A COMPARISON OF MANIFEST ANXIETY LEVELS IN MENTALLY RETARDED STUTTERERS AND NONSTUTTERERS AS MEASURED BY THE CHILDREN’S MANIFEST ANXIETY SCALE A COMPARISON OF MANIFEST ANXIETY LEVELS IN MENTALLY RETARDED STUTTERERS AND NONSTUTTERERS AS MEASURED BY THE CHILDREN'S MANIFEST ANXIETY SCALE by PAUL KAREL STRAUSS, B.A. THESIS Presented to the Faculty of the Graduate School of The University of Texas in Partial Fulfillment of the Requirements For the Degree of MASTER OF ARTS THE UNIVERSITY OF TEXAS Austin, Texas August 1967 ACKNOWLEDGMENTS I wish sincere thanks to Doctors to express my Jesse J. Villarreal, Lennart L. Kopra, and Charles C. Cleland for the patient and invaluable assistance they have given me in the preparation of this thesis. I also wish to express my appreciation to Mrs. Margaret Oliver for her enthusiastic assistance and support in locating subjects for this study. III TABLE OF CONTENTS CHAPTER PAGE I. THE PROBLEM 1 AND DEFINITION OF THE TERMS USED ... The Problem 2 Statement of the problem 2 Importance of the study 2 Definitions of the Terms Used 3 Anxiety 3 11. REVIEW OF THE LITERATURE 6 Literature on and 7 Anxiety Stuttering Literature and Mental Retardation 9 on ... Anxiety Literature on Incidence of Stuttering among Aments 11 The Children's Manifest Anxiety Scale (CMAS) 13 ... 111. SUBJECTS AND PROCEDURE 16 Subjects 16 The CMAS (Children’s Manifest Anxiety Scale) 18 ... Test Procedure 18 IV. RESULTS 20 V. SUMMARY AND CONCLUSIONS 27 Summary 27 Conclusions 28 Recommendations 29 APPENDIX 30 BIBLIOGRAPHY 34 IV LIST OF TABLES TABLE Page I. Descriptive Information and Anxiety for Twenty Nonstuttering Retardates Scores 21 11. Descriptive Information and Anxiety Scores for Twenty Mentally Retarded Stutterers 22 111. Intercorrelation Matrix for Combined Groups of Mentally Retarded Stutterers and Nonstutterers 24 IV. IntercorrelationMatrix for Twenty Mentally Retarded Nonstutterers 25 V. Intercorrelation Matrix for Twenty Mentally Retarded Stutterers 25 CHAPTER I THE PROBLEM AND DEFINITION OF THE TERMS USED "Anxiety," "hostility," "tension," and other emotional states have long been considered factors which contribute to the has frequency and severity of stuttering. Wischner (36, p. 142) stated that "... practically every worker in the field, includ­ those who factors as basic to stuttering, ing espouse physiological the need consideration of emotional—fear and anxiety recognize for —reactions in the understanding and treatment of the stuttering problem." Santostephano (24, p. 346), in administering the Rorschach test to a group of stutterers and nonstutterers, reported that the stutterers projected on the Rorschach "... significantly content indicative of and than did more anxiety hostility nonstutterers." in the field of mental As with stuttering, investigators retardation have found Wischner's "need for consideration" of anxi­ to exist to understand the emotional ety reactions in their attempts character of the retarded individual. Hutt and Gibby (13, p. 145) state that: The proposition that retarded children experience more anxiety supported generally by than other children is the research evidence which has accumulated in recent years. This is certainly the case for overt or manifest anxiety, or in other words, in anxiety which is consciously visible to others and which is experienced by the individual as appre­hension of an immediate situation. While the effects on stutterers and mentally of anxiety retarded individuals have been considered at some length by investi­ gators dealing with separate populations (i.e., stuttering popula­tions or mentally retarded populations), apparently no attention 1 of any decisive nature has been directed toward determining the significance of the anxiety state in the mentally retarded stut­ terer. A common denominator becomes apparent when one examines the latter portion of the foregoing description of manifest anxiety by Hutt and Gibby (italics added): anxiety which is consciously visible to others and which is experienced by the individual as apprehension of an imme­diate situation. ... This related to, if not identical with, appears closely the type of anxiety experienced by the stutterer when confronted by specific speech sounds, words, or situations. I. THE PROBLEM Statement of the problem. It was the purpose of this study to compare manifest anxiety levels in mentally retarded stutterers and mentally retarded nonstutterers through application of one type of objective measurement, the Children's Manifest Anxi­ety (Appendix, p. Scale 30). Importance of the study Luper and Mulder (17) , in an attempt to indicate that an indirect therapy approach may be in­ sufficient or inappropriate in dealing with a young stutterer whose symptoms appears to persist or increase, have equated the speech anxiety or concern felt by the stutterer with "drive," a term de­ rived from Hull’s drive reduction theory. According to Hull's theory, a reduction in anxiety (or drive) following the completion of the stuttering act would serve to condition the subject to react with greater anxiety when again anticipating a speech situation. This approach to stuttering will be discussed more thoroughly in another section of this study. In addition, Cantor (3, p. 94) has indicated that a be­ havior theory of the type developed by Hull may be .of con­ . defective behavior siderable utility in explaining (referring .. to the mentally defective). Wischner, in referring to the work of Dollard and Miller (8) and Mowrer has stated that: (20), Certain studies suggest that stuttering anxiety, at least in specific experimental situations, has certain functional properties which are similar to those assumed for other kinds of experimentally manipulated anxiety. The stimulus for these particular investigations has derived largely from experimental work on anxiety by learning psychologists (36, p. 151). If this is true, then it follows that a stuttering population should show a higher drive level than a nonstuttering population, as de­termined by an accepted measure of drive level. This study attempts to determine whether anxiety level, as measured by the Children’s Manifest Anxiety Scale, is significantly higher for mentally re­tarded subjects who stutter than for mental retardates who do not that the anxi­ stutter, the hypothesis being stuttering subjects' and fears ety concerning speech sounds, words, and situations will have the effect of raising the subjects' anxiety level, or drive level, as measured by the CMAS, to a level significantly above that of the nonstuttering group. This study appears unique in that it relates the concepts of (A) drive theory and (B) manifest anxiety to the conditions of (C) mental retardation and (D) stuttering in a manner which apparently has not been previously attempted. Ì. DEFINITIONS OF THE TERMS USED Anxiety Hilgard (10, p. 614) has defined anxiety as ". .a state of apprehension or uneasiness related to fear." He . states further that "The subject of anxiety (e.g., a vague fear or foreboding) is ordinarily less specific than the object of fear (e.g., a vicious animal)." In another publication (11, p. 298) Hilgard has listed three typex of anxiety, the first of which he indicates is indis­tinguishable from fear, as follows: 1. called real or true Objective anxiety (also anxiety) depends upon real or anticipated danger whose source lies in the external world real known True anxiety implies a danger. . .. 