Stuttering Knowledge among Primary School Teachers in Zahedan, Iran: A Cross-Sectional Survey
Abstract
Background: Primary school teachers play an important role in supporting children who stutter (CWS), and adequate knowledge of stuttering can help them respond appropriately in educational settings. Previous research has identified gaps and misconceptions among teachers, especially regarding causes of stuttering, but evidence from Iran remains limited. This study examined stuttering knowledge among primary school teachers in Zahedan, Iran, and its associations with demographic characteristics and attitudes.
Materials and Methods: In this cross-sectional survey, 136 primary school teachers from 26 urban schools in Zahedan completed the 26-item Alabama Stuttering Knowledge (ASK) Test and the Public Opinion Survey of Human Attributes–Stuttering (POSHA-S). ASK scores (0–26) were summarized descriptively. Associations of demographic characteristics with ASK total score were examined using multiple linear regression, and associations between ASK score and POSHA-S subscales were assessed using Spearman correlations.
Results: Mean ASK score was 14.28 (SD = 2.72; 54.9% correct), with item accuracy ranging from 12.5% to 91.2%. No significant associations emerged between knowledge and demographic or attitudinal variables.
Conclusions: Teachers answered just over half of the ASK items correctly, with notably low accuracy on etiology items. The null knowledge–attitude finding warrants replication in larger samples. Results underscore the need for culturally responsive teacher training addressing both knowledge and underlying beliefs.
1. Yairi, E. and N. Ambrose, Epidemiology of stuttering: 21st century advances. Journal of Fluency Disorders, 2013. 38(2): p. 66-87.
2. Singer, C., et al., Clinical characteristics associated with stuttering persistence: a meta-analysis. Journal of Speech, Language, and Hearing Research, 2020. 63(9): p. 2995-3018.
3. Einarsdóttir, J., K. Crowe, and B. Hermannsdóttir, A prospective 14-year follow-up study of the persistence and recovery of stuttering. Journal of Fluency Disorders, 2024. 80: p. 106058.
4. Månsson, H., Childhood stuttering: incidence and development. Journal of Fluency Disorders, 2000. 25(1): p. 47-57.
5. Johnson, G., et al., Psychosocial features of stuttering for school-age children: A systematic review. International Journal of Language & Communication Disorders, 2023. 58(5): p. 1829-1845.
6. Eggers, K., S. Millard, and E. Kelman, Temperament, anxiety, and depression in school-age children who stutter. Journal of Communication Disorders, 2022. 97: p. 106218.
7. Gerlach-Houck, H., K. Kubart, and E. Cage, Concealing stuttering at school: "when you can't fix it…the only alternative is to hide it". Language, speech, and hearing services in schools, 2022. 54(1): p. 96-113.
8. Daniels, D., R. Gabel, and S. Hughes, Recounting the k-12 school experiences of adults who stutter: a qualitative analysis. Journal of Fluency Disorders, 2012. 37(2): p. 71-82.
9. Rocha, M., J.R. Rato, and J.S. Yaruss, The impact of stuttering on Portuguese school-age children as measured by the OASES-S. Speech, Language and Hearing, 2021. 24(1): p. 38-47.
10. Sari, H. and H. Gökdag, An analysis of difficulties of children with stuttering enrolled in Turkish primary inclusive classes who encounter in academic and social activities: from their perspectives. Journal of Education and Practice, 2017. 8(2): p. 31-43.
11. Plexico, L.W., A.M. Plumb, and J. Beacham, Teacher knowledge and perceptions of stuttering and bullying in school‐age children. Perspectives on Fluency and Fluency Disorders, 2013. 23(2): p. 39-53.
12. Almudhi, A., Investigating the beliefs and attitudes of teachers towards students who stutter. South African Journal of Education, 2022. 42(3): p. 1-15.
13. LaBlance, G.R., K.F. Steckol, and V.L. Smith, Stuttering the role of the classroom teacher. Teaching Exceptional Children, 1994. 26(2): p. 10-12.
14. Grigoropoulos, I., Early childhood educators' knowledge and attitudes toward young children who stutter. Psychiatriki, 2020. 31(4): p. 352-356.
