Stuttering in children
Stuttering in children is a disorder of the tempo-rhythmic side of speech caused by repetitive convulsions in the articulatory, vocal or respiratory part of the speech apparatus. It is characterized by “getting stuck” on certain sounds, their repeated, involuntary repetition, accompanying movements, speech tricks, logophobia, and autonomic reactions. Children with stuttering should be examined by a neurologist, speech therapist, psychologist, psychiatrist. Correction includes a health-improving complex (compliance with the regime, massage, hydrotherapy, exercise therapy, FTL, psychotherapy) and a system of speech therapy classes.
unintentional stops, stutters in oral speech , arising from the convulsive state of the speech muscles. According to scientific data, about 2% of children and 1.5% of adults suffer from stuttering . Stuttering occurs 3-4 times more often in boys than in girls. In addition to speech convulsions, 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 stuttering in a child 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
All factors contributing to the onset of stuttering in children are traditionally divided into predisposing and productive. Predisposing (background) reasons include:
- Hereditary predisposition. Most often it is determined by congenital weakness of the speech apparatus.
- The neuropathic constitution of the child . Children with stuttering often have enuresis , nighttime fears, increased anxiety, and vulnerability.
- Intrauterine CNS damage. Perinatal brain damage in children can be associated with toxicosis of pregnancy , hemolytic disease of the fetus , 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 incidence of stuttering observed in recent years is directly related to the rapid introduction of video games and various computer technologies into everyday life, which unleash a huge stream of audiovisual information on the fragile nervous system of children.
The processes of maturation of the cerebral cortex, the formation of functional asymmetry of the activity of the brain are mainly completed by the age of 5 years, therefore, the effect of any stimulus that is excessive in strength or duration can lead to a nervous breakdown and stuttering in children. Such extreme irritants (or producing causes) of stuttering in children can be:
- severe infections ( meningitis , encephalitis , measles , whooping cough , typhus , etc.);
- TBI ;
- hypotrophy ;
- rickets ;
- instantaneous mental shock or long-term traumatization of the psyche. In the first case, it can be short-term fear, fear, excessive joy; in the second – protracted conflicts, an authoritarian style of upbringing, etc.
It can be caused by imitation of stutters, early learning of foreign languages, overload with complex speech material, and retraining of left-handedness . The literature indicates a connection between stuttering in children with left-handedness, other speech disorders ( dyslalia , tachyllalia , dysarthria , rhinolalia ). Secondary stuttering in children can occur against the background of motor alalia or aphasia .
Depending on the pathogenetic mechanisms underlying convulsive stuttering, there are 2 forms
- neurotic (logoneurosis). Neurotic stuttering in children is a functional disorder;
- neurosis-like . Neurosis-like stuttering is associated with organic damage to the nervous system.
- Mild stuttering in children is characterized by convulsive stuttering only in spontaneous speech; symptoms are barely noticeable and do not interfere with speech communication.
- With moderate severity, stutters occur in monologue and dialogical speech.
- With severe stuttering in children, speech cramps are frequent and prolonged; stuttering occurs in all types of speech, including conjugate and reflected; accompanying movements and embolophrasia appear . In the most extreme cases, stuttering makes speech and communication nearly impossible.
Depending on the nature of the course, the following options for stuttering in children are distinguished:
The main symptoms of stuttering in children include speech cramps, physiological and speech breathing disorders, accompanying movements, speech tricks, and logophobia .
When stuttering, stuttering occurs in children when trying to start a speech or directly in the process of speaking. They are caused by cramps (involuntary contractions) of the speech muscles. By their nature, speech convulsions can be tonic and clonic. Tonic speech cramps are associated with a sharp increase in muscle tone in the lips, tongue, cheeks, which is accompanied by the impossibility of articulation and a pause in speech (for example, “t — rava”).
Clonic speech seizures are characterized by repeated contractions of the speech muscles, leading to the repetition of individual sounds or syllables (for example, “t-t-grass”). Children with stuttering may have tono-clonic or clono-tonic seizures. At the place of origin, speech convulsions can be articulation, voice (phonation), respiratory and mixed.
Breathing during stuttering is irregular, shallow, chest or clavicular; discoordination of breathing and articulation is noted: children begin to speak while inhaling or after a full exhalation.
The speech of children with stuttering is often accompanied by involuntary concomitant movements: twitching of the facial muscles, inflation of the wings of the nose, blinking, swinging of the torso, etc. ). Speech tricks include embolophrasia (the use of unnecessary sounds and words – “well”, “this”, “there”, “here”), changes in intonation, tempo, rhythm, speech, voice, etc.
