Stuttering in children
Stuttering in children is a disorder of the tempo–rhythmic side of speech caused by repeated convulsions in the articulatory, vocal or respiratory part of the speech apparatus. Stuttering in children is characterized by “getting stuck” on individual sounds, their repeated, involuntary repetition, accompanying movements, speech tricks, logophobia, vegetative reactions. Children with stuttering should be examined by a neurologist, speech therapist, psychologist, psychiatrist. Correction of stuttering in children includes a therapeutic and wellness complex (compliance with the regime, massage, hydrotherapy, physical therapy, FTL, psychotherapy) and a system of speech therapy classes.
General information
Stuttering in children is unintentional stops, stuttering in oral speech, resulting from a convulsive state of the speech muscles. According to scientific data, about 2% of children and 1.5% of adults suffer from stuttering. In boys, stuttering is 3-4 times more common than in girls. In addition to speech seizures, stuttering in children is accompanied by a violation of higher nervous activity, which in some cases may be associated with a neurotic reaction, in others with an organic lesion of the central nervous system. Therefore, it would be wrong to consider a child’s stuttering as a purely speech problem; the study and correction of stuttering in children is impossible without the integration of knowledge from the field of speech therapy, neurology, psychology.
Causes of stuttering
Predisposing causes
All factors contributing to the occurrence of stuttering in children are traditionally divided into predisposing and producing. Predisposing (background) causes include:
Hereditary predisposition. Most often it is determined by an innate weakness of the speech apparatus.
The neuropathic constitution of the child. Children suffering from stuttering often have enuresis, night terrors, increased anxiety and vulnerability.
Intrauterine CNS lesion. Perinatal brain damage in children may be associated with pregnancy toxicosis, fetal hemolytic disease, intrauterine hypoxia and asphyxia during childbirth, birth trauma, etc.
Children who are physically weakened, with an insufficiently developed sense of rhythm, general motor skills, facial expressions and articulation are more susceptible to the development of stuttering. The increase in the frequency of stuttering cases observed in recent years is directly related to the rapid introduction of video games and various computer technologies into everyday life, bringing down a huge stream of audiovisual information on the fragile nervous system of children.
Producing causes
The processes of maturation of the cerebral cortex, the formation of functional asymmetry of brain activity are mostly completed by the age of 5, therefore, exposure to any excessive stimulus in strength or duration can lead to a nervous breakdown and stuttering in children. Such extreme stimuli (or producing causes) of stuttering in children can be:
severe infections (meningitis, encephalitis, measles, whooping cough, typhus, etc.);
TBI;
hypotrophy;
rickets;
intoxication;
simultaneous mental shocks or prolonged traumatization of the psyche. In the first case, it may be short–term fear, fright, excessive joy; in the second – protracted conflicts, authoritarian parenting style, etc.
Imitation of stuttering, early learning of foreign languages, overload with complex speech material, retraining of left-handedness can lead to the occurrence of stuttering in children. The literature indicates the connection of stuttering in children with left-handedness, other speech disorders (dyslalia, tachylalia, dysarthria, rhinolalia). Secondary stuttering in children may occur against the background of motor alalia or aphasia.
Classification
Depending on the pathogenetic mechanisms underlying convulsive stuttering, there are 2 forms of stuttering in children:
neurotic (logoneurosis). Neurotic stuttering in children is a functional disorder;
neurosis-like. Neurosis-like stuttering is associated with an organic lesion of the nervous system.
According to the severity of speech seizures, there are mild, moderate and severe degrees of stuttering in children. The severity of stuttering may be variable in the same child in different situations:
A mild degree of stuttering in children is characterized by convulsive stuttering only in spontaneous speech; the symptoms are barely noticeable and do not interfere with speech communication.
With a moderate degree of severity, stammering occurs in monologue and dialogic speech.
With severe stuttering in children, speech seizures are frequent and prolonged; stuttering occurs in all types of speech, including conjugated and reflected; concomitant movements and embolophrasia appear. In the most extreme cases, speech and communication become almost impossible due to stuttering.
Depending on the nature of the course , the following variants of stuttering in children are distinguished:
undulating (stuttering increases and weakens in various situations, but does not disappear);
permanent (stuttering has a relatively stable course)
recurrent (stuttering occurs again after a period of speech well-being).
Symptoms of stuttering in children
The main symptoms of stuttering in children include speech seizures, disorders of physiological and speech breathing, concomitant movements, speech tricks and logophobia.
With stuttering, stuttering in children occurs when trying to start a speech or directly in the process of speech. They are caused by convulsions (involuntary contraction) of the speech muscles. By their nature, speech seizures can be tonic and clonic. Tonic speech convulsions are associated with a sharp increase in muscle tone in the lips, tongue, cheeks, which is accompanied by an inability to articulate and a pause in speech (for example, “t—rava”).
Clonic speech seizures are characterized by multiple contractions of the speech muscles, leading to the repetition of individual sounds or syllables (for example, “t-t-grass”). Children with stuttering may have tonic-clonic or clonic-tonic seizures. At the place of occurrence, speech seizures can be articulatory, vocal (phonation), respiratory and mixed.
Breathing with stuttering is irregular, superficial, thoracic or clavicular; there is discoordination of breathing and articulation: children begin to speak on inspiration or after a full exhalation.
