About the presenters: Sheree Reese is an Associate Professor in the Department of Communication Disorders and Deafness at Kean University in New Jersey where she also serves as Clinic Director. She teaches courses in fluency disorders, assessment and research, and has presented workshops on stuttering around the state. Sheree's interest in this area began when she traveled to China for four weeks in August 1999. She has published two previous papers on the topic.
Joseph Jordania is a Research Assistant at The University of
Melbourne. Originally from Georgia (former USSR) he studied
ethnomusicology at the PhD level. He worked as Professor of Music at
Tbilisi Statye Conservatory and as a Senior Researcher at Tbilisi
State University before moving to Australia in 1995. He became
interested in stuttering in 1989, after his work on the origins of
choral singing led to an interest in the origin of speech, and then
pathologies of speech. He has published a paper on the topic in
Singapore Speech, Language and Hearing Association
You can post Questions/comments about the following paper to Sheree Reese and Joseph Jordania before October 22, 2001.
Stuttering in the Chinese population in some South-East Asian countries: A Preliminary investigation on attitude and Incidence
by Sheree Reese and Joseph Jordania
from New Jersey, USA and Australia
There are, at present, great gaps in our knowledge of the incidence of
stuttering in different cultures. Although research is being done on
attitudes towards stuttering in different cultures (St. Louis et al, 2000)
there is little data being gathered on such topics as incidence, assessment
and treatment of stuttering in Asian cultures. A recent article on the
subject (Reese et al, 1999) indicated that stuttering has never been a
subject of serious study in China and so there are presently no reliable
data. This paper represents our informal attempt to gather information
presently available about stuttering in the Chinese population. To learn
more about the incidence of stuttering among Chinese, we looked at regions
having large Chinese populations.
Efforts to gather information on this population met with limited success.
One author of this paper, Dr. Joseph Jordania, made initial contact with the
Multicultural Interest Group of Victoria, Australia, which led to contact
with the Speech, Language and Hearing Association in Singapore. One contact
led to another, and a total of twenty-eight respondents were identified.
Most of the respondents are Speech-Language Pathologists (with a few
associates from the related spheres), working in South-East Asian countries
with a predominantly Chinese population. Thus, the information presented in
this paper is anecdotal; it relies on personal opinions and while it can
only be considered a 'population of convenience', it is a start.
A two part, informal questionnaire was developed representing the interests
of the two authors of this paper, and was submitted to those respondents who
expressed willingness to participate. In view of the significant lack of
information in this area, all information was gratefully accepted and
included in this paper.
The personal experiences and opinions of three Chinese stutterers was
included as well, since they offer unique insights into the subject under
discussion. B.M. is a 25 year old man from Guangzhou (Canton) in Guangdong
province who describes himself as a 'closet stutterer' and rates himself as
'moderate' in severity. E.T. is a 19 year old male who was assessed by a
professional Speech-Language Pathologist as a severe stutterer. G.F. is a 20
year old male moderate stutterer, who participated in professional speech
therapy and describes his experience at school and in his family.
An initial informal questionnaire was sent to all respondents by Dr. Joseph
Jordania. It was designed to investigate the following: the number of
stutterers seen/treated by the respondent, languages spoken by the
stutterers (and whether or not they stuttered in all languages they spoke),
the age range and gender of the stutterers seen, severity assessment, the
existence of concomitant health/mental problems and secondary behaviors,
treatment results, the respondents background, credentials and working
experience with the Chinese population. Three additional questions were
added after some respondents indicated that such questions could provide
interesting insight into the problem. These questions were designed to find
out whether the respondents have ever heard of a famous Chinese who did (or
does) stutter, what the respondents think about the incidence and prevalence
of stuttering between two different populations (Chinese and Indian, two of
the sizable populations in some of the countries of the South-East Asia),
and whether respondents remember (among their school friends, University
friends, relatives, etc.) knowing Chinese stutterers who did not receive any
A second questionnaire was sent by Dr. Sheree Reese to those respondents who
indicated their willingness to answer additional questions designed to
ascertain information about (1) the training and credentials of the
respondents, (2) their approaches to assessment and treatment, and (3)
attitudes within the culture.
The questionnaires were sent to SLPs working in Singapore, Taiwan, Hong Kong
and Malaysia. (Unfortunately, currently contact with SLPs in mainland China
is difficult. In fact, the profession of Speech-Language pathologist does
not formally exist in China). Whole or partial responses were received from
28 individuals: 23 from Singapore, 2 from Taiwan, 2 from Hong Kong and 1
The following is a summary of some of the information we gathered:
Bearing in mind the shortcomings of our information as mentioned above on
one hand, and it's importance as the first actual data on stuttering in
Chinese population on the other hand, we can outline the following two major
- Most of the information received came from professional SLPs whose
experience varies widely from several months to more than 10 years.