Difficulties in verbal communication cause logophobia (fear of speech in general) or soundophobia (fear of uttering certain sounds) in children with stuttering. In turn, obsessive thoughts about stuttering contribute to an even greater aggravation of speech problems in children.
Stuttering in children is often accompanied by various kinds of autonomic disorders: sweating, tachycardia , blood pressure lability, redness or pallor of the skin, which intensify at the time of speech convulsions.
At the heart of neurotic stuttering in children are strong traumatic experiences, so speech impairment occurs sharply, almost instantly. In this case, parents, as a rule, accurately indicate the time of the onset of stuttering in the child and its cause. Neurotic stuttering usually occurs at 2-6 years of age, that is, at the time of the development of the disorder, children have detailed phrasal speech.
Children with neurotic stuttering have a decrease in speech activity, pronounced logoophobia and fixation on difficult sounds; respiratory-vocal convulsions prevail. Sound pronunciation, as a rule, is impaired, but the lexical and grammatical side develops normally ( FFN takes place ). 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 wavy; speech impairments are triggered by traumatic situations.
In the case of neurosis-like stuttering, which occurs against the background of organic lesions of the central nervous system in the perinatal or early period of the child’s development, the disorder develops gradually, gradually. There is no explicit connection with external circumstances; parents find it difficult to determine the cause of it. Neurosis-like stuttering in children appears from the moment speech begins or at the age of 3-4 years, that is, during the period of formation of phrasal speech.
The speech activity of children is usually increased, while they are not critical to their defect. Speech stuttering is mainly caused by articulatory convulsions; speech is monotonous, inexpressive, the pace is accelerated; sound pronunciation is distorted, the lexical and grammatical side of speech is broken ( OHP takes place ). Children with neurosis-like stuttering have impaired general motor skills: their movements are clumsy, constrained, stereotyped.
Sluggish facial expressions, poor handwriting are characteristic; often have dysgraphia , dyslexia and dyscalculia . The course of neurosis-like stuttering in children is relatively constant; speech impairment can be caused by fatigue, increased speech load, somatic weakness. Neurological examination reveals multiple signs of CNS damage; according to EEG data – increased convulsive readiness.
Examination of children with stuttering is carried out by a speech therapist , pediatrician, child neurologist , child psychologist, child psychiatrist. For all specialists, an important role is played by the study of anamnesis, hereditary burden, information about the early psychoverbal and motor development of children, clarification of the circumstances and time of the onset of stuttering. To identify organic lesions of the central nervous system, a neurologist prescribes EEG, rheoencephalography , EchoEG , MRI of the brain .
During the diagnostic examination of speech in children with stuttering, localization, form, frequency of speech seizures are determined; the features of the tempo of speech, breathing, voice are evaluated; concomitant motor and speech disorders, logophobia are revealed; the child’s attitude to his defect is clarified. For those who stutter, examination of sound pronunciation, phonemic hearing, lexical and grammatical side of speech is mandatory.
The speech therapy report should reflect the form and degree of stuttering in children; the nature of the seizures; concomitant speech disorders. Differential diagnosis should be carried out with tachyllia, stumbling, dysarthria.
Correction of stuttering in children
In speech therapy, an integrated approach to the correction of stuttering in children has been adopted , which implies the conduct of medical and recreational and psychological and pedagogical work. The main goal of the medical and pedagogical complex is to eliminate or weaken speech seizures and associated disorders; strengthening the central nervous system, impact on the personality and behavior of the stutter.
Therapeutic and recreational area of work includes general strengthening procedures ( hydrotherapy , physiotherapy, massage , exercise therapy ), rational and suggestive psychotherapy . Actually speech therapy work for stuttering in children is organized in stages.
- Preparatory stage. At the preliminary stage, a sparing regime, a benevolent atmosphere is created, speech activity is limited, and samples of correct speech are demonstrated.
- Training stage. Work is being carried out to master various forms of speech by children: conjugated-reflected, whispering, rhythmic, question-and-answer, etc. In the classroom it is useful to use various forms of manual labor (modeling, design, drawing, games). At the end of this stage, classes are transferred from the speech therapist’s office to the group, classroom, public places, where children consolidate their free speech skills.
- The final stage. At the final stage, the automation of correct speech and behavior skills in various speech situations and activities is carried out.
In the process of work, important attention is paid to the development of the main components of speech (phonetics, vocabulary, grammar), voice presentation, prosody. Logorhythmic exercises , speech therapy massage , breathing 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.