2. Neurotic anxiety in regard an unknown danger. is to it is found that the Upon analysis danger is, as Freud put it, an instinctive one. That is, a person is afraid of be­ ing overpowered by some impulse or thought that will prove harmful to him. Sometimes there is real threatened a or danger, but the reaction to it is excessive, thus revealing the neurotic element in the anxiety. 3. Moral anxiety is aroused by a perception of danger from the conscience (superego). The fear is that of being punished (belittled, degraded) for doing something that is contrary to the ego ideal. Moral anxiety is experienced as feelings of guilt or shame. Hutt and Gibby (13, p. 145) are a little more definite about their views concerning the relationship of anxiety to fear than is Hilgard. They state emphatically that "anxiety is not the same as fear." They prefer to limit the categories of anxiety types the overt which de­ to two, first being , or manifest anxiety, they scribe ". visible to others and which is as consciously experi­ .. enced as apprehension of an immediate situation," and the other type being "covert," "basic," or "general" anxiety. Cameron (2, pp. 146-147) has defined anxiety as follows: When a is exposed to fear excitants and cannot person flee, his immediate overt behavior is likely to be that of shrinking, hiding or remaining very quiet and still. His covert reactions, however, are not essentially different from to those one sees preparatory flight, even though flight is now impossible and may not even be contemplated. Among other changes, the pulse, blood pressure, and respiratory rate in­ crease, gastro-intestinal functions alter characteristically, kidneys are overactive, tremors and other signs of skeletal tensions appear, the pupils dilate, sweating is present and the mouth These are goes dry. responses all part of the anxiety reaction. We designate as anxiety the predominantly covert skeletal and visceral reactions which, for an unhampered and uninhib­ ited constitutes the normal preliminary phase of emo­ person, tional flight, but which for some reason is prevented from In this going on into its consummatory phase. sense, anxiety is an incomplete or amputated emotional reaction, one that becomes intelligible only when it is understood as originally the preliminary phase of an unconsummated act. This latter definition is the one utilized by Taylor (29) for her manifest as a criterion in developing the anxiety items anxiety scale. As an accepted definition of "manifest anxiety," it best describes the phenomenon with which this study is concerned. CHAPTER II REVIEW OF THE LITERATURE A considerable amount of time and effort has been spent determine what by various investigators of stuttering, trying to role anxiety plays in this disorder. The terms "anxiety," "expec­tancy," "anticipation," etc., used, in the words have been of Wischner (36, p. 139) ". if not always synonymously, at least .. in a context suggesting that the referents of these terms are highly interrelated." Despite a rather haphazard use of terms, interest in the role of anxiety as it to continues. pertains stuttering In the area of mental retardation, it is generally agreed that anxiety, specifically manifest anxiety, presents a problem of considerable significance to the retarded individual. Hutt and Gibby (13, p. 145) have stated: "It is our contention that retarded children are, in general more prone to develop intense anxieties than other children." These authors feel that this is particularly true in the case of "overt," or "manifest" anxiety. One of the most frequently used measures of manifest anxi in the retarded individual has been the Children’s Manifest Anxi ety ety Scale. The following review presents a brief summary of the literature covering research on four subjects with which this study is concerned: (A) the relationship of anxiety to stuttering, (B) the relationship of anxiety to the condition of mental retardation, (C) the incidence of stuttering in a retarded population, and (D) the Children's Manifest Anxiety Scale. 6 I. LITERATURE ON ANXIETY AND STUTTERING Johnson (14, p. 23) has stated that stuttering seems to be an "anxiety-motivated avoidant response that becomes conditioned to the cues or stimuli associated with its occurrences." It is fur ther stated by Johnson (14, that pp. 23-24) responses of this type are anticipatory and that anticipation of the response is apprehen­sive, characterized by some degree "ranging from near panic the to mild sort of affective reaction which very the stutterer expresses by saying simply that he would rather not stutter—an affective con dition or state which we might refer to as 'rather-not-ness' ." .. Johnson indicates that if the the stuttering anxiety is lessened, severity and frequency of occurrence of stuttering also decreases, stating as follows: The more intense the speaker's anxiety or concern over the anticipated "stuttering," the more cues it is likely to responses become associated with, so that the avoidant will occur more frequently, and the more intense or elaborate or prolonged or severe the avoidant responses will be on the average. As the anxiety about stuttering is weakened, there­fore, both the frequency and the severity of the avoidant reactions—the stuttering, that is—are reduced. Improvement is a function, then, of anxiety de-confirmation (14, p. 24). Johnson's statement indicating that de-confirmation of anxiety is a prime factor in improvement of the stutterer's speech presents an idea which is inherent in the formula devised by Van Riper (31, p. 354) to demonstrate the factors which increase or decrease the frequency and severity of stuttering, as indicated; (PFAGH) + (SfWf) + Cs Stuttering frequency _ M + FI and severity In the numerator of this equation, (PFAGH) represents penalty, frustration, anxiety, guilt, and hostility; (SfWf) rep­resents (a) situational fears generated by past stuttering experi­ences in similar situations, and (b) "word and phonetic fears based on memories of past stuttering unpleasantness in similar situations"; Cs represents what Van Riper terms the "communicative importance of what is being said" (31, p. 354). In "morale or the denominator, the symbol M represents ego strength or self-confidence" while FI is described as represent­ing the "amount of felt fluency" (31, p. 