- The respondents work predominantly in either acute care, 'public'
hospital settings or private practices.
- Referrals are primarily from medical doctors or government doctors in
response to parental requests.
- Most of the respondents reported having received their credentials in
countries other than where they were practicing (predominantly the United
Kingdom, United States, or Australia). Their degrees ranged from bachelors
to masters degrees.
- If we take into account the total working experience of all our
respondents and the number of stutterers seen by them the mean will be less
than one and a half stutterers per year seen by an average SLP in South-East
Asian countries. This may be a reflection of a very low referral rate.
- Respondents reported incorporating both subjective and objective
observations in their assessment. Informal questionnaires are frequently
used. They reported evaluating oral motor function, language, frequency of
dysfluency (in syllables per minute), types of dysfluency and the presence
of secondary or associative behaviors. Only one mentioned assessment of
articulation or phonology.
- Respondents reported working on 'easy onset', reduced rate, rhythm,
prolongation of initial sounds, 'smooth vs. bumpy talking'. Counseling and
behavior modification were only mentioned by one respondent; two mentioned
incorporating home programs in their treatment plans.
- Without exception, all respondents reported negative attitudes towards
stutterers by parents and society. Parents attitudes ranged from concerned
support and understanding to annoyance and the attitude that the child who
stutters is 'lazy' and 'doing it on purpose'. In addition, the stutterers
themselves exhibited low self esteem, lack of confidence and a 'warped'
perspective of their own fluency.
1. Some of the information provided by our respondents is comparable to
reports from the research literature. This includes the following:
However interesting and provoking it might seem to speculate on the possible
reasons for the low number of stutterers among Chinese (many unique features
of the Chinese language, culture and history may provide an array of
possible reasons) it seems premature to build any hypothesis. Our research
represents only the first attempt in this sphere and by no means the
conclusions deduced in it should be considered as final. Preliminary
research based on 28 informants cannot represent the biggest population of
the world. It is obvious that more research is needed. Only after the new
independent research on a larger sample will it become clear whether our
conclusion about the low stuttering incidence among Chinese will be
2. Some information, provided in the answers of our respondents, differs
from that of the research literature. This includes the following:
- Chinese of all ages are prone to stuttering, although there are many more
children in the stuttering population then there are adults;
- There are more male stutterers than female stutterers among Chinese;
- Chinese bi- and tri-lingual stutterers stutter in all of the languages
that they speak, and stuttering is often less pronounced in one (usually
their first) language;
- Moderate and severe stutterers often display secondary characteristics,
such as facial tics and head/shoulder movements;
- Reported assessment techniques used to identify stuttering are comparable
to those used in other European countries and the USA. (although no
consistency between our respondents was identified.)
- Results of speech therapy are improved when therapy is conducted in early
childhood, or the earlier the intervention the better the results. Therapy
has a lower success rate when it is conducted among adults
- Chinese stutterers have the same social pressures and problems (fears of
all kinds of verbal communication and feelings of insecurity) as described
in research literature.
- The referral rate among Chinese is very low (less than one and a half
stutterers per year in the caseloads a SLPs);
- The number of hidden or 'concealed' stutterers who do not seek
professional speech therapy is not big as well. Therefore, the information
received from our respondents does not support the view that the main
portion of Chinese stutterers never go to SLPs and remain in families.
- While current approaches to therapy were mentioned, less emphasis was
placed on dealing with feelings and emotions than the traditional easy
onset, continuous phonation, etc., techniques.
- Comparison of the stuttering populations of Chinese and Indians in
Singapore and Malaysia also points to a very small number of stutterers
And finally, we should not forget, that even if the incidence in China is
much lower than in most of the European countries and the USA, we are still
looking at hundreds of thousands (or even millions) of Chinese stutterers,
trying to cope with their condition without the help of available
professional SLPs. Establishing the specialty of Speech-Language Pathology
in China would lead to more available means of therapy and would generally
improve the life condition of hundreds of thousands (and maybe millions) of
Reese, Sheree, Stefan Hoffmann, Li Sheng Li. (1998) The state of stuttering
in China. Published on on-line conference on The Stuttering Home Page,
Minnesota State University, Mankato.
St. Louis, K. O., Lubker, B., Yaruss, J.S., Pill, J., Diggs, C. (2000)
National Project on Attitudes Toward Stuttering: Initial Planning and Status
You can post Questions/comments about the above paper to Sheree Reese and Joseph Jordania before October 22, 2001.
July 1, 2001