personal data:
Sex: male female

1 = without school leaving certificate
2 = high school
3 = college
4 = bachelor
5 = master
6 = doctorate

Education 1 2 3 4 5 6

How old were you when you started to stutter?
(to qualify for this study the onset of stuttering has to be before the age of 12)

Was the stuttering diagnosed by a speech and language pathologist? YesNo

 Did you have previous treatment for stuttering?  YesNo

 If yes, how many years (approximately):  years (if "0", type in "0")

 Are you currently in therapy?  YesNo
 Are you a member of a self-help-group?  YesNo
 Do you have family members who also stutter? YesNo
 If so, who? (If none, type in "none")
01. Almost any little problem or puzzle stimulates my interest.
02. People who know me well would say I am an anxious person.
03. I often feel a strong need to take care of others.
04. When I am frustrated, I usally get angry.
05. I am a person who is easily amused and laughs a lot.
06. I often feel sad.
07. Feeling a oneness with all of creation helps give more meaning to my life.
08. I make an effort to remain aware of my feelings and emotions.
09. I do not get much pleasure out of looking forward to special events.
10. I do not often struggle over making decisions.
11. I think it is ridiculous the way some people carry on around baby animals.
12. If I am blocked from getting what I want, I usually accept it.
13. My friends would probably describe me as being too serious.
14. I seem to be affected less by personal rejection than most people.
15. The meaning in my life does not come from feeling connected to other living things.
16. I will gossip a little at times.
17. I really enjoy looking forward to new experiences.
18. I often think of what I should have done after the opportunity has passed.
19. I like taking care of children.
20. My friends would probably describe me as hotheaded.
21. I am known as one who keeps work fun.
22. I often have the feeling that I want to cry.
23. I am often spiritually touched by the beauty of creation.
24. When listening to music, I sometimes become so absorbed in the music that I lose track of everything else going on around me.
25. I like to set very practical goals rather than grandiose plans.
26. I would not describe myself as worrier.
27. Caring for a sick person would be a burden for me.
28. I cannot remember a time when I became so angry that I wanted to break something.
29. I generally would not enjoy vigorous games which required physical contact.
30. I seem to be less sad than most other people.
31. I rarely rely on spiritual inspiration to help me meet important challenges.
32. I always tell the truth.
33. Seeking an answer is as enjoyable as finding the solution.
34. I am frequently more tense inside than others realize.
35. I love being around baby animals.
36. When I get angry, I often feel like swearing.
37. I usually think about good times and have happy thoughts.
38. I often feel lonely.
39. For me, experiencing a connection to all of life is an important source of inspiration.
40. I like to take pleasure in small things, such as the colors in soap bubbles.
41. I often feel little eagerness or anticipation when thinking about my goals.
42. I have very few fears in my life.
43. I do not especially enjoy being around children.
44. When I am frustrated, I rarely become angry.
45. I dislike humor that gets really silly.
46. I am very attached to my family.
47. For me, spirituality is not a primary source of inner peace or harmony.
48. Sometimes I feel like swearing.
49. I enjoy anticipating and working toward a goal almost is as much as achieving it.
50. I sometimes can not stop worrying about my problems.
51. I often feel softhearted towards stray animals.
52. When someone makes me angry, I tend to remain fired up for a long time.
53. People who know me would say I am a very fun-loving person.
54. I often think about people I have loved who are no longer with me.
55. Contemplating spiritual issues, often fills me with a sense of intense awe and possibility.
56. I have never attempted to express myself by poetry.
57. I am usually not interested in solving problems and puzzles just for the sake of solving them.
58. My friends would say, that I am courageous and that it takes a lot to frigthen me.
59. I would generally consider pets in my home to be more trouble than they are worth.
60. People who know me well would say I almost never become angry.
61. I do not particulary enjoy kidding around and exchanging "wisecracks".
62. It does not particulary sadden me when friends or family members are disapproving of me.
63. My sense of significance and purpose in life do not come from my spiritual beliefs.
64. I have never "played sick" to get out of something.
65. My curiosity sometimes drives me to do things that others might consider a waste of time.
66. I often worry about the future.
67. I feel sorry for the homeless.
68. I tend to get irritated if someone tries to stop me from doing what I want to do.
69. I feel happiness most of the time.
70. I tend to think about losing loved ones often.
71. Feeling a connection with the rest of humanity motivates me to make more ethical choices.
72. I am not typically impressed by poetic language or fancy speech.
73. I rarely feel the need just to get out and explore things.
74. There are very few things that make me anxious.
75. I do not like to feel "needed" by other people.
76. I rarely get angry enough to want to hit someone.
77. I do not tend to see the humor in things many people consider funny.
78. Moving away from my friends would not upset me.
79. The goals I set for myself are not influenced by my spirituality.
80. There have been times in my life when I was afraid of the dark.
81. Whenever I am in a new place, I always like to explore the area and get a better feel for my surroundings.
82. I often worry about whether I am making the correct decision.
83. I frequently do little things for others that make them feel good.
84. When things do not work out the way I want, I sometimes feel like kicking or hitting something.
85. I enjoy all kinds of games including those with physical contact.
86. I frequently feel distressed when I cannot be with my friends.
87. Spirtual inspiration helps me transcend my limitations.
88. While watching a movie or the like, I may become so involved it is as if I were actually part of it.
89. I am not the kind of person that likes probing and investigating problems.
90. I rarely worry about my future.
91. I do not especially want people to be emotionally close to me.
92. I hardly ever become so angry at someone that I feel like yelling at them.
93. I enjoy playing games less when it is just for fun and there is no clear winner.
94. I rarely think about people or relationships I have lost.
95. The suggestion to "Treat other people as they want to be treated" does not arouse strong feelings in me.
96. I have never intentionally told a lie.
97. I often feel like I could accomplish almost anything.
98. I often feel nervous and have difficulty relaxing .
99. I am a person who strongly feels the pain of other people`s losses.
100. Sometimes little quirky things people do really get on my nerves.
101. I see life as being full of opportunities to have fun.
102. I am a person who feels sorrow and the pain of loss strongly.
103. I sometimes feel "chills" or "goosebumps" when listening to music.
104. It often seems that life has no meaning.
105. I am not an extremely inquisitive person.
106. I almost never lose sleep worrying about things.
107. I am not particularly affectionate.
108. When people irritate me, I rarely feel the urge to say nasty things to them.
109. Playing games with other people is not especially enjoyable for me.
110. I am almost always happy to interact with other people.
Finally, we ask you to assess the severity of your current stuttering.

not severe at all 012345678910 very severe

Before pressing the "send" button please verify that all items are answered.