See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/273551962

Coping Strategies and Adolescents: Learning to Take Care of Self and Stuttering
during Treatment

Article  in  Perspectives on Fluency and Fluency Disorders · November 2011

DOI: 10.1044/ffd21.3.68

CITATIONS READS
5 699

5 authors, including:

George Michael Tramontana

Pennsylvania State University
4 PUBLICATIONS   57 CITATIONS   

SEE PROFILE

All content following this page was uploaded by George Michael Tramontana on 29 November 2015.

The user has requested enhancement of the downloaded file.

Unless otherwise noted, the publisher, which is the American Speech-Language
Hearing Association (ASHA), holds the copyright on all materials published in
Perspectives on Fluency and Fluency Disorders, both as a compilation and as
individual articles. Please see Rights and Permissions for terms and conditions of
use of Perspectives content: http://journals.asha.org/perspectives/terms.dtl

Coping Strategies and Adolescents: Learning to Take Care of

Self and Stuttering during Treatment
Gordon W. Blood
Ingrid M. Blood
Sarah Dorward
Michael P. Boyle
G. Michael Tramontana
Department of Communication Sciences and Disorders, The Pennsylvania State University
University Park, PA

Abstract
The purpose of this paper is to describe coping in the context of adolescence and
stuttering. Adolescents who stutter are a unique group of individuals dealing with an
episodic, variable, and chronic disorder during a critical developmental stage in their
lives. We provide a brief review of adolescence, coping constructs, coping during
adolescence, and coping programs. We highlight the role of the speech-language
pathologist is as an advocate/guide assisting adolescents who stutter develop
appropriate, adaptive strategies for dealing with everyday stressors and the added
potential stress associated with stuttering.

Introduction
The importance of understanding the psychosocial aspects of stuttering has been
showcased in a number of recent studies of adults who stutter. These studies show that
stuttering is associated with a risk for negative life outcomes, especially in terms of
psychosocial adjustment (Craig, Blumgart, & Tran, 2009; Cummins, 2010; Iverach, Jones, et
al., 2009a, 2009b; Iverach, O’Brian, et al., 2009; Iverach et al., 2010). The results of studies of
characteristics of successful adaptive coping strategies suggest the association of stuttering
and negative, long-term psychosocial outcomes is not inevitable (Plexico, Manning, & DiLollo,
2005; Plexico, Manning, & Levitt, 2009a, 2009b). Coping strategies determine how individuals
encounter and deal with stressors. Strategies developed in adolescence oftentimes lay the
foundation for individualized coping styles in adulthood (Frydenberg, 2008). Adolescents who
stutter are a unique group of individuals dealing with an episodic, variable, and chronic
disorder during a critical developmental stage of life. Empirical studies are needed to determine
the ways adolescents who stutter cope with common stressors, as well as any additional
stressors associated specifically with their stuttering.
Adolescence, generally regarded as a period between 12 and 22 years (Prester, 2003), is
a time of great physical, cognitive, emotional, and psychosocial change and challenges.
Adolescents usually discover and employ numerous coping techniques during this

