Neurotic stuttering
Neurotic stuttering is a disorder of smoothness and rhythm of speech, which has a functional character and is a consequence of certain pathological psycho—emotional processes. The most characteristic feature of this form of stuttering is the variability of symptoms depending on the emotional state of the patient and the environment that surrounds him in a certain period of time. It has a recurrent course, having a wave-like character. In the diagnosis of this pathological condition, an important role is played by the collection of anamnesis, during which they try to identify the presence of psychological trauma in the patient, which provoked the onset of the painful condition.
The content of the article:
Types of stuttering
Symptoms of neurotic stuttering
Correct diagnosis is the basis for successful correction
Treatment and correction of neurotic stuttering
Neurotic stuttering
Free and smooth speech is not so common. Almost all people speak intermittently — they stretch words, repeat words and interjections, draw sounds. If speech interruptions amount to more than 10%, then this is called logoneurosis (or stuttering). It differs from the usual speech interruption in frequency, type and duration. Stuttering is considered to be a violation of the tempo, rhythm and smoothness of speech caused by convulsions and spasms of the muscles of the speech apparatus. It is characterized by frequent involuntary repetition or lengthening of sounds or syllables, as well as stops and stutters in speech, which breaks its flow. Logoneurosis occurs in children from 2 to 6 years old, it occurs much more often in boys than in girls. It has a psychogenic nature, that is, it is caused by mental trauma of various kinds. If you do not give it due importance in childhood, then in the absence of treatment, stuttering can persist for life. According to statistics, in the Russian Federation, about 1.4% of adults suffer from some form of stuttering.
Types of stuttering
In the 70s of the last century, two clinical types of stuttering were developed and distinguished — neurotic and neurosis-like, differing in etiology and pathogenesis. Neurosis-like stuttering is caused by an organic lesion of the central nervous system, it manifests itself gradually, for no apparent reason, occurs in children aged 3-5 years. As a rule, the pathology of pregnancy and childbirth is noted in the anamnesis — severe toxicosis, the threat of miscarriage, oxygen starvation of the fetus, burdened heredity.
The neurotic form of stuttering is manifested in children without abnormalities of intrauterine development and childbirth. They develop in accordance with the age norm, motor skills are formed in a timely manner. It occurs at an early age during the period of intensive formation of thinking, active cognition of the world, the complexity of speech. In a short time, children learn a lot of new words and concepts, their speech becomes more complicated, complex constructions appear in it, and the vocabulary grows rapidly. At this time, the pace of their speech accelerates, the child seems to “choke on words”, pronouncing them indistinctly and swallowing the endings. The psyche of children subject to neurotic stuttering is labile. They are overly impressionable, timid and shy, with increased anxiety. The onset of stuttering is acute, sudden. It is associated with a mental trauma of a shock nature (severe illness or death of loved ones, severe fright, a sharp change in habitual life stereotypes) or with a long-term traumatic factor (incorrect parenting methods, family problems, prolonged negative effects, etc.). It is very important in such a situation to establish contact with the child, calm him down, create an atmosphere of love and security, improve the psychological climate in the family. Parents need to see a speech therapist as soon as possible, who will provide effective assistance. Medical treatment of stuttering is usually ineffective and gives almost no results.
The course of stuttering has the following types:
permanent — independent of the situation;
undulating — intensifying and weakening, but not disappearing completely;
recurrent — disappearing and returning after long breaks.
The severity of speech disorders is classified as:
easy, when they stutter only in excitement, excitement;
the average, in which the defect is not noticeable enough in a calm state, and in a state of emotional excitement, stuttering becomes strong;
severe, with this degree of stuttering is strong, independent of the situation and accompanied by involuntary movements.
Symptoms of neurotic stuttering
All forms of stuttering are characterized by seizures during the speech act, lasting from fractions of seconds to one and a half minutes. Seizures are different in form (tonic and clonic), frequency and localization (vocal, respiratory and articulatory). With the clonic type, there is a multiple repetition of sounds and syllables; with the tonic type, there are long pauses and a dragging pronunciation of sounds and syllables. There is also a mixed type with a combination of signs of both logoneurosis. When stuttering, there are violations not only of speech, but also of general motor skills (tic, myoclonal seizures). In order to distract attention and to facilitate their speech, stutterers resort to various tricks: movements of the head, limbs, rocking.
