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Identifying the Authoritative Judgments of Stuttering

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Identifying the authoritative judgments of stuttering: Comparisons of self-judgments and observer... By: Ingham, Roger J., Cordes, Anne K., Journal of Speech, Language & Hearing Research, 10924388, Jun97, Vol. 40, Issue 3 IDENTIFYING THE AUTHORITATIVE JUDGMENTS OF STUTTERING: COMPARISONS OF SELF-JUDGMENTS AND OBSERVER JUDGMENTS Reliable and accurate stuttering measurement depends on the existence of unambiguous descriptions or exemplars of stuttered and nonstuttered speech. The development of clinically meaningful and useful exemplars, in turn, requires determining whether persons who stutter judge the same speech to be stuttered that other observers judge to be stuttered. The purpose of these experiments, therefore, was to compare stuttering judgments from several sources: 15 adults who stutter, judging their own spontaneous speech; the same adults who stutter, judging each other's speech; and a panel of 10 authorities on stuttering research and treatment. Judgments were made under several conditions, including self judgments made while the speaker was talking and self- and other-judgments made from recordings in continuous and interval formats. Results showed substantial differences in stuttering judgments across speakers, judges, and judgment conditions, but across-task comparisons were complicated by low self agreement for many judges. Some intervals were judged consistently by all judges to be Stuttered or Nonstuttered, across multiple conditions, but many other intervals were either not assigned replicable judgments or were consistently judged to be Nonstuttered by the speaker who had produced them but were not assigned consistent judgments by other judges. The implications of these findings for stuttering measurement are considered. KEY WORDS: stuttering, measurement, self-judgments, agreement, intervals Recurring concerns about the clinical significance of perceptual judgments of stuttering (e.g., Cooper, 1986; Goldberg, Culatta, Ingham, Cooper, & Brutten, 1992; Ham, 1989), and growing evidence that judgments will differ across observers (see, e.g., Cordes & Ingham, 1994a, 1995; Ham, 1989; Ingham, Cordes, Ingham, & Gow, 1995), imply that standardized judgment procedures and training programs must be developed if researchers and clinicians are to be able to make valid, consistent, and useful judgments of stuttering. Some recent studies have used time-interval based measures in basic research about the nature of stuttering (e.g., Smith et al., 1993), and several studies of stuttering measurement have shown that interval-judgment procedures may lead to markedly better inter- and intrajudge agreement than that usually obtained with procedures requiring the identification of individual stuttering events or stuttered syllables (see Cordes & Ingham, 1994a; Ingham, Cordes, & Gow, 1993). The same studies are also demonstrating, however, that interval measurement itself, without judge training, does not solve the problems of reliability and validity for stuttering. One difficulty with these mixed results is that development of judge training programs presents a circular problem: Trusted referents for stuttered and nonstuttered speech must be developed as a prerequisite to developing training programs, but it is not clear how to identify those referents without training programs. One potential source for standard or referent judgments of stuttering might be agreed exemplars of stuttered speech recorded from a variety of persons who stutter (see Cordes & Ingham, 1996). Precisely whose agreement should be sought to identify these exemplars, however, is a questionthat raises another series of issues. Inexperienced judges might be selected, to provide judgments representative of those that an average, untrained observer would regard as stuttering. Inexperienced observers, however, have been shown repeatedly to display poor intrajudge and interjudge agreement for many stuttering judgment tasks (see Cordes & Ingham, 1994a; Ingham & Cordes, 1992; Young, 1975, 1984), making them poor sources for exemplar judgments. Experienced speech-language pathologists or researchers, whose judgments would be based on specialized academic or clinical knowledge of stuttering, might also be selected. Many experienced judges display exceptionally high self-agreement, and experienced judges often display superior levels of interjudge agreement when compared with less experienced judges (Cordes, 1995; Cordes & Ingham, 1995; Ingham, 1995). Experienced observers, however, including authorities at well-known research clinics, have also been shown to have poor levels of agreement among themselves in identifying stuttering (Cordes & Ingham, 1995; Ham, 1989; Ingham & Cordes, 1992; Kully & Boberg, 1988). These differences across judges, and certainly across research centers, limit both the number and the usefulness of agreed exemplars that can be identified from judgments made by authoritative observers. Judges who stutter are another possibility as the source for exemplar intervals. Their judgments might be argued to carry face validity because of their unique experience and perspective on stuttering. Surprisingly, there is very little information available about judgments of stuttering made by persons who stutter.[1] Tuthill's (1946) original study of stuttering judgments included 20 persons who stuttered as judges (judging speech from other people). Agreement levels were poor overall, with clinicians, inexperienced judges, and judges who stuttered showing similar levels of self-agreement (between 49% and 56.6%). A few previous studies have also investigated judgments of stuttering made by persons who stutter about their own speech. Martin and Haroldson (1986), for example, found large differences for some speakers between the speakers' judgments of "loss of control" while orally reading and the counts of words that an observer identified as stuttered. Some studies on the effects of self-delivered contingencies for stuttering have also included reports that some subjects who stutter, but not all, may display very low agreement with judgments of stuttering made by clinicians or researchers (see Cordes & Ingham, 1994a). The notion that persons who stutter will provide the most valid source of judgments about their own stuttering has been forcefully argued by Perkins (1983,1990; Perkins, Kent, & Curlee, 1991). Indeed, Perkins claims that the only person qualified to identify stuttering is the speaker, because


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