309). Van Riper states that "the task of therapy is to weaken each of the numerator and to strengthen the denominator" (31, p. 355) Wischner (36) has reviewed with competence some of the literature concerning anxiety and stuttering. Wischner describes stuttering anxiety as falling within two general categories: "gen­eral situational anxiety" and "specific word anxiety" (36, p. 143). Studies by Schulman (27) Porter (21), Hahn (9), and others are , described in which the mentioned two types of anxiety (or expectancy) are treated as intervening variables, one being varied experimentally while the other is held constant. It is Wischner's conclusion that stuttering behavior provides "an excellent opportunity for the study of anxiety, only it operates in stuttering, but also as it not as functions in other forms of maladaptive behavior" 152). (36, p. Luper and Mulder, in a of stuttering recent treatment in children (17), make extensive of the use as concept of anxiety a significant one in the description of stuttering behavior. A reference is made earlier to this treatment, which relates anxiety to Hull's drive reduction theory of learning (12). In terms of this theory, the probability of the stutterer's reacting to any speech sound with situation, word, or a stuttering response is determined by a multiplicative relationship between (a) the dominant habit­ stut­ response in a hierarchy of habit-responses, in this case, the or tering response, and (b) the drive level, level of anxiety, hostility, fear, etc. In these terms, an increase in drive level, or anxiety level, will enhance the probability of the stutterer in a stuttering manner in a speech situation. The result- reacting reinforcement of the dominant habit-response (i.e., the stut­ ing tering response) will in turn increase the drive level, due to the and Mulderaforementioned multiplicative relationship. Luper paraphrase from Hull's theory, as follows: the stimulus of leads to a of excess ... anxiety response tension in the speech musculature. Each time this particular pattern is repeated—the combinationof anxiety, tension, and subsequent anxiety reduction—the possibility of excess tension becoming habitually attached to the stimulus of anxi­ety (17, p. 76). is increased Van Riper would seem to have had something of this na­ ture in mind when he disorders have their stated that "speech may origins in emotional storms: in turn they may provoke emotion" (31, p. 66). The significance to this study of the approach to stut­tering taken by Luper and Mulder becomes most apparent when one considers that the measure of manifest anxiety from which the Chil­ dren's Manifest Anxiety Scale adapted—the Taylor Manifest Anxi was ety Scale (30) —was originally designed as a measure of Hullian drive level. that there exists It appears that experimenters agree a relationship between "anxiety" and the frequency and severity of stuttering, although they are by no means agreed as to the exact nature of this relationship. Some have related stuttering anxiety to Hullian "drive level," a concept developed by learning theorists II. LITERATURE ON ANXIETY AND MENTAL RETARDATION Cromwell (7, p. 58) quotes Moss (19) in describing the mentally retarded person as a failure-avoiding person . . . one with a very low generalized expectancy for success who responds which lead to cues in the environment (negative cues) primarily of additional failure." Hutt and to the prevention Gibby (13, p. 148) are in agreement with this, stating that ". . . mentally re­tarded individuals have lower needs to achieve than do normal chil­ dren." state further that "... decreased need to achieve They may the resultant of persistent anxiety." be The the of position of Hutt and Gibby on importance is borne the conclusions of Cochran and anxiety out by a study by Cleland (6) in which seventy-five normal fourth grade students and thirty-seven mentally retarded students who had reached a fourth grade achievement level were administered the Children’s Manifest Anxiety Scale. When results were compared, it was found that the mentally retarded group was "significantly more anxious than normal fourth grade students of their respective sex." In addition to com­ paring groups of similar achievement levels, these authors compared subjects within their two of the same in groups chronological age order to eliminate what they termed "the normal stresses of adoles­ cence" as an intervening variable. Again, they found that the mentally retarded subjects showed a higher level of anxiety. In a study by Wiener, Crawford, and Snyder (34) it was concluded that high anxiety levels prevented mildly retarded chil­ for their dren from achieving academically to a degree appropriate capacity. In another study, utilizing the Children’s Manifest Anxi­ety Scale, Malpass, Mark, and Palerma (18) measured anxiety levels in forty-one noninstitutionalizedmentally retarded children, fifty-three institutionalized retarded children, and sixty-three normals. They found that both groups of retarded children were significantly "more anxious" than the normal children. Similar results were ob­ tained in a study by Warren and Collier, in a study designed spe­ to: cifically (a) investigate the validity of the CMAS as a measure whether the institutionalized ... determine retarded distributed themselves on the and of anxiety, (b) to mentally test, (c) to compare high grade retardates with moderately retarded and with the lowa "normal" sample of this test (32, p. 192). ... This study is discussed in greater detail in the final section of this chapter. To the idea that the retarded person is liable summarize, to demonstrate a higher anxiety level than the nonretarded individ­ ual seems to be generally accepted. III. LITERATURE ON INCIDENCE OF STUTTERING AMONG AMENTS Schlanger and Gottsleben (25) have indicated that the incidence of stuttering in a mentally retarded population is con­siderably higher than the incidence in the normal population. However, they included individuals whom they termed "primary stut­ terers," disfluent individuals who considered to be uncon­ were cerned or unaware of the deviant speech patterns they exhibited. This procedure violates a criterion some speech pathologists con­sider necessary. For example, Robinson (23, 44) has this cri­ p. terion in mind when he says that "speaker awareness colored by distress is assumed before the label of stutterer or stammerer is applicable." It is possible that this writer’s on meeting insistence the criterion expressed by Robinson accounted for the fact that fewer stutterers were found than would be expected from the 17 per­ cent incidence reported by Schlanger and Gottsleben for an insti­ tutionalized, mentally retarded group. These authors make the statement that "secondary reactions were observed in 26 percent of the stutterers." Robinson (23, p. 44) indicates that "... evalua­ tional theorists tend to deny the validity of this dichotomous classi fication. Their concept of stuttering doesn't include the primary stage." If this premise is accepted, then it appears that only 26 of Schlanger and Gottsleben's "stutterers" percent (4.5 percent of the retarded population screened by them) did, in fact, stutter. Cabanas (1) reports an interesting study supporting the point of view presented by Robinson. As a result of observing fifty children with speech defects over a period of two mongoloid years, that: he states It is evident that real stammering does not exist in of low IQ because of the lack of self-observation and cases self-consciousness about speech in our opinion, the symptomology ... of speech in cases of mongolian children is rather of the cluttering type. The statement does not exist" aments that "real stammering among would seem to be an obvious over-statement and need not be consid­ ered. The basis on which Cabanas makes the statement, however, appears significant. Cabanas states that in the of children group observed there lack of use being was a (a) block anticipation, (b) of "synonyms, deviations and omissions of grammatical elements due to the conscious efforts of avoiding words and (c) magic .. ~ words, abnormal resporatory movements, etc." These subjects appear not to have fulfilled the requirements of Johnson's definition of avoidance reaction" (15, 216). stuttering as an "anticipatory, apprehensive hypertonic p. While the present study does not concern itself primarily with the incidence of in a retarded population, it is stuttering to note that in one in which the writer interesting institution, was permitted to interview initially each child in the school rather than depending on the teacher-interview method, five persons were accepted as appropriate subjects for the experimental group, out of a total school population (educables and trainables) of ap­proximately 425. The proposition that the incidence of stuttering among retardates is times normals is consistent not many greater than among with findings in a study by Karlin and Strazzula (16) who examined fifty noninstitutionalizedmentally retarded children in a pediatric clinic to obtain developmental data and to determine the relation­ ship of laterality development to IQ. They state that "stuttering was present in one of the fifty children included in the study, which is the that is approximately same percentage (2 percent) usually given for the number of stutterers found in the normal school population" (16, p. 290). It appears probable, from the evidence noted here, that the incidence of stuttering in a retarded population closely ap­incidence for a proaches figures nonretarded population, provided that one valid the condition of speaker accepts as awareness, or self-labelling by the stutterer. IV. THE CHILDREN'S MANIFEST ANXIETY SCALE (CMAS) Two commonly accepted measures of Hullian drive level have been the Children's Manifest Anxiety Scale as described by Castaneda et at and the Taylor Manifest Anxiety Scale (29), the latter scale being the parent instrument from which the children's scale was derived. Both of these scales have been targets of crit­ icism in the past. Wirt and Brown could not (35), for instance, find a positive correlation between clinical "anxiety" as rated by psychologists and scores on the Children's Manifest Anxiety Scale. Similar findings were noted by Shatin (26) in relation to the Taylor Manifest Anxiety Scale. Shatin compares MAS scores with clinical ratings of anxiety, depression, instability, and hostility in non-psychotic male psychiatric patients and found that while a relation­ship existed between the total pathology scores on their clinical rating scale and manifest anxiety as measured by the Taylor scale, he was unable to demonstrate a correlation between significant Taylor Manifest Anxiety Scale scores and anxiety items on the clin­ ical rating scale. Shatin's research results apparently support a statement by Taylor concerning her scale, as follows: The construction of the test was not aimed at develop­ing a clinically useful test which would diagnose anxiety, but rather was designed solely to select Ss differing in general drive level. Thus the question of the scale's valid­ity (i.e., its agreement with clinical judgments) a is in sense irrelevant to the experimental purpose for which it is developed. In light of this, the test might have been given a more . . . (30, p. 303). noncommittal title Taylor states in the same article, however, that: the fact that the items on the scale were selected ... by clinicians as referring to manifest anxiety as it is described psychiatrically make the title completely inappropriate does not (30, p. 303). Taylor's statement describing the title of the Taylor Manifest Anxiety Scale as "not completely inappropriate" is, in fact, supported by recent studies using the Children's Manifest Scale. Malpass, Mark, and Palerma found that: Anxiety 14 CMAS scores significantly differentiated educable mentally handicapped retardates from institutionalized . .. both of retarded children had groups significantly higher ("more anxious") scores than normal children (18, p. 308). Warren and Collier (32) to determine whether , attempting the Children's Manifest Anxiety clin- Scale did, in fact, measure the as Cameron ical concept of anxiety defined by (2), found a signif­ icant positive correlation between CMAS scores, clinician's ratings of anxiety indicated by Ss, and behavior check list scores. Valid­ ity of the CMAS as a measure of anxiety was investigated in two ways (1) CMAS scores for fifty-four Ss were correlated with of to whom judgments anxiety made by clinical psychologists the CMAS scores were unknown, and (2) CMAS scores were corre­ lated with scores on a behavior check list developed for this study and checked by psychiatric aides supervising these pa­tients at least eight hours a day. Scores on the twenty-five item check list were determined by the number and degree of symptoms marked for each subject. As further positive evidence for the validity of the CMAS as a measure of anxiety, Warren and Collier point to a study (33) in which they found that mentally retarded subjects who showed "a high discrepancy between the Wechsler IQ and the revised Colum­ bia Mental Maturity Scale in favor of the latter," also showed high CMAS scores for their population, whereas when Wechsler scores ex­ ceeded Columbia scores, CMAS scores were relatively low. They point out that the "Wechsler is considered to have tests sensitive to and the Columbia can be assumed not to have much of this 'anxiety' which characteristic." Warren and Collier indicate that "'anxiety' the Wechsler score occurs in the same patients where there depresses is high 'anxiety' measured by the CMAS." These authors explain the negative findings of other investigators —Wirth and