors and hypotheses for stuttering in families with several stutterers. Journal of Speech and Hearing Research, 27, 543-548. Craig, A. (1990). An investigation into the relationship between anxiety and stuttering. Journal of Speech and Hearing Disorders, 55, 290-294. Craig, A., &Hancock, K. (1996). Anxiety in children and young adolescents who stutter. Australian Journal of Human Communication Disorders, 24, 28-38. Craig, A., Hancock, K., Tran, Y, &Craig, M. (2003). Anxiety levels in people who stutter: A randomized population study. Journal of Speech, Language, and Hearing Research, 46, 11971206. Dahlstrom, W., &Craven, D. (1952). The MMPI and stuttering phenomena in young adults. American Psychologist, 7, 341 (Abstract). Embrechts, M., Ebben, H., Franke, P., &van de Poel, C. (2000). Temperament: A comparison between children who stutter and children who do not stutter. In H. Bosshardt, J. Yaruss, &H. Peters (Eds.), Proceedings of the Third World Congress on Fluency Disorders: Theory, research, treatment, and self-help (pp. 557-562). Nijmegen, The Netherlands: University of Nijmegen Press. Ezrati-Vinacour, R., &Levin, I. (2004). The relationship between anxiety and stuttering: A multidimensional approach. Journal of Fluency Disorders, 29, 135-148. Fitzgerald, H., Djurdjic, S., &Maguin, E. (1992). Assessment of sensitivity to interpersonal stress in stutterers. Journal of Communication Disorders, 25, 31-42. Fowlie, G., &Cooper, E. (1978). Traits attributed to stuttering and nonstuttering children by their mothers. Journal of Fluency Disorders, 3, 233-246. Gabel, R., Colcord, R., &Petrosino, L. (2002). Self-reported anxiety of adults who do and do not stutter. Perceptual and Motor Skills. 94, 775-784. Glasner, P. (1949). Personality characteristics and emotional problems in stutterers under the age of five. Journal of Speech and Hearing Disorders, 14, 135-138. Graham, R. (2000). MMPI-2: Assessing personality and psychopathology (3rd ed.). Oxford University Press: Oxford. Gregory, H. (2003). Stuttering therapy: Rationale and procedures. Boston: Allyn &Bacon. Greiner, J., Fitzgerald, H., Cooke, P., &Djurdjic, S. (1985). Assessment of sensitivity to interpersonal stress in stutterers and nonstutterers. Journal of Communication Disorders, 18, 215-225. Guitar, B. (1998). Stuttering: An integral approach to its nature and treatment. Baltimore: Williams &Wilkins. Guitar, B. (2003). Acoustic startle responses and temperament in individuals who stutter. Journal of Speech, Language, and Hearing Research, 46, 233-240. Kohut, H. (1971). The analysis of self: A systematic approach to the psychoanalytic treatment of narcissistic personality disorders. New York: International Universities Press, Inc. Kraaimaat, R, Jansseen, P., &Van Dam-Baggen, R. (1991). Social anxiety and stuttering. Perceptual and Motor Skills, 72, 766. LaSaIIe, L. (1999, November). Temperament In pre-schoolers who stutter: A preliminary investigation. Poster presented at the annual convention of the American Speech-LanguageHearing Association, San Francisco, CA. 24 February 2014 Page 14 of 17 ProQuest

