Applying the Transtheoretical Model to Stuttering Management Among Adolescents: Part II. Exploratory Scale Validation

Abstract

Purpose This article is the second in a two-part series on the application of the Transtheoretical Model to stuttering management among adolescents. The purpose of this article was to apply and explore the validity of newly developed Transtheoretical measures for adolescents who stutter. Method The online survey was completed by a national sample of 173 adolescents who stutter between the ages of 13 and 21 years. The multipart survey included a Stage of Change scale, Decisional Balance scale, and Situational Self-Efficacy scale. Participants also completed the Overall Assessment of the Speaker's Experience of Stuttering (OASES), either the teenage or adult version depending on the participant's age, so preliminary construct validity of the new scales could be examined. Exploratory factor analyses were conducted to determine model fit and reduce the scales to the most meaningful items. External validity of the three-part survey was examined by comparing OASES scores across stage of change as well as evaluating the functional relations between the three scales. Results Adolescents' readiness to manage stuttering could be clearly described with five discrete stages, although most of the respondents reported being in the Maintenance stage. The pros of managing stuttering reliably predicted stage placement. Internal consistency of the scales ranged from good to excellent. OASES scores differed across stages of readiness in complex but predictable ways. Conclusions These findings suggest that the Transtheoretical Model fits the target behaviors involved stuttering management among adolescents. Further examination of the application of the model to validate a stage-based framework for change among individuals who stutter is warranted.

Meet Them Where They're At: Maximizing Adolescents' Engagement in Stuttering Therapy

“…In our prior work, adolescents who stutter and are in Maintenance tend to have lower OASES scores (i.e., less impact of stuttering on their lives) than adolescents in prior stages. 14 As such, this would be a natural time for Luca's clinician to consider gradually reducing the frequency of his therapy sessions. In this process, the clinician should counsel not just Luca, but his parents as well, about the inherent variability of the stuttering experience (behaviors, thoughts, feelings, environments).…”

“…That is, people who stutter categorize themselves as being in one of the five stages of change, and the cognitive predictors of their stage placement mirror those of other populations. 14 The first step of this work was to define what “change” means for people who stutter. This was a challenging pursuit, as “change” for people who stutter is multidimensional and highly personal.…”

“…13 indeed, adolescents who stutter and are in Precontemplation tend to have lower OASES scores (i.e., less impact of stuttering on their lives) than those in the next few stages. 14 In this stage, a clinician may feel frustrated when working with Luca because he seems "unmotivated" to be in therapy; he is not demonstrating any desire to change how he communicates or copes with stuttering, and he may even deny that stuttering is an issue in his life. A typical feature of precontemplators is that the cons of making a change far outweigh the pros; that is, there are many reasons why Luca does not want to change and those reasons are more important to him than the minimal benefits he expects to receive.…”

Identifying perspectives of adults who stutter on therapeutic alliance in stuttering intervention

“…Some researchers have advocated for the influential role of factors outside the specific intervention technique on treatment outcomes. Such factors include TA, or person-related variables such as a client's readiness for change or a clinician's empathy (Botterill, 2011;Connery et al, 2022;Ebert & Kohnert, 2010;Grencavage & Norcross, 1990;Manning, 2000;Rodgers et al, 2021;Zebrowski et al, 2021). This prompts us to consider whether the intervention technique is the primary effective component of stuttering intervention or whether there are other factors that play a role (Connery et al, 2022).…”