68
developmental stage. Fortunately, research documents that the majority of adolescents are
successful at learning adaptive coping mechanisms and pass through this developmental
period without experiencing major life problems or negative, long-term outcomes (Arnett, 2009,
2010; Gilman & Huebner, 2006; Suldo & Shaffer, 2008). However, for some individuals,
adolescence is an extremely vulnerable developmental time. For example, Kessler and
colleagues (2005) report that more than half of all mental health problems (anxiety, phobias,
alcohol/substance abuse, depressive disorders, etc.) begin during adolescence. According to
Offer, Ostrov, Howard, and Atkinson (1990), approximately 20% of adolescents do not find
effective ways to cope with daily stress and challenges during this time. Some have great
difficulty with peer and family relationships, emotion regulation, identity formation, spiritual
issues, and risk-taking behaviors (Aldwin, 2007; DiClemente, Santelli, & Crosby, 2009; Rew,
2005).
The challenges of adolescence can be magnified by stuttering—a social communication
disorder that may disrupt typical patterns of interpersonal relationships. Some research
suggests that increased social anxiety (Blood, Blood, Maloney, Meyer, & Qualls, 2007;
Mulcahy, Hennessey, Beilby, & Byrnes, 2008); heightened communication apprehension (Blood
& Blood, 2004); poorer self-esteem (Blood, Blood, Tellis, & Gabel, 2003); and increased
likelihood for victimization, teasing, and bullying are evident in a subgroup of adolescents who
stutter (Blood & Blood, 2004, 2007; Blood et al., in press; Evans, Healey, Kawai, & Rowland,
2008; Hearne, Packman, Onslow, & Quine, 2008). Additional information is needed to
determine how and why some adolescents who stutter develop successful adaptive coping
strategies during these developmental years, while others appear to be less successful and at
greater risk for long-term, negative psychosocial outcomes.
More than a decade ago, Blood et al. (1998) examined the coping strategies and
perceived communication skills of 32 adolescents who stutter and 32 adolescents who did not
stutter. Using two standardized scales with modified instructions, the investigators instructed
participants who did not stutter to identify a common stressor and complete the scale. In
contrast, participants who stuttered were instructed to complete the scale with the stressor of
stuttering. The researchers concluded that both groups reported similar types of coping skills
and similar rankings in the importance of communication skills.
In a recent issue of Perspectives on Fluency and Fluency Disorders, Zebrowksi and Wolf
(2011) discussed treatment of adolescents who stutter. They outlined their philosophy of
designing therapy approaches based on an understanding of the individual client’s
developmental, psychological, and social status. They stressed the need to design treatment
programs that address the client’s unique challenges and requirements. The complex,
multidimensional structure of coping in children, adolescents, and adults is related to positive
psychological adjustment and healthy long-term psychosocial outcomes (Compas, 1987, 1998,
2009). Examining this construct in adolescents who stutter may provide new insight into how
adolescents cope with stuttering and if they adopt different strategies for different situations
and stressors. This information could assist speech-language pathologists (SLPs) and other
professionals in developing more appropriate treatment programs to help adolescents
strengthen their coping strategies and improve their quality of life.

Coping Constructs
A popular definition of coping—offered more than 25 years ago by Lazarus and Folkman
(1984)—is “constantly changing cognitive and behavioral efforts to manage specific external
and/or internal demands that are appraised as taxing or exceeding the person’s resources” (p.
141). Folkman and Moskowitz (2004) expanded on the definition, emphasizing the situational
context of perceived stressors. They also discussed three critical stages of the coping construct:
the appraisal stage, the coping stage, and the outcome stage. Other researchers classified
coping as emotion-based (crying, avoiding, resignation, acting out) or behavior-based (problem

69
solving, cognitive reappraisal). Moos (2002) argued that the multidimensional aspects of coping
are so complex that simple dichotomies—such as approach and avoidance, emotional and
behavioral, and cognitive and feeling—are artificial and all components are interrelated. He
explained that productive versus non-productive strategies are likely to depend on the specific
context of the problem and the individual’s perception of the stressor as a threat or a challenge.
The interesting point for SLPs examining coping, stress, adaptation, and threat in the person
who stutters (PWS) is that all behavioral strategies offer costs as well as benefits. Frydenberg
(2008) suggests that the individual should have access to an ideal coping inventory that
includes all strategies.
Hobfoll (1988) presented his theory of stress and coping—Conservation of Resource
(COR). The theory is based on the premise that “people have an innate as well as learned desire
to conserve the quality and quantity of their resources and to limit any state that may
jeopardize the security of these resources” (p. 25). In basic terms, stress interferes with one’s
ability to maintain and manage a perceived inventory of resources. The perceived loss or the
threat of losing resources leads to stress, which is created when current resources are
perceived as unstable or inadequate for the specific situation. He labeled this balance between
losing and conserving resources as “ecological congruence.” Hobfoll suggested that COR is an
important factor in developing and utilizing numerous coping strategies and part of a larger
concept called stress resistance. The selection of coping strategies was defined as an attempt to
regain/maintain the balance of resources. In an excellent resource on coping in adolescents,
Frydenberg (2008) shows how COR can be adapted to understand stress in adolescents.
This information is not new territory for individuals knowledgeable about fluency
disorders; Sheehan discussed similar concepts and models as early as 1954. With regard to
stuttering, the adolescent can be in the appraisal stage and begin to search for an effective
strategy to deal with stuttering, which he/she perceives as a threat or challenge. Depending on
the initial appraisal—“Is my stuttering presenting a challenge to my current resources in this
situation?” or “Is my stuttering presenting a threat to my current resources in this
situation?”—the individual can select from and use multiple strategies. Simply put, the client
may either (a) approach the problem with behavioral or cognitive strategies using either fluency
shaping or stuttering modification or (b) avoid the stress by hiding, concealing, or covering up
the problem.
Depending on the perceptions of the PWS, his/her personal standards for fluency,
tolerance threshold for stuttering, and definitions of success and non-success, any strategy
could reflect the client’s “best attempt” at conserving the quality and quantity of his/her
resources. SLPs need to help their adolescent clients who stutter build new and multiple
coping strategies for unpredictable and variable situations involving stuttering. SLPs should
continue to appreciate the fact that these clients are making their perceived “best attempt” at
conserving the quality and quantity of their resources at that specific time.

