Prevalence of Stuttering in African

American Preschoolers

Adele Proctor
Ehud Yairi
Purpose: In this study, the authors sought to determine the prevalence of stuttering
University of Illinois at Urbana – Champaign
in African American (AA) 2- to 5-year-olds as compared with same-age European
Americans (EAs).
Melissa C. Duff Method: A total of 3,164 children participated: 2,223 AAs and 941 EAs. Data
University of Iowa were collected using a 3-pronged approach that included investigators’ individual
interactions with each child, teacher identification, and parent identification of
Jie Zhang stuttering.
University of Illinois at Urbana – Champaign Results: No statistically significant difference for stuttering was found between AA and
EA children. Using the investigator and teacher method of identification, the
prevalence of stuttering was 2.52% for the entire sample. For both racial groups, boys
exhibited a higher prevalence of stuttering than girls. Of the 3 predictors (age, race,
sex) of stuttering, only sex was a significant predictor.
Conclusions: AA 2- to 5-year-olds are not overrepresented in the stuttering
population for this age group. When data are combined for both racial groups, the
prevalence of stuttering is 2.52%. More boys than girls stuttered in this sample of
preschoolers.
KEY WORDS: African American, preschoolers, stuttering, prevalence, children

I
n the United States, African American (AA)1 children are more fre-
quently diagnosed with speech and language impairments than are
their European American (EA)2 peers (Carlson, Hirschorn, Rayaboy, &
Zhao, 1996; Chin & Hughes, 1987; Coutinho, Oswald, & Best, 2002;
Hallahan & Kauffman, 1994; Harry, 1992, 1994; Muller & Markowitz,
2003; National Research Council, 2002; Noguera, 2006; Oswald,
Coutinho, Best, & Singh, 1999; Smith, 1998; U.S. Department of Edu-
cation, 2005; VanKeulen, Weddington, & DeBose, 1998). Available data
reveal a persistent pattern of racial overrepresentation, although the
relative contribution of each type of communication disorder to this
phenomenon remains unclear. One approach to clarify this issue is to
systematically conduct disorder-specific epidemiological studies.
Prevalence (percent of the population exhibiting a condition at a
given time) and incidence (percent of the population who has ever ex-
hibited a condition) studies are among the most basic epidemiological

1
African Americans (or Blacks) are U.S.-born citizens and descendents of those Africans who were
involuntarily transported to the United States from Africa. Their ancestry is mainly from people
indigenous to sub-Saharan Africa (U.S. Census Bureau, 2002). Africans are those individuals who
were born in different countries on the continent of Africa. Sociolinguistic and sociocultural
variables differ between Africans and African Americans along many dimensions such as native
languages and dialects and a range of other customs related to family and community organization,
food, dress, religion, and music.
2
European Americans (or Whites), also U.S.-born residents, are descendants of individuals from
different countries in Europe, the Middle East, and North Africa (U.S. Census Bureau, 2002).