15. Yeakle, M.K. and E.B. Cooper, Teacher perceptions of stuttering. Journal of Fluency Disorders, 1986. 11(4): p. 345-359.
16. Matheson, T., S. Arnott, and M. Donaghy, Australian pre-service primary teachers’ knowledge, attitudes, and skills regarding stuttering. International Journal of Speech-Language Pathology, 2022. 25(5): p. 710-721.
17. Abdalla, F.A. and K.O. St. Louis, Arab school teachers’ knowledge, beliefs and reactions regarding stuttering. Journal of Fluency Disorders, 2012. 37(1): p. 54-69.
18. Hearne, A., et al., Exploring teachers’ attitudes: knowledge and classroom strategies for children who stutter in New Zealand. Speech, Language and Hearing, 2020. 24(1): p. 28-37.
19. Michalczyk, A. and A. Ślusarczyk, Teacher perspectives on supporting students with stuttering in schools and preschools. Horyzonty Wychowania, 2024. 23(68): p. 137-147.
20. Adriaensens, S. and E. Struyf, Secondary school teachers' beliefs, attitudes, and reactions to stuttering. Language, speech, and hearing services in schools, 2016. 47(2): p. 135-147.
21. Elrefaie, D., et al., Survey on Cairene primary school teachers’ knowledge and attitude about stuttering. The Egyptian Journal of Otolaryngology, 2022. 38(1).
22. Al-Qaisi, R.Q.M., E.G. Ali, and A.K. Khudhair, Assessment of primary school teachers’ knowledge about stuttering of school-age children at first al-karkh education directorate in Baghdad city. Indian Journal of Forensic Medicine & Toxicology, 2020. 14(3): p. 1418-1422.
23. Khodair, R., et al., An exploratory study of Jordanian resource-room teachers’ knowledge about stuttering. Journal of Positive School Psychology, 2022. 6(6): p. 1190-1203.
24. Alharbi, E., et al., Investigating Saudi secondary school teachers’ knowledge of stuttering and experiences with adolescents who stutter. Journal of Fluency Disorders, 2026. 87: p. 106193.
25. Kleinman, A., Patients and healers in the context of culture: an exploration of the borderland between anthropology, medicine, and psychiatry. Vol. 3. 1980, Berkeley: University of California Press.
26. Arabiat, D., et al., Beliefs about illness and treatment decision modelling during ill-health in Arabic families. Journal of Multidisciplinary Healthcare, 2021. 8(14): p. 1755-1768.
27. Ayinde, O., et al., Explanatory models, illness, and treatment experiences of patients with psychosis using the services of traditional and faith healers in three African countries: similarities and discontinuities. Transcultural Psychiatry, 2021. 60(3): p. 521-536.
28. Dieste, S., et al., An explanatory framework for understanding mental health needs of Afghan refugees resettled in the global north. International Journal of Psychology, 2025. 60(6): p. e70117.
29. Gudyanga, D., et al., Illness explanatory models of depression among young people in low-resource settings: a qualitative study in Ghana and Zimbabwe. PLOS One, 2026. 21(1): p. e0340267.
30. Crowe, T.A. and E.B. Cooper, Parental attitudes toward and knowledge of stuttering. Journal of Communication Disorders, 1977. 10(4): p. 343-357.
31. Ramada-Rodilla, J.M., C. Serra-Pujadas, and G. Delclós-Clanchet, Cross-cultural adaptation and health questionnaires validation: revision and methodological recommendations. Salud Publica de Mexico, 2013. 55(1): p. 57-66.
32. Epstein, J., R. Santo, and F. Guillemin, A review of guidelines for cross-cultural adaptation of questionnaires could not bring out a consensus. Journal of clinical epidemiology, 2015. 68(4): p. 435-441.
33. St. Louis, K.O., Research and development on a public attitude instrument for stuttering. Journal of Communication Disorders, 2012. 45(2): p. 129-146.
34. Abdi, S., S. Jalaei, and A. Pourmohammad, Development and evaluation of psychometric properties of the Persian version of “Public Opinion Survey of Human Attributes-Stuttering”. Journal of Modern Rehabilitation, 2016. 9(7): p. 86-92.