Coping During Adolescence

Adolescents have numerous stressors from academic, school-based issues to family and
peer relationships (de Anda et al., 2000; Frydenberg, 2008). Communication difficulties
associated with stuttering may exacerbate these stressors and increase the demand for
effective coping strategies. Words like effective and productive convey perceptions based on
experience. SLPs and their clients may not share the same understanding of what is a “best
attempt,” because the client may have a limited amount of experience with a limited number of
different strategies and may not have risked enough different outcomes. As professionals, SLPs
need to provide adolescents who stutter with multiple options and choices during treatment
sessions.

Coping Domains

70
 Authors (Compas, 1987, 1998, 2009; Compas, Davis, Forsythe, & Wagner, 1987; Elgar,
Arlett, & Groves, 2003; Kanner, Coyne, Schafer, & Lazarus, 1981) have categorized adolescent
stressors into four domains. The first is duration. Is the problem or stressor perceived as acute
or chronic? Depending on the client’s perspective, specific strategies will be employed. The
second domain is predictability. Does the client “expect” the stressor? Does the stressor or
problem show great variability, or is there an expected trajectory? Is the adolescent able to
predict the difficulty, or is the problem changeable, erratic, and random? For example,
adolescents with asthma begin to learn what triggers asthma episodes. The adolescent who
learns that exercise is a trigger, for example, can prevent the occurrence of a number of
asthma symptoms. Predictability helps the individual select approach strategies (e.g., warming
up for 10 minutes before strenuous exercise, participating in less strenuous sports, taking
prescribed medication prior to exercise) or avoidance strategies (e.g., walking/stretching
instead of participating in competitive sports, stopping the activity at the first sign of wheezing,
chest pain, extreme fatigue).
The third domain is controllability. Is there a sense of controllability about the stressor
or problem? When there is a death in the family, an adolescent may feel he/she has little
control over the situation and surrounding events. The individual’s choice of coping strategy
would be depend on his/her perception of the most appropriate behavior. The strategy(ies)
might include seeking social support, engaging with special friends, or focusing on the positive.
It could also include coping by ignoring the problem, denial, or worrying about what is really
happening. In contrast, when involved in an argument with a peer or parent, the adolescent
might feel he/she has more control over the situation. The adolescent may decide that the best
options “at that time” would be simply walking away, daydreaming about moving out, self-
blame or deciding to go for a physical workout.
The final domain is the perceived degree of impact. Does the current stressor have a
long-term impact or a short-term impact? Once again, the life experiences of the adolescent
may be limited in comparison to those of adults. The may perceive his first experience with
friendship problems as a major impact on his/her life and select coping strategies accordingly.
As the individual gains more experience and maturity, his/her understanding of long-term and
short-term impact changes. A good motto SLPs can use when working with adolescents who
stutter is “They are doing the very best they can with what they have at that moment.” A few
months or years later, the client may appreciate that other choices were possible, though
he/she did not recognize them at the time. In fact, one of the treatment gems SLPs can provide
to an adolescent who shows this kind of “therapy remorse” is to simply say, “You made the best
choice for yourself, at that time.” Coping is about the individual’s ability to ensure the arsenal
is full of multiple productive strategies, while trying to maintain that equilibrium of resources
(Compas et al., 1987; Compas, Connor-Smith, Saltzman, Harding-Thomsen, & Wadsworth,
2001; Elgar et al., 2003). By determining the client’s responses to the domains of duration
predictability, controllability, and degree of impact, the SLP may be better able to provide
and/or teach optimal coping strategies for specific situations at specific times.