Journal of Speech, Language, and Hearing Research • Vol. 51 • 1465–1479 • December 2008 • D American Speech-Language-Hearing Association 1465
1092-4388/08/5106-1465
information for every disorder or disease. If prevalence
is known for a specific disorder, there are implications
for understanding risk factors as well as planning for
clinical services, training professionals, and educational
policy. Theoretical implications concerning etiology are
also possible when certain populations exhibit either a
higher or lower incidence than the average. For exam-
ple, low incidence of stuttering among the deaf and hard
of hearing (Montgomery & Fitch, 1988) could indicate
involvement of the auditory processes.
As a first step in determining which communica-
tion disorders, if any, reveal disproportionate numbers
of African Americans with speech and language impair-
ment, the present investigation focused only on stutter-
ing in 2- to 5-year olds. In several important respects,
stuttering is a disorder of early childhood, as in the ma-
jority of cases because stuttering begins and stops be-
tween 20 and 60 months of age. It is estimated that 75%
to 90% of all children experience stuttering onset before
age 5 (Andrews, 1984; Yairi & Ambrose, 1999). Yet, as
noted by Yairi and Ambrose (2005), there have been fewer
studies on the occurrence and distribution of stuttering in
preschoolers than in school-age children or adults. Conse-
quently, research-based information on the incidence and
prevalence of stuttering among preschool-age children is
relatively sparse. Additionally, some past studies invite
questions concerning methodological issues, such as the
sole reliance on the identification of stuttering by health
workers’ home visits, which, at times, relied on parents’
reports, not their own direct observations (Andrews &
Harris, 1964); the sole reliance on parental retrospective
reports (e.g., Glasner & Rosenthal, 1957); or on clinical
files (Dalston, Martinkosky, & Hinton, 1987). More re-
cently, Craig, Hancock, Tran, Craig, and Peters (2002)
used a telephone interview with a household member to
identify stuttering, including young children. When pos-
sible, they also obtained a 5-min speech sample that was
recorded over the telephone.
There are several reasons for obtaining more ac-
curate prevalence data on stuttering among AA pre-
school children. First, there are increasing numbers of
AA preschoolers in the U.S. population (McKinnon, 2003;
U.S. Census Bureau, 2002). Second, among speech-
language pathologists (SLPs), there has been a general
belief that there is a higher frequency of occurrence of
stuttering in AA children than in EA children (Cooper &
Cooper, 1998; Dean & Brown, 1977; Gillespie & Cooper,
1973). If SLPs in clinical positions perceive that more
AA children stutter, this could lead to a self-fulfilling
prophecy of identifying stuttering where one expects to
find stuttering. Finally, the completion of a series of
epidemiologic studies may provide data distinguishing
which communication disorders are the strongest con-
tributors to the overrepresentation of African Americans
in speech and language impairment. Inasmuch as no
1466 Journal of Speech, Language, and Hearing Research • Vol. 51 • 1465–1479 • December 2008
study has explored the incidence or prevalence of stut-
tering in AA preschool children, the age during which
the disorder typically begins, the purpose of the present
investigation was to determine the prevalence of stutter-
ing in AA preschool children.
After reviewing many surveys of stuttering in
American schoolchildren, Bloodstein (1995) estimated
that the stuttering incidence ranged from a low of 0.70%
to a high of 15.40% and reported that the prevalence
of stuttering ranged from 0.35% to 2.12%. Andrews and
Harris (1964) followed British English–speaking children
from birth to age 16 years and reported that the incidence
was 4.9%, whereas the prevalence of stuttering was 1%.
Mansson (2000) followed Danish preschoolers over a pe-
riod of several years and reported a stuttering incidence
of 5.19%. Craig et al. (2002) reported a prevalence of
1.4% for children 2–5 years of age in a household sample
of the population of New South Wales, Australia. In
Belgium, Van Borsel et al. (2006) found a prevalence rate
of 0.58% for all 6- to 20-year-olds who attended regular
schools. The highest prevalence (0.78%), however, was
detected in the youngest group of 6- to-10-year-olds. A
recent survey of more than 10,000 primary school stu-
dents in Australia, based on teacher identification and
confirmed by SLPs’ records, yielded a very low stutter-
ing prevalence of 0.33% (McKinnon, McLeod, & Reilly,
2007).
Overall, only a handful of studies of incidence and
prevalence of stuttering in preschool children have been
conducted, and those that are published are not rep-
resentative of the culturally and linguistically diverse
populations in the United States. Thus, the strength of
inferences and the generalizations of past findings may
have questionable applicability for African Americans
and other minorities in the United States. Because there
have been many suggestions that race and /or ethnicity
influence the occurrence of stuttering, particularly among
African Americans (Cooper & Cooper, 1998; Dean &
Brown, 1977; Gillespie & Cooper, 1973), the importance
of obtaining epidemiological data for African Americans
and other U.S. minorities becomes even more apparent.
The central tendency of the various incidence es-
timates indicates that about 5% of the population has
ever stuttered, whereas the prevalence is much lower—
that is, only 1% or less stutter at a given time. By
inference, the discrepancy between the figures for inci-
dence and prevalence suggests that the disorder persists
and becomes chronic in only 20% of all cases. Or, con-
versely, there appears to be a high rate of recovery
(Andrews & Harris, 1964; Mansson, 2000; Yairi &
Ambrose, 2005). Previous studies of incidence and pre-
valence of stuttering in African Americans are scarce,
findings are conflicting and confusing, and no studies
have examined AA preschool children. A critical literature
search was completed to ascertain studies on stuttering
in AA children who had no other disabilities. Table 1 dis-
plays a summary of the studies that were identified and
are sequenced in chronological order, from the earliest to
latest date of publication.
Table 1 reveals that, from 1916 to the present, only
four published studies (Carson & Kanter, 1945; Gillespie
& Cooper, 1973; Goldman, 1967; Louttit & Halls, 1936)
were specifically devoted to the investigation of stutter-
ing in AA children. Wallin’s (1916, 1926) studies reported
on the same data collected in the St. Louis school system
where African Americans represented a portion of the
population. Similarly, Travis, Johnson, and Shover (1937)
included AA children as a part of their participant popu-
lation in a study on bilingualism.
Two unpublished master’s theses (Neely, 1960;
Waddle, 1934) explored stuttering prevalence in AA
children, and one doctoral dissertation (Madding, 1995)
investigated the stuttering prevalence in African Amer-
icans, Asian Americans, European Americans, Latina/os,
and Native Americans/ Pacific Islanders. Gillespie and
Cooper (1973) studied prevalence in adolescents, where-
as all others focused on school-age children. None of the
studies included preschoolers, and some indicated higher
rates of stuttering in AA children.
Of the nine studies in Table 1, four (Carson & Kanter,
1945; Louttit & Halls, 1936; Neely, 1960; Wallin, 1916,
1926) did not provide operational definitions for stutter-
ing, and these same investigators relied solely on teacher
reports. This is not to negate the importance of teachers’
reports but rather to point out that (a) teachers are not
speech experts, (b) the judgments of many people with
different standards were involved, and (c) only a single
source was used for each case. Additionally, procedures
such as questionnaire development, distribution, collec-
tion, and data analysis were often not reported. None of
the studies in Table 1 reported how race was determined
or who determined race. Finally, with the exception of
Gillespie and Cooper (1973) and Madding (1995), the
studies confused prevalence and incidence—that is, re-
sults were reported as incidence, but careful inspection
of the original papers revealed that they were actually
prevalence.
When diverse populations are the focus of an inves-
tigation, sociocultural variables—such as parent–child
relations and family organization—may provide contexts
for interpreting data. Goldman (1967) explored stutter-
ing in AA children relative to different types of fam-
ily organizations, an important sociocultural variable.
Although one primary aim of the investigation was to
determine if there was a relationship between the in-
cidence of stuttering in AA children who lived in matri-
archal families compared with AA children who lived in
patriarchal families, operational definitions were not
given for what constitutes matriarchal versus patriarchal
families. Results of the Goldman (1967) study have often
been interpreted as providing support for the notion that
stuttering is more common in African Americans than in
European Americans, but the number of children par-
ticipating in the study was not specified. Therefore,
without information on the sample size, no prevalence
could have been reported.
Significantly, from 1916 to 1967, investigations on
AA children were conducted in racially segregated school
systems, a fact that has implications for overlooking the
possible effects of African American English (AAE) on
the findings. In these early investigations, it is probable
that the children spoke AAE, a language variety (dialect)
spoken by a large number of AA children, adolescents,
and adults (Dillard, 1973; Labov, 1972). It is a rule-
governed linguistic system in which different types of
normal disfluencies represent distinct semantic functions
(Green, 2002; Smitherman, 1977). For example, more
typically normal disfluencies, such as revisions, phrase
repetitions, filled pauses, and prosodic features, denote
various meanings in AAE (Anderson, 1981; Asante, 1990;
Mufwene, 1993; Mufwene, Rickford, Bailey, & Baugh,
1998; Poplack, 2000; Rickford, 1999). Observing the pres-
ence of a combination of some or all of these linguistic
features in a speaker may be mistaken for stuttering
by individuals who are not familiar with AAE (Proctor,
2006).
Insufficient experience in recognizing language
variation may have affected the diagnosis of stuttering
in studies limited to AA children as well as in studies
of bilingualism that also included AA children. For in-