Broen (35) and Shatin (26) —as being due to the procedural faults and misin­ of results. terpretation Data obtained by Warren and Collier resulted in a test results ob- retest reliability score of .89, a finding similar to tained by Fryer and Cassel, (22). In discussing their results, Warren and Collier state that: since all correlations between measures of "anxiety" based on ratings by observers and the CMAS are posi­ ... . .. tive and many of them are fairly high, there seems reason to believe that what the CMAS measures overlaps with which cli­nicians call "anxiety." Much of the study dealing with the CMAS, as this review shows, has concerned itself with the gathering of evidence for or against the usefulness of the scale as a measurement of "anxiety." In general, early studies placed the CMAS and its parent scale, the Taylor MAS, in an unfavorable light in terms of measuring "anxi­ ety," whereas later studied tended to validate the scale in this respect. In conclusion, it appears that while investigators are not always in agreement as to what they mean by anxiety, they are in general accordance with the proposition that anxiety is a factor to be reckoned with when dealing with a stuttering problem. Moreover, general agreement that the mentally there is retarded population is "more anxious" than the nonretarded a group population. Opinions are anything but unanimous, however, concerning the incidence of stuttering among aments, a possible reason being a lack of uniform definition of the term, "stuttering." Finally, appears that while early experiments it resulted of the effectiveness and of in serious questioning appropriateness the Children's Manifest Anxiety Scale as a measure of manifest anxi­ ety, more recent, highly-controlled studies indicate that the scale is, indeed, a useful instrument in this respect. CHAPTER III SUBJECTS AND PROCEDURE I. SUBJECTS Subjects for this study consisted of twenty institution­ alized mentally retarded stutterers and institutionalized twenty mentally retarded nonstutterers, matched for chronological age, sex, and IQ. Both groups were chosen from the academic and training of five schools for mentally retarded in Texas, follows: programs as the Austin State School, the Travis State School, the Mexia State School, the Abilene State School, and the Denton State School. In one stutterer was chosen of the Brown addition, from the population School Junior Ranch, an institution located in Austin, Texas, and devoted to the care and education of exceptional children in a resi­ dential setting. Choosing of subjects for the experimental group, in the was done initially by the teacher-referral method majority of cases, That is, a teacher or school principal would decide whether or not, in their judgment, a child was a stutterer, and if the decision was affirmative, the child would be referred to the examiner. In two of the schools, it was possible for the examiner to go from classroom to classroom, obtaining initial speech samples from the children in the classrooms. These initial speech samples consisted of having each child state his and home town, how name, had been at the school, and so on. On these occasions, the long he examiner made the initial decision as to whether or not the child should be included in the experimental group. In the other schools, 16 where it was not convenient to do the in question this, subjects were sent to the examiner upon referral by their classroom teacher. Whether a subject was referred by a teacher or chosen initially by the writer, an interview took place for each candidate just prior to an individual testing session during which the child was about his questioned (a) awareness of having a speech problem, (b) how he had been whether long aware of it if a problem existed, (c) he had a name or label for the problem, (d) what the identity of the person was who first identified and labelled the problem as stuttering, and (e) whether there was a history of stuttering in the family. This procedure was carried out to satisfy the criterion of "speaker awareness" referred to by Robinson (23, p, 44). Many of the teacher-referred subjects exhibited articulation problems of every form and degree of severity, and apparently were referred in the mistaken belief that any sort of speech deviation constituted "stuttering." These were quickly eliminated from consideration by the examiner. Subjects for the experimental group were chosen on the basis of (a) whether or not they exhibited observable disfluency and/or struggle in speaking, and (b) whether or not the subject indicated an awareness of the existence of a fluency problem. Of the sixteen males and four females chosen for the experimental group, nineteen stated that they "stuttered," and one girl stated that she had a "disfluency." Thirteen of these subjects were able to single or they the first to discover were out a person persons who, said, the existence of fluency problem and attach a label to it. Eleven a of indicated that the so designated was a parent these subjects person while the other two named a school teacher. Nine of the subjects of from three had received speech therapy, over periods time ranging months to two years. Levels of IQ for the experimental group ranged from 37 to 78, with a mean IQ of 38. Nine of the stuttering subjects fell 60-80 ten of these subjects were within the within the IQ range, 60-80 IQ range, ten of these subjects were within the 40-60 IQ and range, one subject had an IQ of 37. This latter score was con- the of the school in which the sub­ sidered misleading by principal ject was enrolled, because the child came from a bilingual home where English was spoken as a second language. The child’s rela­tively poor command of English as was suggested having a depressing effect on the child’s intelligence test performance. Members of the control group consisted of twenty mentally retarded nonstutterers matched as closely as possible to the experi­ mental group in terms of and sex, chronological age, IQ. II. THE CMAS (CHILDREN'S MANIFEST ANXIETY SCALE) This scale consists of forty-two anxiety items and eleven lie items, the lie items being interspersed randomly among the anxi­ety items. The original propose of the lie items was to supply an index of a subject's tendency to falsify his answers on the anxiety scale. While it has been found that retardates, as a score group, higher on the lie scale than nonretarded subjects, Warren and Collier (32) have indicated that this is probably due to the retardate's inadequacy at self-appraisal, rather than a deliberate attempt to lie. The anxiety scale is scored by adding all affirmative answers. Each of these affirmative answers receives a numeral score of 1. The lie score is calculated in the same with the manner, exception of two items, which if answered negatively, contribute to the lie score. III. TEST PROCEDURE Following