Coping as a Developmental Construct

Zimmer-Gembeck and Skinner (2011) recently reported on the development of coping
across childhood and adolescence. Using 58 studies and creating more than 250 age-related
comparisons, the authors arrived at a number of conclusions about the developmental patterns
of coping. They reported that problem solving, seeking social support, distraction (cognitive and
behavioral), and accommodations were perceived by adolescents as effective strategies they
were likely to use. In contrast, escape, worry, resignation, and aggression and acting out were
not frequently used by adolescents and perceived as maladaptive.
Problem solving and support seeking are moderately common coping strategies, which
increase in use as children approach and traverse adolescence. Changes also occur in the type

71
of support seeking; adolescents look for less adult reliance and develop more self-reliance than
they did during childhood. The SLP may observe that younger adolescent clients use strategies
that hover more closely to adult social support seeking and validation, while older adolescents
begin to use strategies that reinforce their autonomy and independence. Older adolescents
would expect complete disclosure by SLPs about program materials, ideas, and approaches
they have selected. These clients would also expect a detailed explanation of why these were
selected before they agree to practice new behaviors and skills or adopt new ideas and feelings.
Older adolescents are more likely to want shared involvement and mutual decision-making on
goal setting, as well as outlines of numerous options and strategies for reaching these goals.
Distraction is also a common coping strategy reported in the literature for both children
and adolescents. Zimmer-Gembeck and Skinner (2011) discuss older adolescents’ increased
use of cognitive distractors (e.g., thinking about a funny movie, thinking about playing
computer games later), as opposed to behavioral distractors (e.g., getting something to eat,
turning on the TV, participating in a sport). This was especially true for situations that
appeared to be less controllable and in which behavioral distractors would be socially
unacceptable or less optimal. A client who has to present a public speech in History class is
less likely to use behavioral distractors (e.g., start eating a candy bar in the middle of the
presentation, turn on an iPod) and more likely to use cognitive distractors (e.g., thinking about
the fact this is only 3 minutes out of the 1,440 minutes today, starting the talk by explaining
that this will be difficult, or imaging removing a brick from a stuttering wall with each word).
Adolescents viewed a variety of distractors—positive imagery, reading a book, watching a
movie, listening to an iPod, playing a sport—as effective coping strategies for specific stressors.
The authors found that adolescents frequently identified accommodation (e.g., use of
positive self-talk, cognitive restructuring) as an effective method for dealing with stressors
(Zimmer-Gembeck & Skinner, 2011). Adolescents may try to remind themselves of their
positive attributes and use social comparison with individuals who are “worse off” than they
perceive themselves to be. They may actually examine the situation with a different perspective
as a result of this coping strategy.
For adolescents who stutter, cognitive reframing is often a helpful coping strategy; it is
also easy for SLPs to teach and clients to learn. For example, the SLP can begin by asking the
client to bring photos to the therapy session. These photos can also be on a flash drive and
shown on a computer screen. The adolescent is handed picture/photo mats in different formats
(e.g., 3” x 5”, 4” x 6’, 8” x 10”) and shapes (e.g., circles, ovals, squares). The SLP directs the
client to place a mat on top of the photo or the image on the computer screen and describe only
the portion that can be seen within the mat opening. The SLP points out that the image
remains the same; only the viewpoint varies with each new matt. The activity helps the client
understand that the same effect can be achieved by using his/her “mind’s eye” to focus on
what to frame in specific situations.
In contrast, escape was reported as one of the most common maladaptive tactics and
also used infrequently by adolescents. This coping strategy might include sleeping for long
periods of time, daydreaming, and just trying to forget. Zimmer-Gembeck and Skinner (2011)
finally report that children and adolescents don’t often use worry and resignation and
aggression and acting out to deal with stressors. It is unusual for clients to report a preference
for activities such as crying excessively, yelling at others, and destroying property to avoid
dealing with a current stressor. In these rare cases, it is preferable that a strong team
approach is adopted including the assistance of the school counselor and psychologist. These
partners can assist in teaching the client more adaptive coping strategies and determining if
the client uses similar coping strategies for common stressors and when dealing with
stuttering.