stance, in examining the relationship between bilin-
gualism and stuttering, Travis et al. (1937) did not
specify language data of the participant population. It
appears that the differentiation of the presence or ab-
sence of stuttering did not consider normal disfluencies
that may be associated with second-language learning
(Dale, 1977; Karniol, 1992; Nwokah, 1988; Watson &
Kayser, 1994), nor did it consider the range of normal
disfluencies embedded in the AAE linguistic rule sys-
tem. In any study of communication disorders, how one
defines stuttering, how practitioners apply definitions
of stuttering, and how questions are phrased when cul-
tural informants are involved require specification. Fur-
ther, the investigators’ knowledge of the language and
culture of the target population are among variables
that affect validity of data collection and the analyti-
cal procedures used to determine prevalence or inci-
dence (Finn & Cordes, 1997; Kathard, 2001; Van Borsel,
Maes, & Foulon, 2001; Zimmerman, Liljeblad, Frank, &
Cleeland, 1983). Considering the range of methodolog-
ical and procedural issues found in past studies, there
remains a lack of consensus regarding prevalence of
stuttering in African Americans in general, and there
are no available prevalence data for stuttering in AA
Proctor et al.: Prevalence of Stuttering 1467
 1468
Journal of Speech, Language, and Hearing Research • Vol. 51 • 1465–1479 • December 2008
Table 1. Studies on prevalence or incidence of stuttering in African American (AA) children, by date of publication.
Investigator(s) and date
Wallin (1916, 1926)
Waddle (1934)
Louttit & Halls (1936)
Travis, Johnson, &
Shover (1937)
Carson & Kanter (1945)
Neely (1960)
Purpose/research question
To determine prevalence of speech
disorders and need for treatment
among public school children in
St. Louis, MO.
To determine percent of speech
disorders among AA children.
To determine the incidence of children
with speech disorders in Indiana.
To determine the relationship between
stuttering and bilingualism in East
Chicago, IN; sample included AA
and EA and Latina/os.
To determine if incidence of stuttering
was different in AA and EA
children in East Baton Rouge, LA.
To determine the incidence of stuttering
among AA and EA second graders
in Orleans Parish, LA.
Participants
A sample of 89,057 children in
grades K–12.
A sample of 1,582 elementary school
children in 8 segregated schools
in Topeka, KS.
Data collected from 199,839 (or
30% of) Indiana school
population in grades 1–12.
Racially segregated schools and
mixed-race schools were included
in the sample.
A total of 2,405 males and 2,422
females from 9 racially segregated
and mixed-race public schools,
with an average age of
8.54 years. Grades ranged
from K through 6.
A total of 2,776 AA and 2,365 EA
children. Six AAs and 8 EAs in
racially segregated schools. AAs in
Grades 1–7; EAs in Grades 1–6.
Children included 403 AAs and 482
EAs. All schools were racially
segregated.
(Continued on the following page)
Procedures
One-page questionnaire was sent to
principals, was distributed to
teachers for completion, and
was returned to investigator.
Investigator observed each child.
Principals were asked to complete
one-page questionnaire requesting
grade, sex, number of children
who stuttered, number with other
speech disorders, and racial
makeup of school.
Each child was individually interviewed
by a speech-language pathologist
(SLP), and an interpreter was
employed when child did not
speak English.
Teachers were asked to identify
children who stuttered and refer
to investigator. Investigator then
interviewed students.
Teachers referred children who
stuttered. Investigator listened to
children during 6 tasks (e.g.,
reading aloud, conversation).
Findings
For this study, prevalence was 0.7%
AA: 1.6%
EA: 1.1%
Results reported as incidence data.
AA: 7.8%
EA: 4.11%
Incidence rate: 0.77%
No distinction of stuttering incidence by
race. A slightly higher frequency of
occurrence for all types of speech
disorders reported for EA children.
2.61% of total sample diagnosed as
stuttering.
Monolingual EAs:1.80%
Bilingual EAs: 2.80%
AAs: 3.76% stuttered. For all 3 groups,
rates were higher for boys.
Incidence rates
AAs: 1.6%
EAs: 1.1%
Male/female ratio:
AAs: 2.2:1
EAs: 1.9:4.
Overall incidence: 1.3%. No
statistically significant difference
for stuttering in AAs and EAs.
 Table 1 Continued. Studies on prevalence or incidence of stuttering in African American (AA) children, by date of publication.
Investigator(s) and date
Goldman (1967)
Gillespie & Cooper (1973)
Madding (1995)
Proctor et al.: Prevalence of Stuttering
1469
Purpose/research question
Two-phase study. Phase 1 sought to
determine incidence of sex ratio of
stuttering in AA and EA children.
Phase 2 sought to determine sex
ratio of stuttering among AA
children in matriarchal and
patriarchal families. All children
lived in Tennessee.
To determine prevalence of speech
problems in junior and senior high
schools in Alabama.
To determine prevalence of stuttering
in diverse U.S. cultures; Latinas/os;
AAs; EAs; and Asian Americans,
Native Americans, and Pacific
Islanders.
Participants
In Phase 1, 694 children were identified
by SLPs as stutterers. There were
285 AAs and 409 EAs. To complete
Phase 2, an additional 14 AA-only
public schools were screened,
resulting in a total of 115 AAs
diagnosed as stuttering. All
schools were racially segregated.
The sample included 2,380 AAs and
2,674 EAs.
A total of 49,263 children in
2 southern California school
districts.
Procedures
SLPs were given 3 criteria to identify
children who stuttered: (a) child
exhibited secondary symptoms,
(b) child considered self a
stutterer, and (c) parents
considered child a stutterer.
SLPs reported data to investigator.
All participants were interviewed by
an SLP.
A 31-item questionnaire was
distributed to SLPs in the
districts and was returned to
the investigator.
Findings
No overall incidence reported.
Male/female ratio in Phase 1:
EAs: 4.93:1
AAs: 2.53:1
Statistically significant relationship for
sex ratio and race observed; AAs
exhibited higher rate of stuttering.
Phase 2 reported a higher
proportion of AA females who
stuttered and who lived in
matriarchal homes and more
AA males who stuttered and
who lived in patriarchal homes.
AAs: 2.8% stuttered.
EAs: 0.7% stuttered.
Prevalence rates:
AAs: 0.40%
EAs: 0.60%
Latina/os: 0.293%
Asian Americans, Native
Americans, and Pacific
Islanders: 0.08%
preschoolers. Therefore, using a culturally and linguis-
tically sensitive approach, the purpose of the present
investigation was to determine the prevalence of stut-
tering in AA preschool children.
To achieve our objective, the target population con-
sisted of 2- to 5-year-old African Americans and same-
aged European Americans who were attending regular
programs for the general population in their respec-
tive areas in the state of Illinois. The sample was drawn
from 49 different, racially integrated preschools in ur-
ban, rural, small-town, and suburban areas in Illinois,
reflecting a broad stratum of communities with different
levels of economic resources. Preschools included both
private and public programs, and economic resources var-
ied among individual children within the same schools.
Geographically, populations from the north, south, east,
west, and central areas of Illinois were targeted.
Method
Participants
Participants in this survey of stuttering prevalence
constituted a preschool age population of 3,164 children
between the ages of 2 and 5 years. Of these children,
2,223 (70.25%) were African American (AA) and 941
(29.74%) were European American (EA). Boys consti-
tuted up to 1,137, or 51%, of the AA group (M = 4.4 years,
SD = 0.7). Girls constituted 1,086, or 49%, of the AA
group (M = 4.4 years, SD = 0.7). Boys represented 474, or
50%, of the EA children (M = 4.3 years, SD = 0.08). Girls
constituted 467, or 50%, of the total EA group (M = 4.3,
SD = 0.08). Participants produced social and regional lan-
guage varieties that are spoken in Illinois (e.g., Chicago
dialects, southern accented American English used in
southern Illinois, and AAE) and presented other char-
acteristics of heartland English (Frazer, 1993). In many
cases, regional and social dialects co-occurred in the
same speaker. Parents or guardians identified the race
of their children. No children were identified as biracial
or multiracial. The population from which this sample
was drawn consisted of more African Americans than
Table 2. Demographic background of preschoolers in the total sample (N = 3,164).
African American children
Age Boys Girls Total
2 22 20 42
3 295 284 579
4 567 547 1,114
5 253 235 488
Total (%) 1,137 (51%) 1,086 (49%) 2,223 (100%)
1470 Journal of Speech, Language, and Hearing Research • Vol. 51 • 1465–1479 • December 2008
European Americans. Table 2 summarizes sex, race, and
chronological ages of the participants.
Background Data and Staff Qualifications
The present investigation addressed several vari-
ables that are crucial to research in diverse cultural and
linguistic groups and to the identification of communi-
cation disorders in these groups. Most important, each
of the 3,164 participant children received individual
speech, language, voice, and fluency screening. A mea-
sure that is sensitive to characteristics of AAE, the
Fluharty Preschool Speech and Language Screening Test
(Fluharty, 1978), was used for the speech and language
portions of the screening. For 2,151 of the participants,
the preschool SLPs also provided speech-language-voice
screening data based on the American Speech-Language-
Hearing Association (ASHA, 2004) practice protocols,
which they routinely administered. Therefore, the 1,013
children for whom these data were not available were
administered the ASHA practice protocols by the three
certified SLPs who collected data for this research pro-
ject. A hearing screening was administered to all chil-
dren, and only those who passed were included.
Sociocultural and sociolinguistic variables that may
affect communication were addressed in the selection
and preparation of the research team. Cultural infor-
mants were integrally involved in the design, data col-
lection, and data analysis. The senior author, who is
African American and a native speaker of AAE, served
as the primary informant on sociocultural and sociolin-
guistic variables. Another author, an Illinois native with
lifelong interactions with AAE speakers, served as the
informant for the mainstream culture as well as for the
area’s social and regional language varieties. Both are
certified SLPs who are also referred to in this article as
“investigators.” A third certified SLP/investigator also had
academic knowledge and some experience with AAE. The
