Below is our final grant proposal:
Executive summary (paper abstract)
In this project, we seek to apply the concept of measuring implicit association to stuttering. Stuttering can have a negative impact on a child’s development as many people hold negative attitudes, stereotypes, and prejudices towards people who stutter. These negative attitudes can manifest themselves in the form of prejudice and discrimination. The previous studies on biases against those who stutter rely primarily on explicit association, so it is important and necessary to apply the concept of implicit association to the issue of childhood stuttering to further understand the attitudes towards stuttering.
Implicit association tasks (IATs) attempt to elucidate these attitudes and information that are not available to introspective access even if people are motivated to retrieve and express these biases. These tasks typically require participants to quickly categorize words or pictures, and the lengths of the time required for response are used to determine automatic associations between concepts. If these lengths of times are significantly differently, this may provide an indication that some unconscious and impulsive operations may be at play involving the association of stereotypes with good/bad. IATs are a well-validated measure.
We seek to use the general methods of IATs in the context of measuring responses to stuttering. Data will be collected from this for purposes of understanding the biases against those who stutter, but the program is mostly intended to be available for people to become more aware of their own prejudices.
Description of the problem to be solved
An attitude is an evaluation of a person, object, or event that involves an emotion. Once attitudes are formed, they can have negative impacts on the mental processes, emotional well-being, and physical behavior of people. There are two types of attitudes, explicit and implicit.
Published research often relies on self-reported attitudes. The biggest advantage for this is the ease of collecting the data. These explicit reports, however, are often be fabricated or incorrect. We must assume that each participant in these studies is highly honest and self-aware, which may not often be the case. For example, if you ask a racist person if they are prejudiced towards people of the race that they dislike, there are additional motivators (social, legal, etc.) that may discourage them from revealing their true biases. Explicit attitude reporting along may also fail to capture the entire picture in the event that an ingrained attitude may be unknown to the subject. For example, a person may have an underlying preference for people of his or her own gender without realizing.
In this project, we seek to apply this concept to stuttering. Stuttering can have a negative impact on a child’s development as many people hold negative attitudes, stereotypes, and prejudices towards people who stutter. The previous studies on biases against those who stutter rely primarily on explicit association, so it is important and necessary to apply the concept of implicit association to the issue of childhood stuttering to further understand the attitudes towards stuttering.
Project objective statement
Implicit association tasks (IATs) attempt to elucidate these attitudes and information that are not available to introspective access even if people are motivated to retrieve and express these biases. These tasks typically require participants to quickly categorize words or pictures, and the lengths of the time required for response are used to determine automatic associations between concepts. Subjects sort stimuli examples from four concepts using just two response options, each of which is assigned to two of the four concepts. For example, an IAT testing implicit age biases would ask a subject first to sort words of typically good association (“happiness, love, smile”) and pictures of young people to the left and to sort words of typically bad association (“sadness, frown, dejection”) and pictures of old people. Then it would would ask a subject first to sort words of typically good association and pictures of old people to the left and to sort words of typically bad association and pictures of young people.
The reasoning behind this task is that it should be easier to sort when the concepts are associated than when they are not associated, and therefore the amount of time required will be lesser. If these lengths of times are significantly differently, this may provide an indication that some unconscious and impulsive operations may be at play involving the association of stereotypes with good/bad.
While IATs primarily rely on words and pictures, our design will rely on audio recordings for two primary reasons. First, stuttering is primarily manifested audially, not visually. Second, this project is meant for use by children, and often these children do not have the capability to read proficiently. Our project’s main purpose is to develop a web-based program that will offer an audio-based IAT on a widespread scale. Data will be collected from this for purposes of understanding the biases against those who stutter, but the program is mostly intended to be available for people to become more aware of their own prejudices.
Documentation of the final design (one page).
The IAT that we have designed does the following functions:
● Establishes the purpose of the task
● Explains how the task will proceed
● Demonstrates how to complete the associations
● Displays a clear user interface
● Presents audio files of both normal speech and stuttered speech
● Records individual response times
● Calculates overall response times
● Calculates statistics related to response times
● Presents user with estimation of bias level
● Stores data for long-term analysis
Prototype of the final design
It will continue to be improved in both design and function.
Proof that the design is functional and will solve the problem
A prototype of the design has been developed and is in the process of being optimized for large-scale usage. However, no test data, market research, or pre-clinical trials can be included as that phase of the project has not yet occurred.
Results of a patent search and/or search for prior art, assessment and patentability
Similar Implicit Association Tasks (IATs) have been created, and a number of them have become open-source as well. Most prominent among these are the Harvard IATs. While these options are important and necessary, they do not address the important issue of implicit biases of children towards childhood stuttering.
Anticipated regulatory pathway
A medical device is “an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory which is:
● recognized in the official National Formulary, or the United States Pharmacopoeia, or any supplement to them,
● intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals, or
● intended to affect the structure or any function of the body of man or other animals, and which does not achieve any of its primary intended purposes through chemical action within or on the body of man or other animals and which is not dependent upon being metabolized for the achievement of any of its primary intended purposes
Our project does not meet this definition of a medical device. The project is not subject to regulation, and therefore there would be no anticipated regulatory pathway.
Reimbursement
As described below in “Estimated manufacturing costs,” the expected total cost is $120. This will be funded by the Vanderbilt Bill Wilkerson Center which focuses on speech language pathology. No additional reimbursement will be necessary.
Estimated manufacturing costs
Manufacturing costs will be zero. Operating costs will follow the standard operating costs of maintaining a website, which we project to be around $120 for one year of website hosting through a domain hosting company. If the project design is found to be a reliable source of generating implicit association data, it will continue to be offered as a service at the same yearly cost.
Potential market
During the first year, we intend to make the program available to anyone with access to the internet as a web-based program. Therefore, our potential market is immense. However, this program is being designed specifically for use by children with the assistance of their parents. We fully intend this program being used by adults in order for them to also become aware of their biases.