Flower and Thorn on the Same Rose

72
 Different strategies may be more effective for different stressors and for different
adolescents. For example, Zimmer-Gembeck and Skinner (2011) reported that, as children
become adolescents, they show an increase in the use of problem solving and strategizing for
dealing with specific “controllable” stressors. These might include arguments with parents,
failing a test, deciding on clothing to wear, difficulty with homework, body image concerns, and
the adolescents’ own expectations. However, the authors suggested that adolescents showed an
increase in the use of distraction strategies to manage emotions and deal with what is
perceived as an “uncontrollable stressor.” Uncontrollable stressors might include parental
conflict and divorce, chronic disorders, death of family members, gang violence, or
drug/alcohol use.
This is important information for SLPs working with this age group. Adolescents who
live with stuttering need to cope with everyday common stressors as well as potential stuttering
associated stressors that may seem uncontrollable. Clarke (2006) conducted a meta-analysis
on 40 studies of coping with interpersonal stress among children and adolescents. He reported
that active coping strategies are not always optimal for perceived uncontrollable stressors like
chronic illness or chronic disorders. Extrapolating from these findings, one might surmise that
the individual’s perception of his/her stuttering as either a threat or challenge may dominate
the strategies he/she selects to cope with the disorder during a specific time and in a specific
context. During adolescence, when the chronic nature of stuttering becomes more apparent,
selecting and experimenting with multiple coping strategies could actually provide the client
with a broader base of experiences.
It has been speculated that experience with and exposure to stressors associated with
some chronic disorders (e.g., asthma, epilepsy, diabetes, anorexia nervosa, and congenital
heart disease) actually lead to improved coping skills in adolescence and stress inoculation for
use during later life (Meichenbaum, 2007; Spirito, Stark, Grace, & Stamoulis, 1991). Stress
Inoculation Training is a cognitive-behavioral treatment to assist individuals in coping with
repetitive stressful events or the consequences of stressful events as a prevention to further
"inoculate" them from these ongoing stressors; individuals may also develop strategies through
trial and error that inoculate them against the negative outcomes of future common and/or
specific stressors. With life-long histories of attempting multiple coping strategies with a
chronic stressor like stuttering, adolescents who stutter have the potential for developing and
using productive coping strategies.

Coping Training Programs

Coping is related to perceived resources and perceived outcomes. Successful skill
building programs for coping have been reported with adolescents (Frydenberg, 2008;
Frydenberg & Brandon, 2002; Lewis & Frydenberg, 2004,). For some adolescents, cognitive,
behavioral, and task activities may appear to be more abundant or more effective than
emotion-orientated strategies, based on an individual’s past experience. SLPs may want to
teach cognitive-behavioral techniques to help adolescents who stutter manage their stuttering
more effectively and increase their perceived availability of resources. An excellent tutorial on
cognitive-behavioral therapies for individuals who stutter has been provided by Menzies,
Onslow, Packman, and O’Brian (2009). Although the authors link social anxiety and stuttering
in some adults who stutter, the training techniques could also be useful for individuals who
display communication anxiety. In adolescents, the methods that the authors explain and
discuss (e.g., training in fear hierarchies, cognitive re-structuring attention training) may
actually serve as a pre-emptive activity for adolescents predisposed to social anxiety. The
methods might assist the PWS in either developing new adaptive coping skills or refining
current skills already in use.
There are other types of therapy programs that may be beneficial to adolescents as well.
Mindfulness training has been reported to be useful with children and adolescents who do not