three SLPs/investigators who collected data had academic
and clinical experience with childhood stuttering and pro-
vide clinical services to AAE speakers that involve distin-
guishing language differences from language disorders.
European American children
Boys Girls Total
26 29 55
139 140 279
213 196 409
96 102 198
474 (50%) 467 (50%) 941 (100%)
 Graduate students who assisted with screenings re-
ceived formal training in AAE, AA culture, social and
regional varieties, and stuttering by the first and second
authors, respectively. Using videotaped samples, another
experienced researcher in childhood stuttering (Nicoline
Ambrose3) provided additional student training on iden-
tifying stuttering. Teachers and parents did not receive
formal training in the identification of stuttering.
General Strategy and Definition
To reduce risks of errors in relying on a single source
of stuttering identification, a three-pronged data collec-
tion approach was conducted. The three-pronged approach
consisted of (a) the investigator’s face-to-face interaction
with each child, (b) teacher reports on each child, and
(c) parent reports on each of their children. The total
number of participating children was determined by the
number of families that signed consent forms agreeing to
their child’s participation in the survey conducted at the
respective school. Stuttering was operationally defined
as an attention-calling occurrence of sound, syllable, and
single-syllable word repetitions, sound prolongations, or
complete blockages of speech. These could be associated
with facial grimaces, eye blinks, head movements, and/or
other body movements and struggles. Significantly, each
child who was identified as exhibiting stuttering, based
on the operational definition of stuttering, was so diag-
nosed by either two SLPs who observed his or her speaking
or by a teacher followed by the examination of two SLPs.
Data Collection
The first author telephoned directors of preschools
throughout the state of Illinois identified from published
lists provided by local, state, and federal agencies. The
project’s objectives were explained, and permission was
requested to individually observe and interact with chil-
dren, interview teachers, and contact parents. After per-
mission was granted, a packet of printed materials that
included an explanatory letter, a brief parent question-
naire (see Appendix), and a statement of informed con-
sent was distributed to parents through the collaborating
schools. After the preschools received returned consent
forms and questionnaires from the families, visits to the
schools were scheduled.
Teacher identification. A total of 220 classroom teach-
ers from 49 schools participated. Of the children with
signed parental consent forms, the primary classroom
teacher was asked to indicate on the classroom roster
those suspected of, or identified as, having any type of
speech (including articulation and stuttering), language,
voice, or hearing difficulty. Verbal/vocal examples of spe-
cific features of these communication disorders were given.
3
Nicoline Ambrose was not one of the investigators.
Investigators’ screening. For each preschool visit,
there was one SLP/investigator in charge of the testing
session. Upon arrival, this person met with the site’s
director and/or each classroom teacher. The signed con-
sent forms were received, and the class roster was marked
accordingly to ensure that only students for whom con-
sents were received were participants. An additional list
of students suspected by the staff to exhibit a communi-
cation disorder was also made available to the respon-
sible investigator. The SLPs/investigators then proceeded
with the data collection.
Investigators individually observed each child with
permission during interaction with teachers, teachers’
aides, and classroom peers. Additionally, at the appro-
priate times (e.g., when not sleeping or eating, and when
interested in play), each of the 3,164 children was en-
gaged in play-conversation activities with one investi-
gator for 15–20 min. If an SLP/investigator identified a
speech-language problem, including fluency, the sec-
ond investigator was asked to re-examine the child and
make a judgment regarding the presence or absence of a
problem. Typically, this was done within 20–30 min and,
in some cases, at the end of the session. Of the two SLPs/
investigators present, only one could have known if the
teacher had a concern about the student. Thus, in all
cases, a teacher’s judgment was always compared with
the independent judgment of at least one investigator.
Children who were identified as stuttering by any data
source were audiotaped, and tapes were further exam-
ined to determine presence or absence of stuttering.
Parent identification. The families of each of the
children received two documents: (a) a letter concerning
the study with an attached consent form for the child’s
participation in the school interview and (b) a question-
naire (see Appendix) asking them to indicate any con-
cerns regarding past or present speech, language, hearing,
voice, and fluency problems. Parents were invited to
return the consent form and the questionnaire. Face-to-
face counseling pertaining to parents’ concerns was of-
fered, but only a few took advantage of the offer. The
investigator did not examine returned parental question-
naires prior to the beginning of the screenings.
Results
Race Comparisons
Investigators’ procedures for identification of stut-
tering were applied to the entire sample of 3,164 pre-
schoolers. With this method, 81 children (2.56%) were
identified as exhibiting stuttering. Of the 2,223 AA subset,
58 (2.60%) stuttered, and of the 941 EA subset, 23 (2.44%)
stuttered. A c2 test indicated no significant difference
between the two racial groups, c2(1, N = 3,164) = 0.07,
p > .05.
Proctor et al.: Prevalence of Stuttering 1471
 To determine if the current sample size (N = 3,164) Table 3. Investigator and teacher identification of stuttering, by race
was large enough for detecting the racial differences in and age.
stuttering, power analysis of the c2 test was performed.
Assuming a very small effect size ( = 0.05) was found Age Investigator Teacher
between two racial groups at a = .05, we asked the (yrs) Race n identification % identification %
following question: What is the required sample size to 2 AA 42 0 0.00% 0 0.00%
reach a high power of 0.80? Results of the power analysis EA 55 2 3.64% 1 1.82%
indicated that the total sample of 3,164 participants would
3 AA 579 17 2.94% 18 3.11%
allow detection of a very small racial effect ( = 0.05).
EA 279 7 2.51% 6 2.15%
Therefore, the number of participants in the survey
(N = 3,164) satisfies this requirement. Further, what if 4 AA 1,114 25 2.24% 19 1.71%
detecting an effect size of 0.10 and the remaining con- EA 409 11 2.69% 6 1.47%
ditions are the same? The required sample size to reach 5 AA 488 16 3.28% 19 3.89%
a high power of 0.80 is 785. Even the smaller sample EA 198 3 1.52% 3 1.52%
size of the EA group (n = 941) reached this criterion. Total 3,164 81 2.56% 72 2.28%
Thus, the sample sizes in this study are large enough for
both racial groups and did not impact the prevalence rate Note. yrs = years; AA = African American; EA = European American.
differences in this study.
The teachers’ identification method revealed a total
of 72 children (2.27% of the sample) as exhibiting c2(1, N = 3,164) = 0.03, p > .05. Parent current and past
stuttering. Of these, 56 (2.51%) were African Americans. concerns are presented in Table 4.
Among the European Americans, only 16 children
(1.70%) were so identified. The c2 test for teacher iden-
tification also revealed no significant difference between Sex and Age Comparisons
the two racial groups, c2(1, N = 3,164) = 2.93, p > .05.
In view of the importance of the sex and age fac-
Overall, as expected, preschool boys exhibited a higher
tors in stuttering, and because these preschool children
prevalence of stuttering than did preschool girls. For
represented an age span of 3 years, the prevalence of
AAs, statistically significant differences were found be-
stuttering in our sample was analyzed accordingly. The
tween boys and girls for investigator identification,
distributions of stuttering by age and sex based on both
c2(1, N = 2,223) = 11.65, p = .00, as well as for teacher
the investigator and teacher identification methods are
identification, c2(1, N = 2,223) = 12.07, p = .00. For
displayed in Table 5. According to the investigator iden-
European Americans, a statistically significant differ-
tification, 59 boys and 22 girls stuttered among the 3,164
ence between boys and girls was found for investigator
preschool children, yielding a male/female (M/ F) ratio
identification, c2(1, N = 941) = 0.26, p < .05, but not
of 2.68. The c2 test indicated a significant difference
for teacher identification, c2(1, N = 941) = 1.00, p = .31.
between boys and girls, c2(1, N = 3,164) = 16.00, p < .05.
When data for investigator and teacher identification
Based on teacher identification, 51 boys and 21 girls
of stuttering were combined for both racial groups, the
stuttered (M/F ratio = 2.42), a difference that was also
prevalence of stuttering was 2.52%. Parent data were
statistically significant, c2(1, N = 3,164) = 11.68, p < .05.
not included in the calculation for overall prevalence
Overall, as expected, preschool boys exhibited a higher
due to the small return rate of questionnaires. Table 3
prevalence of stuttering than did preschool girls. Also,
presents numbers and percentages for investigator and
the sex ratios for investigator and teacher identification
teacher identification of stuttering by race.
are very similar. They are also similar to those reported
Concerning parent identification, of the 3,164 fam- by other investigators for this age group (Mansson, 2000,
ilies, only 1,107 parents/guardians—including 707 AA
and 400 EA—returned the questionnaires. The return
rate was 31.8% for the AA families and 42% for the EA
Table 4. Current and past parent identification of stuttering
families. Of the 1,107 families that responded, 48 AA (n = 1,107).
families (6.78%) and 20 EA families (5%) indicated current
concerns of stuttering in their children. This racial differ- Current concern Past concern
ence was not statistically significant, c2(1, N = 3,164) =
1.34, p > .05. Parents expressed past concerns for stut- Race n % n %
tering in a total of 40 children. AA parents indicated
AA (707) 48 6.78% 25 3.53%
past concerns for 25 (3.53%) children, and EA par- EA (400) 20 5.00% 15 3.75%
ents indicated past concerns for 15 (3.75%) children. Total (1,107) 68 5.68% 40 3.61%
This difference was also not statistically significant,

