ASSESSING THE COMMUNICATION APPREHENSION OF
CHILDREN WITH VELOPHARYNGEAL INSUFFICIENCY
Agnieszka Dzioba, Ph.D.
1
(Candidate) ,
Murad Husein,
2
MD , Anne
Dworschak-Stokan,
3
SLP ,
& Philip C. Doyle,
1
Ph.D.
1. Voice Production and Perception Lab, University of Western Ontario; 2. London Health Sciences Centre; 3. Thames Valley Children’s Centre
Abstract
The study evaluated communication apprehension (CA)
in 40 adolescents (ages 8-14) with velopharyngeal
insufficiency (VPI) and 40 age-matched controls. Children
with VPI reported higher levels of CA compared to
children in the control group.
Comprehensive
consideration of communication performance in those
with VPI is warranted.
Methods
Data Analysis
Participants
1) Experimental Group: 40 children (mean age 10 years,
8 months; range 8 to 14 years) diagnosed with VPI
2) Control group: 40 age- and gender-matched children
(mean age 11 years, 1 month; range 8 to 14 years)
who exhibited no voice or speech deficits
Introduction
Individuals with communication disorders face many
deficits in social communication (Klompas and Ross,
2004). One concern specific to those with communication
disorders may be found in the construct of communication
apprehension (CA) defined as “an individual’s level of fear
or anxiety associated with either real or anticipated
communication with another person or persons”
(McCroskey, 1978).
Individuals who are highly
apprehensive about their communication will experience
distress and feelings of anxiety when placed into different
social situations such as talking to an authority figure or
presenting a speech in front of an audience (McCroskey et
al., 1977). Individuals with velopharyngeal insufficiency
(VPI) present with a variety of speech and resonance
issues including hypernasality, nasal air emission, and
short utterance length (Kummer, 2002). These deficits are
frequently noticeable to the listener. Consequently, children
with VPI may be evaluated negatively by listeners with the
potential for CA observed.
Statement of Problem
Research with VPI often include attempts to measure the
success of interventions that seek to remediate various
aspects of the disorder. In many instances, this is achieved
through objective measures such as nasometry (Conley et
al., 1997), pressure/flow measures, endoscopy, and
auditory-perceptual measures (Van Demark et al., 1985).
Although these measures provide valuable information
relative to VPI, they are limited relative to the impact that
VPI has on social communication and performance, and
quality of life. Measuring CA may then provide a more
comprehensive understanding of treatment outcome and
potential social limitations experienced secondary to VPI.
Experimental Question
Do adolescents with VPI experience higher levels of CA
than adolescents who do not have a voice or speech
disorder?
Summary
• A Mann-Whitney U test was conducted to assess
potential differences in MECA scores between those in
the VPI group when compared to the control group
• Test-retest reliability of the MECA was assessed by
calculating the intra-class correlation coefficient (ICC)
between initial MECA scores and scores on the
instrument completed one to two weeks later
• Internal consistency of the MECA was calculated using
Cronbach’s alpha
• On average, children in the VPI group reported higher
levels of CA compared to children in the control group
• Researchers studying CA often divide CA scores into
three categories: low, medium, and high
• Applying Garrison and Garrison's (1979) normative
data to CA levels obtained from the present study, on
average children in the control group would be
categorized as experiencing low CA and children in the
VPI group would be categorized as experiencing
moderate CA
• The present data suggest that children in the VPI
group belong to a separate category of CA, reporting
Participant Demographic Summary
more limitations in social communication than the
Demographic
VPI Group (n = 40)
Control Group (n = 40)
control group
Sex
Female/Male
19/21
19/21
• Differences in CA between the two groups may be
Ages [mean (range)]
10 years 8 months (8-14)
11 years 1 month (8-14)
attributed,
at
least
in
part,
to
the
perceptible
speech
5 (2 – 9)
5 (2-9)
Grade in school [median
(range)]
characteristics commonly observed with VPI
Surgical Repair of VPI:
• Reliability of the MECA in the present study indicated
Yes/No
26/14
N/A
good test-retest reliability (ICC .76) and good internal
Time Since Surgery [mean
(range)]
55 months (4-198)
N/A
consistency (Cronbach’s alpha .84)
• Reliability scores of the present study are consistent
with reliability scores reported previously for the MECA
(Garrison and Garrison, 1979; Krol-Jersevic, 2004),
• A statistically significant difference in MECA scores providing support for the stability of the MECA in
evaluating CA.
between the two groups of children (p = 0.009)
• Children in the VPI group reported higher levels of CA
(mean = 54.64, SD = 11.50), compared to children in the
VPI group (mean = 47.35, SD = 9.10)
• A difference in mean scores of 7-points was found Our results suggest that awareness needs to be made
that potential limitations in social functioning may exist
between the two groups
in children with VPI. Thus, efforts should be made to
try to identify individuals with high CA, perhaps through
the completion of a simple, self-report measure such as
the MECA, so that efforts to reduce CA may be
pursued. Our results also provide initial support for
work that explores the influence and impact of speech
and resonance disorders in children. Consequently, the
ability to further conceptualize speech disorders and
how such deficits relate to the larger issue of
communication performance in children deserves
continued empirical efforts.
Results
MECA Scores
Measurement Instrument
• All children completed the Measure of Elementary
Communication Apprehension (MECA) questionnaire
(Garrison and Garrison, 1979)
• The MECA is a 20-item measure of CA that uses a Likerttype faces scale
• Participants are asked to answer each question by
circling one of the following responses: very happy/I like
it a lot, happy/I like it, no feeling/I don’t care, unhappy/I
don’t like it, or very unhappy/I really don’t like it
• Responses are scored from 1 to 5 with higher scores
reflecting greater perceived levels of CA
• Children completed the MECA one week after initial data
collection to assess the test-retest reliability of the
questionnaire
Title
Sample Question from the Measure of Elementary
Communication Apprehension
References
How do you feel when you talk in front of an audience?
very happy
happy
no feeling
unhappy
very unhappy
I like it a lot
I like it
I don’t care
I don’t like it
I really don’t
like it
Acknowledgments
Support for this project was provided by the Ontario
Graduate Scholarship and the Voice Production and
Perception
Laboratory.
For
more
Information:
http://uwo.ca/fhs/twolabs/
Clinical Implications
Reliability
• Test-retest reliability revealed an ICC of .76, indicating
good reliability of responses provided for the MECA
• The internal consistency of the instrument resulted in a
Cronbach’s alpha of .84, indicating good internal
consistency of the instrument
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