73
stutter. Recently, Burke (2010) analyzed the results of 15 studies that used mindfulness-based
approaches with children and adolescents. She concludes that, although empirical,
longitudinal studies are needed, feasibility data clearly supports these types of interventions
with adolescents. In 2011, Boyle developed a tutorial for SLPs on mindfulness and stuttering.
He reviewed terminology and reported benefits of mindfulness practices, including increased
behavioral exposure, emotional regulation, changes in thought processing, increased
attentional control and acceptance. He then outlined the applications of mindfulness to
stuttering treatment. He concluded that mindfulness training may assist PWS in successfully
managing stuttering at motor, sensory, and psychosocial levels. These cognitive-behavioral
techniques to manage stuttering may support adolescents who stutter in developing productive
life-long coping strategies.
As an initial step in the therapy process, the SLP may need to teach young clients who
stutter about the different categories of help-seeking, problem-solving, emotion regulation,
distraction, strategic planning, information-seeking, and comfort-seeking coping strategies.
Then, the clients will be able to identify their current strategies and confront or deal with
stuttering. Therapy change for adolescents may include the investment in talking about,
exposure to, and instruction in multiple ways to cope with specific situations using task-
orientated, emotion-orientated, or avoidance-orientated strategies.

Summary
This brief review suggests that working on coping strategies, attitudes, and feelings with
adolescents may be as productive as working on behavior changes. Understanding a few new
constructs and concepts may be just the prompt an adolescent needs to start googling and
researching ideas about coping, their resilience, self-esteem, and social support networks.
Encouraging and allowing adolescents to learn more about ways to deal with situations using
approach and avoidance strategies, differences between cognitive reappraisal and logical
analysis, and reasons they might select strategies may open new discussions about the
effective and/or ineffective use of their resources. These therapy talks may generate new
insight into an adolescent’s stuttering, his/her changing identity and, the “why” behind
selecting specific speech modification or fluency shaping techniques.

References
Aldwin, C. M. (2007). Stress, coping, and development: An integrative perspective. New York, NY: Guilford
Press.
Arnett, J. J. (2009). Adolescent storm and stress, reconsidered. American Psychologist, 54(5), 317-326.
Arnett, J. J. (2010). Adolescence and emerging adulthood: A cultural approach, 4/E. Upper Saddle River,
NJ: Prentice Hall.
Blood, G. W., & Blood, I. M. (2004). Bullying in adolescents who stutter: Communicative competence and
self-esteem. Contemporary Issues in Communicative Sciences and Disorders, 31, 68-78.
Blood, G. W., & Blood, I. M. (2007). Preliminary study of self-reported experience of physical aggression
and bullying of boys who stutter: Relation to increased anxiety. Perceptual and Motor Skills, 104, 1060-
1066.
Blood, G. W., Blood, I. M., Maloney, K., Meyer, C., & Qualls, C. D. (2007). Anxiety levels in adolescents
who stutter. Journal of Communication Disorders, 40(6), 452-469.
Blood, G. W., Blood, I. M., Tellis, G., & Gabel, R. (2001). Communication apprehension and self-perceived
communication competence in adolescents who stutter. Journal of Fluency Disorders, 26(3), 161-178.
Blood, G. W., Blood, I. M., Tellis, G. M., & Gabel, R. M. (2003). A preliminary study of self-esteem, stigma,
and disclosure in adolescents who stutter. Journal of Fluency Disorders, 28(2), 143-159.