1472 Journal of Speech, Language, and Hearing Research • Vol. 51 • 1465–1479 • December 2008
 Table 5. Investigator and teacher identification of stuttering, by sex and age.

Investigator identification Teacher identification

Age (yrs) Boys (n = 1,611) Girls (n = 1,553) Ratio Boys (n = 1,611) Girls (n = 1,553) Ratio

2 (n = 97) 1 1 1.00 1 0 3.00

3 (n = 858) 18 6 3.00 16 8 2.00
4 (n = 1,523) 23 13 1.76 16 9 1.77
5 (n = 686) 17 2 8.50 18 4 4.50
Total 59 22 2.68 51 21 2.42

Note. To compute sex ratio in Tables 5 and 6, 0.5 was added to all of the related cells when zeros occurred in the cell. For
example, in this table, teacher identification of stuttering in boys and girls at age 2 years is 1 and 0, respectively, and the sex
ratio is (1 + 0.5)/(0 + 0.5) = 3.00. yrs = years.

in Denmark; Yairi & Ambrose, 1999, 2005, in the United
States).
No age difference in stuttering prevalence among
the four age subgroups was found for either investiga-
tor identification, c2(3, N = 3,164) = 0.6, p > .05, or teacher
identification, c2 (3, N = 3,164) = 3.75, p > .05. The
two-way Age × Sex contingency table analyses for in-
vestigators, c2 (3, N = 3,164) = 0.6, p > .05, and teachers,
c2 (3, N = 3,164) = 2.46, p > .05, suggested independence
between age difference and sex.
For the parent responses, the age and sex distribu-
tion was proportional to the demographic characteristics
of the original sample. A total of 45 parents of boys and
23 parents of girls indicated their current concerns for
stuttering. The M/F ratio of 1.96 is lower but still close to
that yielded by the other two sources. The c2 test showed
that the sex difference was significant, c2(1, N = 3,164) =
8.07, p < .05. Parents of 26 boys and parents of 14 girls
indicated parental past concerns. This sex difference was
not significant, c2(1, N = 3,164) = 3.40, p > .05. No age dif-
ference was found for either (a) parent current concerns,
c2(3, N = 3,164) = 4.92, p > .05) or (b) parent past con-
cerns, c2(3, N = 3,164) = 0.67, p > .05. Overall, statisti-
cal analysis for investigator, teacher, and parent data
revealed no specific age between 2 and 5 years at which
there was a higher prevalence of boys or girls who stut-
tered. Sex ratio is presented in Tables 5 and 6.
Logistic regression was used to determine whether
the prevalence of stuttering for 2- to 5-year-olds could be
predicted using race, sex, and age based on investigator
and teacher identification. Consistent with the previous
analyses, only sex was a significant predictor of stut-
tering for both investigator and teacher identification,
c2(1, N = 3,164) = 14.85, p < .001, and c2(1, N = 3,164) =
10.96, p < .001, respectively. Race was not a significant
predictor for investigators, c2(1, N = 3,164) = 0.06, p > .05,
or for teachers, c2(1, N = 3,164) = 1.81, p > .05. For in-
vestigators, age, c2(1, N = 3,164) = 0.0, p > .05, was not a
significant predictor for stuttering, nor was age a signifi-
cant predictor of stuttering according to teacher identifi-
cation of stuttering, c2(1, N = 3,164) = 0.31, p > .05.
The investigator identification data were fitted by
the following logistic model:
log ðqÞ ¼ 4:2957 þ 0:9725  Sex þ 0:0028  Age
þ 0:0599  Race; ð1Þ
where q is the odds of stuttering cases. Using data
from investigator identification, the odds of stuttering

Table 6. Current and past parent concerns about stuttering, by age and sex (n = 1,107).

Current concerns (total number) Past concerns (total number)

Age (no.) Boys (n = 558) Girls (n = 549) Ratio Boys (n = 558) Girls (n = 549) Ratio

2(28) 2 2 1.00 0 1 0.33

3(322) 11 5 2.20 5 6 0.83
4(515) 25 11 2.27 14 7 2.00
5(242) 7 5 1.40 7 0 15.00
Total 45 23 1.95 26 14 1.85

Note. To compute sex ratio in Tables 5 and 6, 0.5 was added to all of the related cells when zeros occurred in the cell. See
explanation in Table 5 note. no. = number.

Proctor et al.: Prevalence of Stuttering 1473

is 2.64 times more likely for boys, exponent (0.9725 = Table 8. Investigator and teacher identification of stuttering, by race,
2.64), than for girls, after controlling for age and race. sex, and age.
The teacher identification data were fitted by the fol-
lowing logistic model: Investigator Teacher
identification identification
log ðqÞ ¼ 4:9190 þ 0:8669  Sex þ 0:0881  Age
Age (yrs) Race Boys Girls OR Boys Girls OR
þ 0:3861  Race:
2 AA 0 0 1.00 0 0 0.33
Based on teacher identification, the odds of stuttering is EA 1 1 1 0
2.37 times more likely for boys, exponent (0.8669) = 2.37,
than for girls, after controlling for age and race. Table 7 3 AA 12 5 0.40 12 6 1.00
EA 6 1 4 2
displays the parameter estimates for the two logistic re-
gression models. 4 AA 15 10 0.56 13 6 2.16
EA 8 3 3 3