The speech of children with stuttering is often accompanied by involuntary accompanying movements: twitching of the muscles of the face, inflating of the wings of the nose, blinking, swaying of the trunk, etc. Often stuttering people use so-called motor and speech tricks aimed at hiding stumbles (smile, yawning, coughing, etc.). Speech tricks include embolophrasies (the use of unnecessary sounds and words – “well”, “this”, “there”, “here”), changes in intonation, tempo, rhythm, speech, voice, etc.
Difficulties in speech communication cause logophobia (fear of speech in general) or sonophobia (fear of pronouncing individual sounds) in children with stuttering. In turn, obsessive thoughts about stuttering contribute to an even greater aggravation of speech distress in children.
Stuttering in children is often accompanied by various kinds of vegetative disorders: sweating, tachycardia, blood pressure lability, redness or pallor of the skin, which increase at the time of speech convulsions.
Neurotic stuttering
Neurotic stuttering in children is based on strong psychotraumatic experiences, so speech disorders occur acutely, almost simultaneously. In this case, parents, as a rule, accurately indicate the time of the appearance of stuttering in the child and its cause. Neurotic stuttering usually occurs at 2-6 years old, i.e. at the time of the development of the disorder, children have a detailed phrasal speech.
In children with neurotic stuttering, there is a decrease in speech activity, pronounced logophobia and fixation on difficult sounds; respiratory and vocal seizures prevail. Sound reproduction is usually impaired, but the lexical and grammatical side develops normally (FFN occurs). Children often accompany their speech by inflating the wings of the nose and accompanying movements. The nature of the course of neurotic stuttering in children is undulating; speech impairments are provoked by traumatic situations.
Neurosis-like stuttering
In the case of neurosis-like stuttering, which occurs against the background of organic damage to the central nervous system in the perinatal or early period of the child’s development, the disorder develops gradually, gradually. There is no obvious connection with external circumstances; parents find it difficult to determine the cause of stuttering in children. Neurosis-like stuttering in children appears from the moment of the beginning of speech or at the age of 3-4 years, i.e. during the formation of phrasal speech.
The speech activity of children is usually increased, while they are not critical to their defect. Speech stutters are caused mainly by articulatory convulsions; speech is monotonous, expressionless, the tempo is accelerated; sound pronunciation is distorted, the lexico-grammatical side of speech is broken (there is an ONR). Children with neurosis-like stuttering have impaired general motor skills: their movements are clumsy, constrained, stereotyped.
Sluggish facial expressions, poor handwriting are characteristic; dysgraphy, dyslexia and dyscalculia often occur. The course of neurosis-like stuttering in children is relatively constant; speech impairments can be caused by overwork, increased speech load, somatic weakness. Neurological examination reveals multiple signs of central nervous system damage; according to EEG data – increased convulsive readiness.
Diagnostics
Examination of children with stuttering is carried out by a speech therapist, pediatrician, pediatric neurologist, child psychologist, child psychiatrist. For all specialists, an important role is played by the study of anamnesis, hereditary burden, information about the early speech and motor development of children, clarification of the circumstances and time of occurrence of stuttering. To detect organic lesions of the central nervous system, a neurologist prescribes EEG, rheoencephalography, EchoEG, MRI of the brain.
In the process of diagnostic examination of speech in children with stuttering, localization, form, frequency of speech seizures are determined; features of the pace of speech, breathing, voice are evaluated; concomitant motor and speech disorders, logophobia are revealed; the child’s attitude to his defect is clarified. The examination of sound pronunciation, phonemic hearing, lexico-grammatical side of speech is mandatory for stuttering people.
The speech therapy conclusion should reflect the form and degree of stuttering in children; the nature of seizures; concomitant speech disorders. Differential diagnosis of stuttering in children should be carried out with tachylalia, stumbling, dysarthria.
Correction of stuttering in children
Speech therapy has adopted a comprehensive approach to the correction of stuttering in children, involving the conduct of therapeutic and psychological and pedagogical work. The main purpose of the therapeutic and pedagogical complex is to eliminate or weaken speech seizures and concomitant disorders; strengthen the central nervous system, influence the personality and behavior of the stutterer.
The therapeutic and health-improving direction of work includes general restorative procedures (hydrotherapy, physiotherapy, massage, physical therapy), rational and suggestive psychotherapy. The actual speech therapy work with stuttering in children is organized in stages.
Preparatory stage. At the preliminary stage, a gentle regime is created, a friendly atmosphere is created, speech activity is limited, samples of correct speech are demonstrated.
The training stage. Work is being carried out on mastering various forms of speech by children: conjugated, reflected, whispered, rhythmic, question-and-answer, etc. In the classroom, it is useful to use various forms of manual labor (modeling, designing, drawing, games). At the end of this stage, classes are transferred from the speech therapist’s office to a group, classroom, public places where children consolidate their free speech skills.
The final stage. At the final stage, the automation of the skills of correct speech and behavior in various speech situations and activities is carried out.
Important attention in the process of work is paid to the development of the main components of speech (phonetics, vocabulary, grammar), voice delivery, prosody. Logorhythmic exercises, speech therapy massage, respiratory and articulatory gymnastics play an important role in the correction of stuttering in children. Speech therapy classes for the correction of stuttering in children are conducted in an individual and group format.