the interview to determine whether a person was an appropriate (stutterer or nonstutterer) subject for either the experimental or control group, the Children's Manifest Anxiety Scale was administered in a manner similar to the procedure followed by Warren and Collier (32). Test procedure differed from that of Warren and Collier in that each subject was tested individually. Test items were the presented orally in the second person, eliminating necessity for the subjects' having to read the items, and removing the possibility of confusing the subject as to whether the test items referred to him or to the examiner. There was no indication that the the subjects experienced any difficulty in understanding test items or that they experienced difficulty in responding appro­ priately. The subject was asked to respond with a "yes" or "no" to each test item as it was presented, and the examiner recorded each subject's response. CHAPTER IV RESULTS Table I presents the raw scores and information obtained from the control group, or nonstuttering retardates, together with means and standard deviations for the variables indicated (IQ, anxi­ ety scores, lie scores, and chronological age). A comparison of manifest anxiety score means for the con­trol in which and group, the mean was 20.0, thirty-nine male, insti­tutionalized retardates tested by Warren and Collier, in which the mean was 19.5, indicates that anxiety score means for the two groups are practically identical. This is interpreted as one indication that this study’s control group is of the retarded representative population in general, at least insofar as anxiety levels are concerned. It should be noted that Warren and Collier found a "con­ sistently higher" anxiety score mean for MR females with a mean score of 26.0 for 30 subjects than for their MR male group. This is in accordance with other studies involving the Children's Manifest Anxiety Scale (4, 5). The small number of female subjects included in this study precluded any significant conclusions being drawn in this area. Table II presents the raw data obtained from the experi­ mental group consisting of twenty mentally retarded stutterers, to-and standard deviations for each variable. These gether with means scores were combined with those for the control group (Table I) and the combined scores were then subjected to a computerized, MVAR of statistical with (multivariate analysis regression) program, in order to determine whether (a) anxiety score as a criterion, 20 TABLE I DESCRIPTIVE INFORMATION AND ANXIETY SCORES FOR TWENTY NONSTUTTERING RETARDATES Sex IQ A-Score L-Score CA M63 28 617 M64 20 315 M61 17 711 M53 14 813 M57 23 413 M74 24 718 M60 17 218 F61 18 618 M51 24 416 F44 21 416 M68 11 717 M67 22 210 M42 19 412 M57 26 213 M56 23 315 M54 20 717 M70 20 218 F55 20 519 F 63 11 119 M 56 21 117 58.8 20.0 4.3 15.6 Mean Standard 7.9 4.3 2.2 2.7 Deviation TABLE II DESCRIPTIVE ANXIETY SCORES FOR TWENTY MENTALLY RETARDED INFORMATION AND STUTTERERS Sex CA IQ A-Score L-Score M 70 38 518 M 69 13 617 M 279 68 12 M 44 36 712 M 59 20 512 M 78 27 417 M5 6330 17 F 30 67 421 M 50 27 516 F 37 33 416 M 66 31 616 M6420 5 9 M 42 30 210 M 55 31 5 13 M 54 39 515 M 52 31 318 M 52 30 522 F 52 30 4 19 F 66 24 120 M54 19 717 Mean 58.1 28.3 4.9 15.9 Standard 6.4 1.7 3.5 10.4 Deviation there was a statistically significant difference between anxiety scores of MR stutterers and MR nonstutterers, and (b) whether there was a significant correlation between anxiety scores and any of the other intervening variables, excluding group membership (stutterers vs. nonstutterers). It was found that the mean anxiety scores for stutteres and nonstutterers were significantly different at the .001 level of confidence (F = 21.44 with df = 1/34). As indicated in tables I and 11, the mean anxiety score for nonstutterers was 20.0 and for stut­ terers it was 28.3. An intercorrelation matrix for the combined stuttering and nonstuttering groups was included as an integral part of the MVAR program (Table III). It is evident from an examination of this table that the correlation between anxiety score and group membership (stutterers vs. nonstutterers) is the only correlation involving anxiety score which is statistically significant with df = 38). Examination of correlations between the other variables reveals (excluding anxiety score) none of statistical significance with the exception of that between chronological and sex. If age the correlation between chronological and sex were actually age reliable, a significant correlation between these variables would simply indicate that the females chosen for this study were, on the older than the males. average, Table IV and Table V the results from a further present attempt at evaluating the relationship between anxiety scores and the other variables involved. In these two instances, the stutter­ ing group and the nonstuttering group are treated separately. An intercorrelation matrix for the mentally retarded nonstuttering control group is presented in Table IV. An rof .42 is required for any of these correlations to be significant at the .05 level of and none of the correlations between anxiety score and confidence, the other four variables meet this requirement. TABLE 111 INTERCORRELATION MATRIX FOR COMBINED GROUPS OF MENTALLY RETARDED STUTTERERS AND NONSTUTTERERS Variable IQ A-Score L-Score CA Stutterers vs. Nonstutterers Sex IQ A-Score L-Score CA .16 .05 -.20 .23 .07 .01 -.45* .21 .04 -.14 0 .04 -.61** -.15 -.04 *p A O Ln **p < .01 with df = 18. TABLE IV INTERCORRELATION MATRIX FOR TWENTY MENTALLY RETARDED NONSTUTTERERS Variable IQ A-Score L-Score CA Sex .21 .28 .06 -.45* IQ -.06 .02 .23 A-Score -.13 -.15 L-Score -.03 *P < .05 with df = 18. TABLE V INTERCORRELATION MATRIX FOR TWENTY MENTALLY RETARDED STUTTERERS Variable IQ A-Score L-Score CA Sex .13 -.07 -.31 .47* .14 -.10 -.45* .20 .10 -.27 *P < .05 with df = 18. Table V 25) an intercorrelation matrix for (p. presents the experimental group of twenty mentally retarded stutterers. ,05 level Again, an r of .42 is required for significance at the of confidence, and none of the correlations between A-scores and the other variables meet this standard. in Table V, the r for to It is interesting note that, sex and lie score is .47 (P < .05). If this correlation were ac­ tually reliable, then the males had a significantly higher lie score than the females. selection resulted in 16 However, since subject males and the observed correlation only four females, significant may statistically artifactual. be In conclusion, it is felt that the primary inferences which may be drawn from the information presented in this chapter are (a) that retarded stutterers demonstrated a significantly higher level of manifest anxiety, as a group, than retarded nonstutterers, as indicated by F-test results, and (b) the correlation between manifest anxiety and group membership (stutterers vs. nonstutterers) demonstrates a strong relationship between these variables, r = .61 (P < .001). CHAPTER V SUMMARY AND CONCLUSIONS I. SUMMARY Twenty institutionalizedmentally retarded stutterers and twenty institutionalized matched nonstuttering retardates, as closely as possible in terms of sex, measured IQ, and chronological age, were administered the Childrens Manifest. Anxiety Scale. A statistical analysis of the results indicates that (a) the stutter- as a scored than ers, group, significantly higher, anxiety-wise, their nonstuttering counterparts, and (b) the aforementioned inter­ vening variables had no statistically significant affect on anxiety scores for either group. One interesting factor which came to light relatively early in the study was the of what the examiner surprising scarcity considered stutterers the retarded concerned since, among groups according to Schlanger (25), the retarded population is supposed to contain a high incidence of stutterers. In actuality, the in- the en­ cidence of stuttering among retarded population which was countered in this study was not far different from the incidence A for the reported for a nonretarded population. suspected reason greater incidence of stuttering indicated by Schlanger is the fact as a stutterer or that, in classifying a subject nonstutterer, he made use of a dichotomous classification system involving the con- to which cept of "primary" and "secondary" stuttering, according a is unaware and un­ a "primary" stutterer would be person who of, concerned about, his nonfluencies. As indicated by Robinson (23, p. 44), there is considerable controversy concerning the validity 27 of since feel that an element this concept, many speech pathologists of speaker-awareness for an individual tinged by anxiety is necessary to be accurately labelled a stutterer. This is one of the criteria considered in this study in determining whether or not a subject be­longed in the experimental group. II. CONCLUSIONS Wischner (36, p. 151) asks the question, "Is anxiety in stuttering unique or does it bear a relationship to anxiety as it has been studied in other experimental contexts and to other behavior assumed to be driven by anxiety motivation?" The fact that, in this study, stutterers indicated a higher anxiety level than nonstutterers when administered an anxiety scale not specifically related to stuttering or speech per se, seems to indicate the strong possibility of a relationship between stutter­ ing anxiety and anxiety as described in other contexts. It is most interesting to note, in light of the obtained results, that none of the anxiety items in the Children's Manifest Anxiety Scale per­ tain either to stuttering, specifically, or to speech handicaps in general. Viewing the experimental results in another light, this study lends support to the results obtained by Warren and Collier (32), Malpass et al (18), and others, indicating that retardates, as a group, present a significantly higher anxiety level, as meas­ured by the CMAS, than nonretarded subjects. Also, considering the facts that (a) retardates in general indicate a higher anxiety level situation than nonretarded subjects, and (b) that in an experimental stuttering retardates indicate an even higher anxiety level than retarded controls on an identical scale, it be- their nonstuttering comes easy to hypothesize a relationship between stuttering anxiety and what Wischner calls "other kinds of experimentally manipulated anxiety" (36, p. 151). It might well be concluded, therefore, that anxiety experienced by stutterers about their disfluencies and about speech in general is basically no different from anxiety due to other factors, and therefore may be measured by any device, such as the Children's Manifest Anxiety Scale, considered adequate for the meas­ urement of anxiety not specifically related to speech and stuttering. III. RECOMMENDATIONS There to be several possibilities for further re­ appear search related to difficulties experienced For this study. instance, in this study in locating an adequate number of mentally retarded stutterers to need for reexamination of appear point up a previously reported incidence figures and the manner in which they were obtained It is not surprising that incidence figures tend to differ when there appears to be no uniform definitionof stuttering and no con­ sistent method of differentiating the stutterer from the nonstutterer. Another area for investigation which has already been in­directly pointed out might be a study of the possible relationship between sex differences and manifest anxiety scores among mentally retarded stutterers. APPENDIX C.M.A.S. Year Month Day Name Sex Date Residence Born Telephone Age M.A. 1.0. Test Used When Verbal Score Performance Score Grade Birthplace Native Language Classification Diagnosis Etiology of father of mother Occupation of mother Birthplace of father Examiner Place of Examination Raw Score (A) Raw Score (L) InitialDiagnosis of Stuttering by Stuttering Severity Onset Additional Handicaps Est. of Social Adequacy Previous Therapy Type Therapy of Previous History of Stuttering in Family Remarks: Please answer ALL the following items Yes or No by circling the word Yes the word No. or Yes No 1. It is hard for me to keep mind on my anything. Yes No 2. I nervous when someone watches me. get Yes No 3. I feel I have to be best in everything. Yes No 4. I blush easily. Yes No 5. I like everyone I know. Yes No 6. I notice my heart beats very fast sometimes. Yes No 7. At times I feel like shouting. Yes No 8. I wish I could be far from here. very Yes No 9. Others seem to do things easier than I can. Yes No 10. I would rather win than lose in a game* Yes No 11. lam secretly afraid of a lot of things. Yes No 12. I feel that others do not like the way Ido things. Yes No 13. I feel alone even when there are people around me. Yes No 14. I have trouble making up my mind. Yes No 15. I get nervous when things do not go the right way for me. Yes No 16. I worry most of the time. No kind. Yes 17. lam always I about what will say to me. Yes No 18. worry my parents Yes No 19. Often I have trouble getting my breath. Yes No 20. I get angry easily. Yes No 21. I always have good manners. 