5 AA 15 1 7.50 16 3 2.66
Homogeneous Association Between EA 2 1 2 1
Race and Sex Given Age
Total AA 42 16 0.92 41 15 1.64
The prevalence data were further examined to EA 17 6 10 6
determine if the two racial groups were similar relative
to sex (see Table 8). Marginal odds ratios were 0.92 for Note. To compute the odds ratio in Table 8, 0.5 was added to all of
the related cells when zeros occurred in the cell. For example, teachers’
investigator identification and 1.64 for teacher identifi-
identification of stuttering in 2-year-old boys and girls who are AA and
cation. The marginal independence test for investigator
EA is 0,0 and 1,0, respectively, and the odds ratio is (0.5/0.5)/(1.5/0.5) =
identification, c2(1, N = 81) = 0.0187, p > .05, and for
0.33. OR = odds ratio.
teacher identification, c2(1, N = 72) = 0.69, p > .05,
suggested that sex and race were statistically indepen-
dent, indicating that the marginal odds ratios of stut-
tering boys to stuttering girls for AA versus EA were on teachers’ identification, yielded a similar result: Race
approximate to 1.0, which substantiates the indepen- and sex were conditionally independent after controlling
dence between sex and race. for age, CMH (1) = 0.6594, p > .05. The Breslow–Day test
To test if race and sex were conditionally indepen- indicated homogeneous association between race and
dent after controlling for age—that is, if the conditional sex at each age level, c2(3) = 0.458, p >.05. In summary,
odds ratios between race and sex were equal to 1 at all both the marginal independence test and the conditional
age levels—the Cochran–Mantel–Haenszel (CMH) chi- independence test indicated the independence between
square test was used for the Race (2) × Sex (2) × Age (4) race and sex.
interaction listed in Table 7. The CMH test, based on the
investigators’ identification, indicated that race and sex Agreement Among Investigator, Teacher,
were conditionally independent after controlling for age,
CMH (1) = 0.3551, p > .05. The Breslow–Day test sug-
and Parent Identification
gested homogeneous association between race and sex at There was agreement between investigator identifi-
each age level, c2(3) = 3.27, p >.05. The CMH test, based cation and teacher identification of children who stuttered.

Table 7. Results of logistic regression.

Parameter df Estimate SE Wald 95% confidence limits c2 Pr > c2

Investigator identification
Sex 1 0.9725 0.2524 0.4778 1.4672 14.85 0.0001
Age 1 0.0028 0.1469 –0.2851 0.2907 0.00 0.9850
Race 1 0.0599 0.2508 –0.4317 0.5516 0.06 0.8111
Teacher identification
Sex 1 0.8669 0.2618 0.3737 1.3801 10.69 0.0009
Age 1 0.0881 0.1576 –0.2208 0.3969 0.31 0.5763
Race 1 0.3861 0.2872 –0.1768 0.9489 1.81 0.1788

Note. SE = standard error; Pr = probability.