74
Blood, G., Blood, I., Tellis, G., Gabel, R., Mapp, C., Wertz, H., & Wade, J. (1998). Coping with stuttering
during adolescence. In C. Healey & H. Peters (Eds.), Proceedings of the Second World Congress on Fluency
Disorders (pp. 319–324). Nijmegen, The Netherlands: Nijmegen University Press.
Blood, G. W., Blood, I. M., Tramontana, G. M., Sylvia, A. J., Boyle, M. P., & Motzko, G. R. (in press). Self-
reported experience of bullying of students who stutter: Relations with life satisfaction, life orientation,
and self-esteem. Perceptual and Motor Skills.
Boyle, M. P. (2011). Mindfulness training in stuttering therapy: A tutorial for speech-language
pathologists. Journal of Fluency Disorders 36, 122–129.
Burke, C. A. (2010). Mindfulness-based approaches with children and adolescents: A preliminary review
of current research in an emergent field. Journal of Child and Family Studies, 19, 133–144.
Clarke, A. T. (2006). Coping with interpersonal stress and psychosocial health among children and
adolescents: A meta-analysis. Journal of Youth and Adolescence, 35, 11–24
Compas, B. E. (1987). Coping with stress during childhood and adolescence. Psychological Bulletin, 101,
393-403.
Compas, B. E. (1998). An agenda for coping research and theory: Basic and applied developmental issues.
International Journal of Behavioural Development, 22, 231-237.
Compas, B. E. (2009). Coping, regulation, and development during childhood and adolescence. New
Directions for Child and Adolescent Development, 24, 87-99.
Compas, B. E., Connor-Smith, J. K., Saltzman, H., Harding Thomsen, A., & Wadsworth, M. E. (2001).
Coping with stress during childhood and adolescence: Problems, progress, and potential in theory and
research. Psychological Bulletin, 127, 87–127.
Compas, B. E., Davis, G. E., Forsythe, C. J., & Wagner, B. M. (1987). Assessment of major and daily
stressful events during adolescence: The Adolescent Perceived Events Scale. Journal of Consulting and
Clinical Psychology, 55, 534-541.
Compas, B. E., Malcarne, V. L, & Fondacaro, K. M. (1988). Coping with stressful events in older children
and young adolescents. Journal of Consulting and Clinical Psychology, 56(3), 405-411.
Craig, A., Blumgart, E., & Tran, Y. (2009). The impact of stuttering on the quality of life in adults who
stutter. Journal of Fluency Disorders, 34, 61–71.
Cummins, R. A. (2010). Fluency disorders and life quality: Subjective wellbeing vs. health related quality
of life. Journal of Fluency Disorders 35, 161–172.
de Anda, D., Baroni, S., Boskin, L., Buchwald, L., Morgan, J., Ow, J., et al. (2000). Stress, stressors and
coping strategies among high school students. Children and Youth Services Review, 22, 441–463.
DiClemente, R. J., Santelli, J. S., & Crosby, R. A. (2009). Adolescent health: Understanding and preventing
risk behaviors. San Francisco, CA: John Wiley & Sons.
Dolgin, K. G. ( 2011). The adolescent: Development, relationships, and culture (13th ed.). Boston, MA: Allyn
& Bacon.
Elgar, F. J., Arlett, C., & Groves, R. (2003). Stress, coping, and behavioral problems among rural and
urban adolescents. Journal of Adolescence, 26, 574-585.
Evans, D., Healey, E. C., Kawai, N., & Rowland, S. (2008). Middle school students' perceptions of a peer
who stutters. Journal of Fluency Disorders, 33, 203-219.
Fraser, J., & Perkins, W. H. (Eds.). (2000). Do you stutter? A guide for teens (3rd ed.). Memphis, TN:
Stuttering Foundation of America.
Folkman, S. & Moskowitz, J.T. (2004). Coping: Pitfalls and promise. Annual Review of Psychology, 55,
745-774.
Frydenberg, E. (2008). Adolescent coping: Advances in theory, research and practice. New York, NY:
Routledge.
Frydenberg, E., & Brandon, C. (2002). The best of coping: Instructors manual. Melbourne, Australia: OZ
Child.
Gilman, R., & Huebner, E. S. (2006). Characteristics of adolescents who report very high life satisfaction.
Journal of Youth and Adolescence, 35, 311-319.