Mahr, G., &Torosian, T. (1999). Anxiety and social phobia. Journal of Fluency Disorders, 24, 119126. Manning, W. (2001). Clinical decision making in fluency disorders (2nd d.). Vancourver, BC: Singular/Thomson Learning, Inc. Miller, S., &Watson, B. (1992). The relationship between communication attitude, anxiety and depression in stutterers and nonstutterers. Journal of Speech and Hearing Research, 35, 789-798. Millon, T. (1996). Disorders of personality: DSM-IV and beyond. New York: John Wiley &Sons. Molt, L., &Guilford, A. (1979). Auditory processing and anxiety in stutterers. Journal of Fluency Disorders, 4, 255-267. National Institute of Mental Health (2003). Gene more than doubles risk of depression following life stresses. NIHNews Release, July 17, 2003. Oliver, P. (1981). An investigation of the cognitive mediating variables of adult stutterers and the relationship of these variables to performance anxiety. Dissertation Abstracts International, 42, 1837-1838. Oyler, M. (1996). Vulnerability in stuttering children. Dissertation Abstracts International, 56, 3374. Oyler, M. (1999, November). Temperamental sensitivity in children who stutter. Session presented at the annual convention of the American Speech-Language-Hearing Association, San Francisco, CA. Perkins, D. (1947). An item by item compilation and comparison of the scores of 75 young stutterers on the California Test of Personality. Speech Monographs, 14, 211 (Abstract). Peters, H., &Hulstijn, W. (1984). Stuttering and anxiety: The difference between stutterers and nonstutterers in verbal apprehension and physiologic arousal during the anticipation of speech and non-speech tasks. Journal of Fluency Disorders, 9, 67-84. Pukacova, M. (1974). Psychologicke charakteristiky balbutikov. dsh Abstracts, 14, 308 (Abstract). Quarrington, B. (1953). The performace of stutterers on the Rosenzweig Picture-Frustration Test. Journal of Clinical Psychology, 9, 189-192. Richardson, L. (1944). A personality study of stutterers and non-stutterers. Journal of Speech Disorders, 9, 152160. Santostefano, S. (1960). Anxiety and hostility in stuttering. Journal of Speech and Hearing Research, 3, 337347. Saul, L. (1977). The childhood emotional pattern: The key to personality, its disorders and therapy. New York: Van Nostrand Reinhold Company. Silverman, F. (2004). Stuttering and other fluency disorders (3rd ed.). Long Grove, IL: Waveland Press, Inc. Snidman, N., &Kagan, J. (1994). The contribution of infant temperamental differences to acoustic startle response. Psychophysiology, 31 (Suppl. 1), S92. Stein, M., Baird, A., &Walker, J. (1996). Social phobia in adults with stuttering. American Journal of Psychiatry, 153, 278-280. Treon, M. (1995). A bipolar etiologic stuttering threshold hypothesis and related proposed treatment approach. Psychology: A Journal of Human Behavior, 32, 35-51. Treon, M. (2002). A proposed etiologic psychopathology and neurolinguipathology based linguistic and paralinguistic processing deficit syndrome in stuttering. Psychology and Education: An Interdisciplinary Journal, 39 (3/4), 42-64. Van Riper, C. (1971). The nature of stuttering. Englewood Cliffs, NJ: Prentice-Hall. Wakaba, Y. (1998). Research on temperament of children who stutter with early onset. In E. Healey &H. Peters (Eds.), Stuttering: Proceedings of the second World Congress on Fluency Disorders (Vol. 2, pp. 84-87). Nijmegen, The Netherlands: University Press Nijmegen. Walnut, F. (1954). A personality inventory item analysis of individuals who stutter and individuals who have other handicaps. Journal of Speech and Hearing Disorders, 19, 220-227. 24 February 2014 Page 15 of 17 ProQuest

Wingate, M. (2002). Foundations of stuttering. San Diego, CA: Academic Press. Woolf, G. ( 1967). Perceptions of stuttering inventory. British Journal of Disorders of Communication, 2, 158177. Zeltzer, C. (1982). The relationship of causal attributions to performance anxiety as exemplified in stuttering. Dissertation Abstracts International, 42, 4947. Zenner, C., &Shepherd, W. (1980). Trait anxiety of stutterers and nonstutterers. ASHA, 22, 712. AuthorAffiliation MARTIN TREON LLOYD DEMPSTER Texas A &M University-Kingsville, Kingsville, TX, USA KAREN BLAESING Our Lady of the Lake University, San Antonio, TX, USA AuthorAffiliation Martin Treon, PhD, Lloyd Dempster, PhD, Texas A&M University-Kingsville, Kingsville, TX, USA; Karen Blaesing, PhD, Our Lady of the Lake University, San Antonio, TX, USA. The authors wish to acknowledge the important contributions of the following speech-language pathology graduate students who worked as coresearchers with the authors during the data collection phase of this study: Priscilla Villanueva, Jennifer Tristan, Nicci Alien, Jessica Garcia, Rosemary Garza, Stefanie Bemal, Stephanie West, and Talisha Long. Also, the authors wish to acknowledge the valuable consultation with - and advice from - our faculty colleagues, Paul Vowell, PhD (Sociology) and Thomas Fields, PhD (Communication Sciences and Disorders) during the data analysis phase of this study. Finally, the authors wish to thank the 120 volunteer subject participants in this study for their valuable time and efforts. Special thanks need to be extended to the 22 National Stuttering Association subject participants, many of whom also helped recruit NSA members for this study, and to the Research Committee of the NSA National Office for allowing the authors to contact local NSA chapters in this regard. This research was partially funded by grants from the Texas Excellence Fund. Appreciation is due to reviewers including: William H. Perkins, PhD, 5425 Weatherford Dr, Los Angeles, CA 90008, USA. Please address correspondence and reprint requests to: Martin Treon, PhD, Texas A&M University Kingsville, 13348 S. 176th Lane, Goodyear, AZ 85338, USA. Phone: 623-386-9007; Email: treonm2@msn.com Publication title: Social Behavior and Personality Volume: 34 Issue: 3 Pages: 271-293 Number of pages: 23 Publication year: 2006 Publication date: 2006 Year: 2006 Publisher: Society for Personality Research, Incorporated Place of publication: Palmerston North Country of publication: New Zealand Publication subject: Sociology, Psychology

24 February 2014

Page 16 of 17

ProQuest

ISSN: 03012212 CODEN: SBHPAF Source type: Scholarly Journals Language of publication: English Document type: General Information ProQuest document ID: 209897804 Document URL: http://search.proquest.com/docview/209897804?accountid=15533 Copyright: Copyright Society for Personality Research, Incorporated 2006 Last updated: 2012-11-20 Database: ProQuest Central

_______________________________________________________________
Contact ProQuest

Copyright 2014 ProQuest LLC. All rights reserved. - Terms and Conditions

24 February 2014

Page 17 of 17

ProQuest