1474 Journal of Speech, Language, and Hearing Research • Vol. 51 • 1465–1479 • December 2008
The  coefficient (a special case of correlation for binary
variables) between the results of the two identification
methods was .82 ( p < .001). A total of 153 children were
identified as exhibiting stuttering among 3,164 children
by three identifiers: teacher, investigator, and parents.
Further examination of investigator and teacher
identification of stuttering revealed that 81 children
were so identified by investigators, whereas teachers
identified 72 children who stuttered. Teachers and in-
vestigators agreed on 63 of the children who were iden-
tified as stuttering. Teachers did not agree on 18 of the
81 children identified as stuttering by investigators.
Of the 72 children who were identified as stuttering by
teachers, 9 were not so identified by investigators. Rela-
tive to the total sample of 3,164, teachers and investiga-
tors agreed that 3,074 children did not exhibit stuttering.
Investigators identified 3,083 as not stuttering, whereas
teachers identified 3,092 children as not stuttering. In-
vestigator and teacher identifications of stuttering are
shown in Table 9.
The unavailable majority of potential parent iden-
tification data made it difficult to analyze the level of
agreement with the other two identification methods.
For instance, among the 63 children for whom there was
consensus by teachers and investigators, there were 12
for whom parents also indicated concerns. Yet, for this
same group of 63 preschoolers, 15 parents indicated
no concerns, and data were unavailable for parents of
36 children. We did find, however, a mismatch pattern
between teacher/investigator identification and parent
identification. Parents tended to identify children as cur-
rently stuttering when the investigators and teachers
did not—that is, a total of 68 (48 AA and 20 EA) children
were identified as stuttering by their parents but not by
investigators or teachers.
Discussion
Prior to evaluating the findings of this study, it is
pertinent to briefly compare its central methodological
features with those of previous investigations of stutter-
ing prevalence among African Americans. First, the age
of the participants is important. Whereas all previous
studies examined African Americans of elementary
Table 9. Investigator and teacher identification of stuttering.
Teacher
Investigator Yes No
Yes 63 18
No 9 3,074
Total 72 3,092
through high school age, ours is the first to focus ex-
clusively on preschoolers. This is significant because
much more information is gained about occurrence and
distribution of stuttering during the early years of life
rather than in any other period. When investigating
children who are only 3 or 4 years older than the current
sample, we found that approximately 75%, if not more, of
those who previously were diagnosed as stuttering have
already experienced the disappearance of their stutter-
ing due to natural recovery (Andrews, 1984; Andrews &
Harris, 1964; Mansson, 2000; Yairi & Ambrose, 2005).
This factor is particularly strong for girls, a fact that
clouds the true sex ratio in stuttering, which, owing to
recovery, greatly increases with age. Second, previous
studies used only a single source of information, primarily
teachers’ responses to questionnaires. In a few studies, a
single investigator or a school clinician identified children
who stuttered. In the present study, investigators, teach-
ers, and parents served as the three sources of identifi-
cation (although one provided only partial data). Further,
all children who stuttered were so identified by at least
two people making an independent judgment based on
direct observations. Also, the present study provided a
clear definition of stuttering, and all children who were
suspected of stuttering were audio tape-recorded for ad-
ditional verification. Last, in the present study, the
investigators /interviewers were knowledgeable about
the AA culture and English language used by African
Americans and, therefore, were better able to interact
with the children and to distinguish normal disfluen-
cies from stuttering.
In light of the above, key findings from this study
provide noteworthy information about stuttering in
AA preschoolers. Most pertinent to the objectives of
the current study is that all three data sources indicated
no statistically significant differences in the prevalence
of stuttering for 2- to 5-year-old African Americans and
same-age European Americans during the period when
the overwhelming majority of stuttering onsets occur.
The similarity between the two racial groups extended
to factors of age and sex. In both racial groups, boys
exhibited a higher prevalence of stuttering than girls
in ratios that are similar to what has been previously
reported, thus adding validity to the findings, and there
were no statistically significant differences in the over-
all prevalence of stuttering among the four discrete age
groups within the sample. Also, both groups exhibited
similar patterns of changing sex ratio with age. Inves-
tigator and teacher identification of stuttering revealed
that the prevalence of stuttering was 2.52% for this
Total sample of preschoolers. Still, although our large sample
was very diverse, it should be noted that the children
81
3,083
lived in a single state in the United States. Thus, in-
3,164 asmuch as the present study is the first to examine the
prevalence of stuttering in AA preschool children with
Proctor et al.: Prevalence of Stuttering 1475
the inclusion of a sample of same-age European Amer-
icans, the nonsignificant differences that were found lead
us to conclude that popular assumptions about stuttering
in African Americans should be re-evaluated.
The present study elicited stuttering identification,
as well as additional information, from parents, but only
1,107 (35%) of them responded. Although the reason for
this medium level of responding to a questionnaire sur-
vey is not clear, it is interesting that, contrary to pre-
vious reports (e.g., Yairi & Ambrose, 2005), parents tended
to identify children as currently exhibiting stuttering,
whereas the investigators and teachers did not. Four
reasons may account for this phenomenon: (a) parents’
confusion between past and present stuttering, (b) chil-
dren might stutter at home but not in school or vice versa,
(c) parents may have identified some other type of speech
disorder as stuttering, and (d) certain types of nonverbal
behaviors may have been considered as stuttering. It is
possible that the minority of parents who responded
represent those who were particularly sensitive about
their children’s speech, a possibility that is a factor in
the previous explanations. These same reasons may ac-
count for some of the investigator and teacher mismatches.
Regardless, the differences between parent identifica-
tion of stuttering and investigator and teacher identi-
fication invite further investigation regarding factors
that influence parent perception and assessment of
stuttering.
As the number of culturally and linguistically di-
verse groups increase in the United States, there is a
commensurate demand for strong, empirically generated
theoretical bases to support assessment and intervention
practices. A systematic approach to developing a scien-
tific body of information prior to sorting out what types of
assessment and treatment processes are appropriate for
AA preschool children should begin with establishing
epidemiological data such as the prevalence of stutter-
ing. Data from the present investigation suggest that
investigators may not expect to observe more AA 2- to
5-year-olds who stutter than EA peers in this age group.
The current research base in early childhood stuttering
in the United States has examined stuttering in the con-
text of mainstream American English–speaking children
and has not considered the diversity of the life experi-
ences of children from racially/ethnically and linguisti-
cally diverse backgrounds. As a result of such a view of
children who stutter, there remains a lack of knowledge
of treatment efficacy for children from AA culture and
from other diverse groups residing in the United States.
Some investigators (Kathard, 2001; Mower, 1998) argued
that the experimental designs in stuttering have not ac-
commodated the complexity of stuttering as a social issue.
Consequently, creative and alternative strategies are re-
quired to expand the existing view about how investiga-
tions of stuttering should be carried out (Perkins, 2000).
1476 Journal of Speech, Language, and Hearing Research • Vol. 51 • 1465–1479 • December 2008
For example, the present study did not rely on children
being brought to a laboratory setting for diagnosis. Instead,
children were identified during interaction in natural-
istic contexts.
In summary, the results of the present study con-
tribute to dispelling the long-held belief among many
practitioners and researchers that a higher percentage
of African Americans stutter than do European Amer-
icans. Still, the current study did not investigate the
possible racial or ethnic factors in natural recovery. The
possibility that African Americans exhibit a smaller re-
covery rate, and hence a higher percentage of stuttering
prevalence in later ages, should also be investigated. The
results of this study also support the need for cultur-
ally and linguistically sensitive research in stuttering—
research that addresses a variety of issues such as the
prevalence of stuttering in other racial/ethnic groups,
older age groups, alternative research designs, and treat-
ment efficacy in diverse populations.
Acknowledgments
The first author was the minority scholar who was respon-
sible for this research. The study was supported by a Minority
Supplement Grant from the National Institute on Deafness
and Other Communication Disorders (NIDCD). The NIDCD
Grant R01-DC 00459 was awarded to the second author, who
was the principal investigator. Melissa Duff was instrumental
in data collection, and Jie Zhang was instrumental in data
analysis. We thank all of the children, parents, and teachers
who participated in the study.
References
American Speech-Language-Hearing Association.
(2004). Preferred practice patterns for the practice of speech-
language pathology [Preferred Practice Patterns]. Available
from www.asha.org/policy.
Anderson, B. (1981). An analysis of the relationship of age
and sex to type and frequency of disfluencies in lower
socioeconomic preschool Black children. Unpublished doc-
toral dissertation, Northwestern University.
Andrews, G. (1984). The epidemiology of stuttering. In
R. Curlee & W. Perkins (Eds.), Nature and treatment of
stuttering (pp. 1–12). San Diego, CA: College Hill.
Andrews, G., & Harris, M. (1964). The syndrome of stuttering
[Clinics in Developmental Medicine, No. 17]. London:
Spastics Society Medical Education and Information Unit,
in association with William Heinemann Medical Books.
Asante, M. K. (1990). African elements in African American
English. In J. E. Holloway (Ed.), Africanisms in American
culture. Bloomington, IN: Indiana University Press.
Bloodstein, O. (1995). A handbook of stuttering. San Diego,
CA: Singular.
Carlson, E., Hirschorn, R. R., Rayaboy, S., & Zhao, M.
(1996). Factors associated with disability prevalence in
different racial/ethnic groups. [Report to the Office of Special
 Education programs, U.S. Department of Education (Deliv-
erable #36, Contract #HS9 203500)]. Washington, DC: U.S.
Department of Education.
Carson, C., & Kanter, C. E. (1945). Incidence of stuttering
among White and colored school children. Southern Speech
Journal, 10, 57–59.
Chin, P. C., & Hughes, S. (1987). Representation of minority
students in special education classes. Remedial and Special
Education, 8, 41–46.
Cooper, E. B., & Cooper, C. S. (1998). Multicultural con-
siderations in the assessment and treatment of stuttering.
In D. Battle (Ed.), Communication disorders in multicul-
tural populations (2nd ed., pp. 247–274). Boston: Butterworth-
Heinemann.
Coutinho, M. J., Oswald, D. P., & Best, A. M. (2002). The
influence of sociodemographics and gender on dispropor-
tionate identification of minority students as having learn-
ing disabilities. RASE: Remedial and Special Education, 23,
49–59.
Craig, A., Hancock, K., Tran, Y., Craig, M., & Peters, K.
(2002). Epidemiology of stuttering in the community across
the entire life span. Journal of Speech, Language, and
Hearing Research, 45, 1097–1105.
Dale, P. (1977). Factors related to dysfluent speech in bi-
lingual Cuban American adolescents. Journal of Fluency
Disorders, 2, 311–314.
Dalston, R., Martinkosky, S., & Hinton, V. (1987). Stut-
tering prevalence among patients at risk for velopharyngeal
inadequacy: A preliminary investigation. Cleft Palate Jour-
nal, 24, 233–239.
Dean, C. R., & Brown, R. A. (1977). A more recent look at
prevalence of stuttering in the United States. Journal of
Fluency Disorders, 2, 157–166.
Dillard, J. L. (1973). Black English: Its history and usage in
the United States. New York: Random House.
Finn, P., & Cordes, A. K. (1997). Multicultural identification
and treatment of stuttering: A continuing need for research.
Journal of Fluency Disorders, 22, 219–236.
Fluharty, N. (1978). Fluharty Preschool Speech and Language
Screening Test. Hingham, MA: Teaching Resources Corp.
Frazer, T. (1993). Heartland English. Tuscaloosa, AL: Univer-
sity of Alabama Press.
Glasner, P. J., & Rosenthal, D. (1957). Parental diagnosis of
stuttering in young children. Journal of Speech and Hearing
Disorders, 22, 288–295.
Gillespie, S. K., & Cooper, E. B. (1973). Prevalence of speech
problems in junior and senior high schools. Journal of
Speech and Hearing Research, 16, 739–743.
Goldman, R. (1967). Cultural influences on the sex ratio in the
incidence of stuttering. American Anthropologist, 69, 78–81.
Green, L. J. (2002). African American English: A linguistic
introduction. New York: Cambridge University Press.
Hallahan, D. P., & Kaufman, J. M. (1994). Exceptional
children: Introduction to special education. Boston: Allyn &
Bacon.
Harry, B. (1992). Cultural diversity, families, and the special
education system. New York: Teachers College Press.
Harry, B. (1994). The disproportionate representation of minority
students in special education: Theories and recommendations.
Alexandria, VA: National Association of State Directors of
Special Education.
Karniol, R. (1992). Stuttering out of bilingualism. First
Language, 12, 255–283.
Kathard, H. (2001). Sharing stories: Life history narratives in
stuttering. International Journal of Language and Com-
munication Disorders, 36, 52–57.
Labov, W. (1972). Language in the inner city: Studies in Black
English vernacular. Philadelphia: University of Pennsylvania
Press.
Louttit, C. M., & Halls, E. C. (1936). Survey of speech defects
among public school children of Indiana. Journal of Speech
Disorders, 1, 73–80.
Madding, C. C. (1995). The stuttering syndrome: Feelings and
attitudes of stutterers and non-stutterers among four cultu-
ral groups. Unpublished doctoral dissertation, Claremont
Graduate School.
Mansson, H. (2000). Childhood stuttering incidence and
development. Journal of Fluency Disorders, 25, 47–57.
McKinnon, D., McLeod, S., & Reilly, S. (2007). The prev-
alence of stuttering, voice, and speech-sound disorders in
primary school students in Australia. Language, Speech,
and Hearing Services in Schools, 38, 5–15.
McKinnon, J. (2003). The Black population in the United
States: March 2002 [Current population reports, Series
P20-541]. Washington, DC: U.S. Census Bureau.
Montgomery, B. M., & Fitch, J. L. (1988). The prevalence
of stuttering in the hearing-impaired school age population.
Journal of Speech and Hearing Disorders, 53, 131–135.
Mower, D. E. (1998). Alternative research strategies for the
investigation of stuttering. Journal of Fluency Disorders, 23,
89–97.
Mufwene, S. S. (Ed.). (1993). Africanisms in Afro-American
language varieties. Athens, GA: University of Georgia Press.
Mufwene, S. S., Rickford, J. R., Bailey, G., & Baugh, J.
(1998). African American English: Structure, history and use.
New York: Routledge.
Muller, E., & Markowitz, J. (2003). Biennial performance
reports—Disproportionality. Project Forum at NASDSE. Re-
trieved from http://www.projectforum.org on October 5, 2008.
National Research Council. (2002). Minority students in
special and gifted education. Washington, DC: National
Academies Press.
Neely, M. M. (1960). An investigation of the incidence of
stuttering among elementary school children in the parochial
schools of Orleans parish. Unpublished master’s thesis,
Tulane University.
Noguera, P. A. (2006, July). Getting the elephant out of the
living room: Finding ways to reduce the disproportionate
placement of minority students into special education.
Presentation at the Office of Special Education Programs
Project Directors’ Conference, Washington, DC.
Nwokah, E. E. (1988). The imbalance of stuttering behav-
ior in bilingual speakers. Journal of Fluency Disorders, 13,
357–373.
Oswald, D. P., Coutinho, M. J., Best, A. M., & Singh, N. N.
(1999). Ethnic representation in special education: The in-
fluence of school-related economic and demographic vari-
ables. Journal of Special Education, 32, 194–206.
Proctor et al.: Prevalence of Stuttering 1477
Perkins, W. H. (2000). Tongue wars—Recovery from stuttering.
Reno, NV: Athens Press.
Poplack, S. (2000). The English history of African American
English. Malden, MA: Blackwell.
Proctor, A. (2006). Normal disfluency versus stuttering in
preschoolers who speak African American English (AAE).
ASHA Leader, 11(11), 133.
Rickford, J. R. (1999). African American English vernacular.
New York: Routledge.
Smith, D. D. (1998). Introduction to special education: Teaching
in an age of challenge. Boston: Allyn & Bacon.
Smitherman, G. (1977). Talkin’ an’ testifyin’: The language of
Black America. Boston: Houghton Mifflin.
Travis, L. E., Johnson, D. W., & Shover, J. (1937). The
relation of bilingualism to stuttering: A survey in the East
Chicago, Indiana, schools. Journal of Speech Disorders, 2,
185–189.
U.S. Census Bureau. (2002). Census 2000 PHC-T-1 Popu-
lation by Race and Hispanic or Latino Origin. Retrieved
September 10, 2008 from http://www.census.gov/population.
U.S. Department of Education. (2005). Twenty-seventh
annual report to Congress on the implementation of the
Individuals with Disabilities Education Act. Washington,
DC: U.S. Government Printing Office.
Van Borsel, J., Maes, E., & Foulon, S. (2001). Stuttering and
bilingualism: A review. Journal of Fluency Disorders, 26,
179–205.
Van Borsel, J., Moeyart, J., Mostaert, C., Rosseel, R.,
Van Loo, E., & Van Renterghem, T. (2006). Prevalence
of stuttering in regular and special school populations in
Belgium based on teacher perceptions. Folia Phoniatrica
et Logopaedica, 58, 289–302.
VanKeulen, J. E., Weddington, G. T., & DeBose, C. E.
(1998). Speech, language, and learning in the African
American child. Boston: Allyn & Bacon.
1478 Journal of Speech, Language, and Hearing Research • Vol. 51 • 1465–1479 • December 2008
Waddle, E. (1934). A comparison of speech defects in colored
and White children. Unpublished master’s thesis, University
of Iowa.
Wallin, J. E. (1916). Census of speech defectives among
89,057 public school pupils. School and Society, 3, 213–216.
Wallin, J. E. (1926). Speech defective children in a large
school system. Miami University Bulletin, 25(4), 3–45.
Watson, J. B., & Kayser, H. (1994). Assessment of bilingual/
bicultural children and adults who stutter. Seminars in
Speech and Language, 15, 149–164.
Yairi, E., & Ambrose, N. G. (1999). Early childhood stutter-
ing: I. Persistency and recovery rates. Journal of Speech and
Hearing Research, 42, 1097–1112.
Yairi, E., & Ambrose, N. G. (2005). Early childhood stuttering.
Austin, TX: Pro-Ed.
Zimmerman, G., Liljeblad, S., Frank, A., & Cleeland, C.
(1983). The Indians have many terms for it: Stuttering
among the Bannock-Shoshoni. Journal of Speech and
Hearing Research, 26, 315–318.
Received March 5, 2007
Revision received August 19, 2007
Accepted March 19, 2008
DOI: 10.1044/1092-4388(2008/07-0057)
Contact author: Adele Proctor, Department of Speech
and Hearing Science, University of Illinois at Urbana–
Champaign, 901 South 6th Street, Champaign, IL 61820.
E-mail: aproctor@uiuc.edu.
Appendix. Letter to parents of study participants.

