QUESTIONNAIRE

 

Below, you will find a list of questions.  Please read carefully and then answer with your first impression. Please check X  the box that best answers each question.

Question

Almost Never

Occasionally

Sometimes

Frequently

Almost

Always

I like to meet new people

 

 

 

 

 

My speech therapist is on my side

 

 

 

 

 

I know when and how I stutter

 

 

 

 

 

I am embarrassed by my stuttering

 

 

 

 

 

I am able to communicate with my family

 

 

 

 

 

I meditate

 

 

 

 

 

People tell me that I stutter

 

 

 

 

 

I feel anxious

 

 

 

 

 

I don’t think clearly when I stutter

 

 

 

 

 

I sometimes laugh at myself

 

 

 

 

 

I order what I want in restaurants

 

 

 

 

 

I help friends when called upon

 

 

 

 

 

I feel comfortable with others that stutter

 

 

 

 

 

I cope well with stress

 

 

 

 

 

I make a list of questions for my speech therapist

 

 

 

 

 

I can talk with friends and family about my stutter

 

 

 

 

 

I am a spiritual person

 

 

 

 

 

I have a regular exercise routine

 

 

 

 

 

I eat the right foods

 

 

 

 

 

I view my stuttering as a chronic condition

 

 

 

 

 

The important people in my life know I stutter

 

 

 

 

 

I have a good support system

 

 

 

 

 

I think people focus on my stuttering rather than hearing what I say

 

 

 

 

 

I have a positive attitude

 

 

 

 

 

I speak up when I have a question

 

 

 

 

 

I have people who care about me

 

 

 

 

 

I feel frozen in new speaking situations

 

 

 

 

 

I express my feelings