35. Abrahams, K., et al., Primary school teachers' opinions and attitudes towards stuttering in two South African urban education districts. South African Journal of Communication Disorders, 2016. 63(1): p. 1-10.
36. Modrego-Alarcón, M., et al., Analyzing the attitudes of teachers in Spain toward stuttering. International Journal of Language & Communication Disorders, 2026. 61(3): p. e70223.
37. Lefort, M., et al., Stuttering in the classroom: an exploration of Australian teachers' attitudes. International Journal of Speech-Language Pathology, 2026. 31: p. 1-15.
2. Singer, C., et al., Clinical characteristics associated with stuttering persistence: a meta-analysis. Journal of Speech, Language, and Hearing Research, 2020. 63(9): p. 2995-3018.
3. Einarsdóttir, J., K. Crowe, and B. Hermannsdóttir, A prospective 14-year follow-up study of the persistence and recovery of stuttering. Journal of Fluency Disorders, 2024. 80: p. 106058.
4. Månsson, H., Childhood stuttering: incidence and development. Journal of Fluency Disorders, 2000. 25(1): p. 47-57.
5. Johnson, G., et al., Psychosocial features of stuttering for school-age children: A systematic review. International Journal of Language & Communication Disorders, 2023. 58(5): p. 1829-1845.
6. Eggers, K., S. Millard, and E. Kelman, Temperament, anxiety, and depression in school-age children who stutter. Journal of Communication Disorders, 2022. 97: p. 106218.
7. Gerlach-Houck, H., K. Kubart, and E. Cage, Concealing stuttering at school: "when you can't fix it…the only alternative is to hide it". Language, speech, and hearing services in schools, 2022. 54(1): p. 96-113.
8. Daniels, D., R. Gabel, and S. Hughes, Recounting the k-12 school experiences of adults who stutter: a qualitative analysis. Journal of Fluency Disorders, 2012. 37(2): p. 71-82.
9. Rocha, M., J.R. Rato, and J.S. Yaruss, The impact of stuttering on Portuguese school-age children as measured by the OASES-S. Speech, Language and Hearing, 2021. 24(1): p. 38-47.
10. Sari, H. and H. Gökdag, An analysis of difficulties of children with stuttering enrolled in Turkish primary inclusive classes who encounter in academic and social activities: from their perspectives. Journal of Education and Practice, 2017. 8(2): p. 31-43.
11. Plexico, L.W., A.M. Plumb, and J. Beacham, Teacher knowledge and perceptions of stuttering and bullying in school‐age children. Perspectives on Fluency and Fluency Disorders, 2013. 23(2): p. 39-53.
12. Almudhi, A., Investigating the beliefs and attitudes of teachers towards students who stutter. South African Journal of Education, 2022. 42(3): p. 1-15.
13. LaBlance, G.R., K.F. Steckol, and V.L. Smith, Stuttering the role of the classroom teacher. Teaching Exceptional Children, 1994. 26(2): p. 10-12.
14. Grigoropoulos, I., Early childhood educators' knowledge and attitudes toward young children who stutter. Psychiatriki, 2020. 31(4): p. 352-356.
15. Yeakle, M.K. and E.B. Cooper, Teacher perceptions of stuttering. Journal of Fluency Disorders, 1986. 11(4): p. 345-359.
16. Matheson, T., S. Arnott, and M. Donaghy, Australian pre-service primary teachers’ knowledge, attitudes, and skills regarding stuttering. International Journal of Speech-Language Pathology, 2022. 25(5): p. 710-721.
17. Abdalla, F.A. and K.O. St. Louis, Arab school teachers’ knowledge, beliefs and reactions regarding stuttering. Journal of Fluency Disorders, 2012. 37(1): p. 54-69.
18. Hearne, A., et al., Exploring teachers’ attitudes: knowledge and classroom strategies for children who stutter in New Zealand. Speech, Language and Hearing, 2020. 24(1): p. 28-37.
19. Michalczyk, A. and A. Ślusarczyk, Teacher perspectives on supporting students with stuttering in schools and preschools. Horyzonty Wychowania, 2024. 23(68): p. 137-147.