Dear Parent, Date

The Department of Speech & Hearing Science, University of Illinois, with the cooperation of your child’s daycare center/school, is conducting a survey of
young children’s speech. For the most part, we plan to listen to each child while he/she plays at school. We would also like to ask your thoughts of your child’s
speech, language, and hearing at present as well as in the past. Please take a minute to help us out by responding to the following items. Your cooperation is
very important to us.
Your Child’s Name_________________________ Classroom:________________________

At present, I have questions/concerns about my child’s speech, language, hearing skills:

___________Speech (speech sounds used)
___________Language (how well he/she expresses him/herself)
___________Stuttering (or other problems of speech rhythm)
___________Voice (for example, hoarseness)
___________Hearing (how well he/she hears in the environment)
If any were checked yes, please explain:
____________________________________________________________________________________
____________________________________________________________________________________
In the past, but not now, I had questions/concerns about my child’s speech, language, hearing skills:
_____________Speech
_____________Language
_____________Stuttering
_____________Voice
_____________Hearing
______________________________________________________________
If any were checked yes, please explain and give approximate ages.
Thank you for taking the time to answer our questions. Please return this form to your child’s daycare center/school. If you have any questions about this project
you may call _________.

Sincerely,
Dr. Adele Proctor Dr. Ehud Yairi
Associate Professor Professor

Proctor et al.: Prevalence of Stuttering 1479