NAME: ______________________________________________DATE:______________

1. Is it best to keep your mouth shut when you are in trouble?                                 Yes  No

2. When the teacher calls on you, do you get nervous?                                             Yes  No

3. Do you ask a lot of questions in class?                                                                   Yes  No

4. Do you like to talk on the phone?                                                                            Yes  No

5. If you do not know a person, would you tell them your name?                               Yes  No

6. Is it hard to talk to your teacher?                                                                             Yes  No

7. Would you go up to a new boy or girl in your class?                                                Yes  No

8. Is it hard to keep control of your voice when talking?                                             Yes  No

9. Even when you know the right answer, are you afraid to say it?                            Yes  No

10. Do you like to tell other children what to do?                                                        Yes   No

11. Is it fun to talk to your dad?                                                                                    Yes   No

12. Do you like to tell stories to your classmates?                                                       Yes  No

13. Do you wish you could say things as clearly as the other kids do?                        Yes  No

14. Would you rather look at a comic book than talk to a friend?                                Yes  No

15. Are you upset when someone interrupts you?                                                          Yes  No

16. When you want to say something, do you just say it?                                              Yes  No

17. Is talking to your friends more fun than playing by yourself?                                  Yes  No

18. Are you sometimes unhappy?                                                                                    Yes  No

19. Are you a little afraid to talk on the phone?                                                             Yes  No

Susan Andre and Barry Guitar

University of Vermont

Establish rapport with the child and make sure that he/she is physically comfortable before

beginning administration. Explain the task to the child and make sure he/she understands

what is required. Some simple directions might be used:

“I am going to ask you some questions. Listen carefully and then

tell me what you think; Yes or No. There is no right or wrong

answer. I just want to know what you think.”

To begin the scale, ask the questions in a natural manner. Do no urge the child to respond before he/she is ready, and repeat the question if the child did not hear it or you feel that he/she did not understand it. Do not reword the question unless you feel it is absolutely necessary, and then write the question you asked under that item.

Circle the answer that corresponds with the child’s response. Be accepting of the child’s response because there is no right or wrong answer. If all the child will say is “I don’t know”, even after prompting, record that response next to the question.

For the younger children (kindergarten and firs grade), it might be necessary to give a few simple examples to ensure comprehension of the required task:

a. Are you a boy? YES NO

b. Do you have black hair? YES NO

Similar, obvious questions may be inserted, if necessary, to reassure the examiner that the child is actively cooperating at all times. Adequately praise the child for listening and assure him/her that a good job is being done.

It is important to be familiar with the questions so that they can be read in a natural manner.

The child is given one point for answers that match those given below. The higher a child’s score, the more probable it is that he/she has developed negative attitudes toward communication. In our study, the mean score of the K through 4^{th stutterers (N=28) was 9.07 (S.D. = 2.44), and for the 28 matched controls, it was 8.17 (S.D.=1.80).}

Score one point for each answer that matches these:

1.YES                 10. NO

2.YES                 11. NO

3. NO                 12. NO

4. NO                 13. YES

5.NO                 14. YES

6.YES                 15. YES

7.NO                 16. NO

8.YES                 17. NO

9. YES                 18. YES

                            19. YES