75
Guitar, B. (2006). Stuttering: An integrated approach to its nature and treatment (3rd ed.). Philadelphia, PA:
Lippincott Williams & Wilkins.
Hearne, A., Packman, A., Onslow, M., & Quine, S. (2008). Stuttering and its treatment in adolescence:
The perceptions of people who stutter. Journal of Fluency Disorders, 33(2), 81-98.
Hobfoll, S. E. (1988). The ecology of stress. Bristol, PA: Hemisphere Publishing.
Iverach, L., Jones, M., O’Brian, S., Block, S., Lincoln, M., Harrison, E., et al. (2009a). Screening for
personality disorders among adults seeking speech treatment for stuttering. Journal of Fluency Disorders,
34, 173–186.
Iverach, L., Jones, M., O’Brian, S., Block, S., Lincoln, M., Harrison, E., et al. (2009b). The relationship
between mental health disorders and treatment outcomes among adults who stutter. Journal of Fluency
Disorders, 34, 29-43.
Iverach, L., O’Brian, S., Jones, M., Block, S., Lincoln, M., Harrison, E., et al. (2009). Prevalence of anxiety
disorders among adults seeking speech therapy for stuttering. Journal of Anxiety Disorders, 23, 928–934.
Iverach, L., O’Brian, S., Jones, M., Block, S., Lincoln, M., Harrison, E., et al. (2010). The Five Factor
Model of personality applied to adults who stutter. Journal of Communication Disorders, 43, 120–132.
Kanner, A. D., Coyne, J. C., Schafer, C., & Lazarus, R. S. (1981). Comparison of two modes of stress
measurement: Daily hassles and uplifts versus major life events. Journal of Behavioral Medicine, 4, 1–39.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K., & Walters, E. E. (2005) Lifetime
prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey
replication. Archives of General Psychiatry, 62, 593-602.
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal and coping. New York, NY: Springer.
Lewis, R., & Frydenberg, E. (2004). Thriving, surviving, or going under: Which coping strategies relate to
which outcomes? In E. Frydenberg (Ed.), Thriving, surviving, or going under (pp. 3-23). Greenwich, CT:
Information Age.
Manning, W. H. (2010). Clinical decision making in fluency disorders (3rd ed.). Albany, NY: Delmar,
Cengage Learning.
Meichenbaum, D. (2007). Stress inoculation training: A perspective and treatment approach. In P. M.
Leheer, R. L. Woolfolk, & W. E. Sime (Eds.), Principles and practice of stress management (3rd ed., pp.
497-518). Mahwah, NJ: Erlbaum Associates.
Menzies, R. G., Onslow, M., Packman, A., & O’Brian, S. (2009). Cognitive behavior therapy for adults who
stutter: A tutorial for speech-language pathologists. Journal of Fluency Disorders, 34, 187-200.
Moos, R. (2002). The mystery of human context and coping: An unraveling of clues. American Journal of
Community Psychology, 30, 67–88.
Mulcahy, K., Hennessey, N., Beilby, J., & Byrnes, M. (2008). Social anxiety and the severity and
typography of stuttering in adolescents. Journal of Fluency Disorders, 33(4), 306-319.
Offer, D., Ostrov, E., Howard, K. I., & Atkinson, R. R. (1990) Normality and adolescence. Psychiatric
Clinics of North America, 13, 377-388.
Plexico, L., Manning, W., & DiLollo, A. (2005). A phenomenological understanding of successful stuttering
management. Journal of Fluency Disorders, 30(1) 1-22.
Plexico, L. W., Manning, W. H., & Levitt, H. (2009a). Coping responses by adults who stutter: Part I.
Protecting the self and others. Journal of Fluency Disorders, 34, 87-107.
Plexico, L. W., Manning, W. H., & Levitt, H. (2009b). Coping responses by adults who stutter: Part II.
Approaching the problem and achieving agency. Journal of Fluency Disorders, 34, 108-126.
Prester, T. A. (Ed.). (2003). Psychology of adolescents. New York, NY: Nova Science Publishers.
Rew, L. (2005). Adolescent health: A multidisciplinary approach to theory, research, and intervention.
Thousand Oaks, CA: Sage Publications.
Sheehan, J. G. (1954). An integration of psychotherapy and speech therapy through a conflict theory of
stuttering. Journal of Speech and Hearing Disorders, 19, 474-482.
Spirito, A., Stark, L. J., Grace, N., & Stamoulis, D. (1991). Common problems and coping strategies
reported in childhood and early adolescence. Journal of Youth and Adolescence 20, 531-544.

76
 Suldo, S. M., & Shaffer, E. J. (2008). Looking beyond psychopathology: The dual-factor model of mental
health in youth. School Psychology Review, 37, 52-68.
Zebrowski, P. M., & Wolf, A. (2011). Working with teenagers who stutter: Simple suggestions for a
complex challenge. Perspectives in Fluency and Fluency Disorders, 21, 37-42.
Zimmer-Gembeck, M. J., & Skinner, E. A. (2011). The development of coping across childhood and
adolescence: An integrative review and critique of research. International Journal of Behavioral
Development, 35, 1-17.

77

View publication stats