Usually young children do not notice their illness and do not pay attention to it. But as they grow up, their behavior goes through several stages. Usually, when you come to school, a relapse of stuttering begins, since with an increase in workload, an expansion of the circle of communication, there is also an increase in speech and mental tension. The child begins to have logophobia and personality traits such as isolation, fear of communication are formed. In adolescence, these qualities are especially pronounced. For some, this causes a sharp restriction of contacts, they say little, simplifying their speech to the simplest, easily pronounceable phrases, while others behave defiantly, aggressively (hypercompensation).
The neurotic form of stuttering has its own characteristics. So, for the same person, it can vary in the intensity of intermittent speech. Situational dependence is especially noticeable. In a quiet home environment among close and loving people, stuttering manifests itself so little that it becomes almost invisible. On the contrary, when communicating with strangers, the need to speak to an audience, at a responsible meeting, there is a sharp increase in the symptoms of stuttering.
Communication with people suffering from severe stuttering is difficult and painful for both sides. Their speech is accompanied by various movements of the head, body, arms and legs, increased speech motor skills (lip biting, smacking, silent articulation of sounds), which makes a heavy impression.
Correct diagnosis is the basis for successful correction
Speech therapists deal with various speech disorders. A correct diagnosis is important for timely and effective correction of defects. At the beginning of the disease, stuttering is sometimes confused with tachylalia, which looks like logoneurosis. Tachylalia manifests itself with a pathologically fast pace of speech, incorrect phrase construction (battarism), stumbling, stuttering, pauses (poltern). But intermittent speech is not associated with convulsions of the muscles of the respiratory-speech apparatus (as with stuttering), but occurs, as a rule, when the processes of excitation in the cerebral cortex prevail over the processes of inhibition. Aggravating reasons may be:
imitation of the speech of the adult environment of the child;
lack of attention during speech formation;
fuzzy, blurred articulation.
It is possible to distinguish tachylalia from neurotic stuttering by comparing a number of factors.
Tachylalia:
there is no awareness of the defect;
the speech act gets better under stress;
focusing attention improves speech;
demanding accurate answers improves speech;
reading a familiar text worsens speech;
reading an unfamiliar text improves speech;
the letter is repetitive, hurried, the handwriting is unclear;
the attitude to his speech is indifferent;
the psychological experience is postponed.
Neurotic stuttering:
awareness of the defect is present;
the speech act becomes worse under stress;
focusing attention worsens speech;
demanding accurate answers worsens speech;
reading a familiar text improves speech;
the letter is slow, tense;
attitude to his speech with pronounced fearfulness;
the psychological experience is anticipatory.
In addition to tachylalia, it is necessary to differentiate the types of stuttering, since correction methods depend on it. Neurosis-like stuttering is practically untreatable due to the organic nature of its origin. Diagnosis together with a speech therapist should be carried out by a neurologist. To determine the nature of this speech disorder, it is necessary to conduct a thorough examination. To exclude the organic origin of the speech defect, the patient must undergo an electroencephalogram, a computer tomogram of the brain or a magnetic resonance imaging.
Treatment and correction of neurotic stuttering
Treatment of stuttering should be started as early as possible, until a persistent logophobia has formed and, as a result, disharmonic personality development.
Stuttering therapy is effective only in an integrated approach to treatment, and the elimination of the psychotraumatic factor should be the basis. This is especially important if the cause of logoneurosis in a child was an unhealthy situation in the family. In this case, it is necessary to consult family members and family psychological therapy. There are many methods of treating stuttering, outpatient, at home and in a hospital setting. This course, introduced into practice by V.I. Seliverstov, consists of 3 stages.
The first stage:
observance of a firm daily routine;
creating a calm psychological environment;
minimal speech communication.
Speech therapy classes are conducted in accordance with age, small simple texts are memorized that do not cause convulsive readiness.
The second stage:
complication of classes;
introduction of outdoor games;
consolidation of acquired skills.
The third stage:
fixing smooth speech;
introduction of role-playing games.
Methods of treatment of adolescents and adults have their own characteristics. The main role here is played by the patient’s motivation and desire to get rid of the disease, readiness for long classes to achieve results. Methods of correction of stuttering are based on three factors: speech therapy, medication and psychotherapy. Classes with a speech therapist form a person’s correct speech technique; the use of anticonvulsants and sedatives reduces convulsive readiness and relieves nervous tension; psychotherapeutic classes and auto-training help to adequately and constructively approach your problem.
In addition, methods of alternative medicine are used — phytotherapy, acupressure, acupuncture, hypnosis and others. There are author’s methods and developments: A.N. Strelnikova (based on breathing exercises); Yu.B. Nekrasova (based on sociorehabilitation); L.Z. Andronova-Harutyunyan (suggests synchronizing speech with finger movements). All these methods have passed the test of time and can be used in combination with speech therapy activities.