22. hands Yes No My feel sweaty. Yes No 23. I have to go to the toilet more than most people. Yes No 24. Other children are happier than I. think about me. 25. Yes No 26. I have trouble swallowing. Yes No I worry about what other people that did not difference later. Yes No 27. I have worried about things really make any Yes No 28. My feelings get hurt easily. Yes No 29. I worry about doing the right things. Yes No 30. lam always good. Yes No 31, I worry about what is going to happen. Yes No 32. It is hard for me to go to sleep at night. Yes No 33. I about how well lam doing in school. worry Yes No 34. lam always nice to everyone. Yes No 35. lam scolded. My feelings get hurt easily when Yes No 36. I tell the truth every single time. Yes No 37. I often get lonesome when lam with people. Yes No 38. I feel someone will tell me Ido things the wrong way Yes No 39. I am afraid of the dark. Yes No 40. It is hard for me to mind on school work. keep my my Yes No 41. I never get angry. Yes No 42. Often I feel sick in stomach. my Yes No 43. I worry when Igo to bed at night. Yes No 44. I often do things I wish I had never done. Yes No 45. I get headaches. I often about what to Yes No 46. worry could happen my parents. Yes No 47. I never say things I shouldn't. Yes No 48. I get tired easily. Yes No 49. It is good to get high grades in school. Yes No 50. I have bad dreams. 51. Yes No I am nervous. Yes No 52. I never lie. Yes No 53. I often worry about something bad happening to me. BIBLIOGRAPHY 1. R. Some Cabanas, findings in speech and voice therapy among mentally Folia Phoniatrica 1954, deficient children. , 6, 34-37. 2. Cameron, Norman A. The Psychology of Behavior Disorders: A Biosocial Interpretation. Boston: Houghton-Mifflin Co,, 1947. 3. Cantor, G. N. Chap. 3, Hull-Spence behavior theory and mental deficiency. In Handbook of Mental Deficiency (N, R. Ellis, ed.), New York: McGraw-Hill, Inc., 1963. 4. Castaneda, A., B. R, McCandless and D. S. Palerma. The chil­ dren's form of the manifest anxiety scale. Child De­ velopment, 1956, 27, 317-326. 5. Cochran, I. L. "Some Correlates of Anxiety in Children." Un­ published Master's thesis, The University of Texas, Austin, 1957. 6. and C. C. Cleland. Manifest anxiety of retardates and , normals matched as to academic achievement. American 539-542. Journal of Mental Deficiency , 1963, 67, 7. Cromwell, R. L. Chap, 2, A social learning approach to mental retardation. In Handbook of Mental Deficiency (N. R. New York: 1963. Ellis, ed.), McGraw-Hill, Inc., 8. Dollard J. and N. E. Miller. Personality and Psychotherapy. New McGraw-Hill, Inc., 1950. York: 9. Hahn, E. F. A study of relationship between the social complex­ity of oral reading severity the situation and the of 4-14. stuttering. Journal of Speech Disorders, 1940, 5, 10. Hilgard, E. R. Introduction to Psychology 3rd ed. New York: 3 Harcourt, Brace, and World, Inc., 1962. 2nd ed. New York: 11. Theories of Learning , Appleton­Century-Crofts, Inc., 1956. 12. Hull, C. L. Principles of Behavior. Appleton­ , New York: Century-Crofts, Inc., 1943. L. and R. C. Gibby. The Mentally Retarded Child 13. Hutt, M. 3 2nd ed. Boston: Allyn and Bacon, Inc., 1966. 14. 34 Johnson, Wendell, et al. Stuttering in Children and Adults. Minneapolis: U. of Minn. Press, 1955. et al. School Children rev. ed. 15. Speech Handicapped,3 New York: Harper and Row, Inc., 1956. 16. I. W. and M. Karlin, Strazzula. Speech and language problems of mentally deficient children. Journal of Speech and Hearing Disorders 3 1952, 17, 286-294. 17. H. L. and for Chil- Luper, R. L, Mulder. Stuttering: Therapy dren. 1964 Englewood Cliffs, N.J.: Prentice-Hall, Inc., 18. Malpass, L. F., S. Mark, and D. S. Palerma. Responses of re­tarded children to the CMAS. Journal of Educational Psy­chology, 1960, 51, 305-308. 19. Moss, J. W. Failure-avoiding and success-striving behavior in mentally retraded and normal children. Ann Arbor, Mich.: University Microfilms, 1958. 20. Mowrer, 0. H. Learning Theory and Personality Dynamics. New York: 1950. Ronald Press, 21. Porter, H. K. V. Studies in the psychology of stuttering. XIV. Stuttering phenomena in relation to size and per­ sonnel of audience. Journal of Speech Disorders 3 1939, 4, 323-333. 22. Pryer, M. and R. H. Cassel. The children's manifest anxiety scale: reliability with aments. American Journal of Mental Deficiency1962, 66, 733-735. 3 23. Robinson, F. B. Introduction to Stuttering. Englewood Cliffs, N.J.: Prentice-Hall, Inc., 1964. 24. Santostephano, S. Anxiety and hostility in stuttering. Journal of Speech and Hearing Research 1960, 3, 337-347. 3 25. Schlanger, B. and R. Gottsleben. Analysis of speech defects among the institutionalizedmentally retarded. Journal of Speech and Hearing Disorders 1957, 22, 98-103. 3 clinical correlative study of the manifest anxi­ 26. Shatin, L. A ety scale. Journal of Clinical Psychology 1961, 17, 198. 27. Shulman, E. "A Study of Certain Factors Influencing the Vari­ ability of Stuttering." Unpublished Ph.D. Dissertation, State U. of lowa, 1944. S. New York: McGraw-Hill, Inc., 1956. 28. Siegal, Nonparometric Statistics for the Behavioral Sciences 29. Taylor, Janet A. A personality scale of manifest anxiety. Journal of Abnormal and Social Psychology 3 1953, 48, 285-290. 30. Drive theory and manifest anxiety. Psychological . Bulletin 1956, 53, 303-320. 3 31. Van Riper, C. Speech Correction,4th ed. Englewood Cliffs, N.J.: Prentice-Hall, Inc., 1963. scale: 32. Warren, S. and H. L. Collier. Children's manifest anxiety and com- validity and applicability for retarded subjects parison to normals. The Training School Bulletin 1964, 3 60, 192-200. 33. and H. L. Collier. Suitability of Columbia mental maturity scale with mentally retarded institutionalized female patients. American Journal of Mental Deficiency 1960, 64, 916-920. 34. Wiener, G., E. E. Crawford, and R. T. Snyder. Some correlates of anxiety in mentally retarded patients. American Journal of Mental Deficiency 1960, 64, 735-739. 3 35. Wirt, R. D. and W. E. Broen, Jr. The relation of the children's manifest anxiety scale to the concept of anxiety as used in the clinic. Journal of Consulting Psychologists 3 1956, 20, 482. 36. Wischner, G. J. An experimental approach to expectancy and anxiety in stuttering behavior. Journal of Speech and Hearing disorders 1952, 17, 139-154. 3 37. Young, R. K. and D. J. Veldman. Introductory Statistics for the Behavioral Sciences. New York; Rinehart and Winston, 1965. Inc., VITA Paul Karel Strauss was born in Sterling, Arenac County, Michigan, the oldest son of Andries M. and Grace W. Strauss, on June 27, 1930. He was graduated from high school in Corpus Christi, Texas in the spring of 1947, following a move to Texas in 1942. He attended Del Mar College in Corpus Christi from September of 1947 until the spring of 1949. In the fall of 1950, he entered The Uni­ versity of Texas, leaving in the spring of 1951 to work for an oil refining corporation in Corpus Christi. During this time he met and married Patricia Ann Leighton. reentered The University He of Texas in the summer of 1952, leaving in the spring of 1954 for re­ employment by a petroleum firm in Corpus Christi. He enrolled in absentia in The University of Texas in the fall of 1961, receiv­ing the degree of Bachelor of Arts in January, 1962. He began his and graduate studies in the spring of 1963, is currently employed as executive director of the Corpus Christi Hearing and Speech Center. Permanent address: 813 Belmeade Corpus Christ!, Texas 78412 W. This thesis was typed by Roy Holley.