20. Adriaensens, S. and E. Struyf, Secondary school teachers' beliefs, attitudes, and reactions to stuttering. Language, speech, and hearing services in schools, 2016. 47(2): p. 135-147.
21. Elrefaie, D., et al., Survey on Cairene primary school teachers’ knowledge and attitude about stuttering. The Egyptian Journal of Otolaryngology, 2022. 38(1).
22. Al-Qaisi, R.Q.M., E.G. Ali, and A.K. Khudhair, Assessment of primary school teachers’ knowledge about stuttering of school-age children at first al-karkh education directorate in Baghdad city. Indian Journal of Forensic Medicine & Toxicology, 2020. 14(3): p. 1418-1422.
23. Khodair, R., et al., An exploratory study of Jordanian resource-room teachers’ knowledge about stuttering. Journal of Positive School Psychology, 2022. 6(6): p. 1190-1203.
24. Alharbi, E., et al., Investigating Saudi secondary school teachers’ knowledge of stuttering and experiences with adolescents who stutter. Journal of Fluency Disorders, 2026. 87: p. 106193.
25. Kleinman, A., Patients and healers in the context of culture: an exploration of the borderland between anthropology, medicine, and psychiatry. Vol. 3. 1980, Berkeley: University of California Press.
26. Arabiat, D., et al., Beliefs about illness and treatment decision modelling during ill-health in Arabic families. Journal of Multidisciplinary Healthcare, 2021. 8(14): p. 1755-1768.
27. Ayinde, O., et al., Explanatory models, illness, and treatment experiences of patients with psychosis using the services of traditional and faith healers in three African countries: similarities and discontinuities. Transcultural Psychiatry, 2021. 60(3): p. 521-536.
28. Dieste, S., et al., An explanatory framework for understanding mental health needs of Afghan refugees resettled in the global north. International Journal of Psychology, 2025. 60(6): p. e70117.
29. Gudyanga, D., et al., Illness explanatory models of depression among young people in low-resource settings: a qualitative study in Ghana and Zimbabwe. PLOS One, 2026. 21(1): p. e0340267.
30. Crowe, T.A. and E.B. Cooper, Parental attitudes toward and knowledge of stuttering. Journal of Communication Disorders, 1977. 10(4): p. 343-357.
31. Ramada-Rodilla, J.M., C. Serra-Pujadas, and G. Delclós-Clanchet, Cross-cultural adaptation and health questionnaires validation: revision and methodological recommendations. Salud Publica de Mexico, 2013. 55(1): p. 57-66.
32. Epstein, J., R. Santo, and F. Guillemin, A review of guidelines for cross-cultural adaptation of questionnaires could not bring out a consensus. Journal of clinical epidemiology, 2015. 68(4): p. 435-441.
33. St. Louis, K.O., Research and development on a public attitude instrument for stuttering. Journal of Communication Disorders, 2012. 45(2): p. 129-146.
34. Abdi, S., S. Jalaei, and A. Pourmohammad, Development and evaluation of psychometric properties of the Persian version of “Public Opinion Survey of Human Attributes-Stuttering”. Journal of Modern Rehabilitation, 2016. 9(7): p. 86-92.
35. Abrahams, K., et al., Primary school teachers' opinions and attitudes towards stuttering in two South African urban education districts. South African Journal of Communication Disorders, 2016. 63(1): p. 1-10.
36. Modrego-Alarcón, M., et al., Analyzing the attitudes of teachers in Spain toward stuttering. International Journal of Language & Communication Disorders, 2026. 61(3): p. e70223.
37. Lefort, M., et al., Stuttering in the classroom: an exploration of Australian teachers' attitudes. International Journal of Speech-Language Pathology, 2026. 31: p. 1-15.
| Issue | Articles in Press | |
| Section | Research Article(s) | |
| Keywords | ||
| Stuttering; School Teachers; Knowledge Attitudes; Iran | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Sakhai F, Arab Nakhaei M, Asadollahpour F. Stuttering Knowledge among Primary School Teachers in Zahedan, Iran: A Cross-Sectional Survey. jmr. 2026;(-).
