Stuttering – convulsive movements of the articulatory and laryngeal muscles that occur more often at the beginning of speech (less often in the middle), as a result of which the patient is forced to linger on any sound (group of sounds). These symptoms of stuttering are very similar to clonic and tonic seizures. With clonic stuttering, repeated formation of words, syllables and sounds is observed. Tonic stuttering prevents the patient from moving from a sound stop to move to articulating another sound. In its development, stuttering goes through 4 phases from rare attacks of intermittent stuttering to a serious personality problem that limits a person’s ability to communicate. Stuttering symptoms reasons and classification
Stuttering – convulsive movements of the articulatory and laryngeal muscles that occur more often at the beginning of speech (less often in the middle), as a result of which the patient is forced to linger on any sound (group of sounds). These symptoms of stuttering are very similar to clonic and tonic seizures. With clonic stuttering, repeated formation of words, syllables and sounds is observed. Tonic stuttering prevents the patient from moving from a sound stop to move to articulating another sound.
Allocate neurotic and neurosis-like forms of stuttering. Neurotic stuttering occurs in healthy children as a result of stress and neurosis . Neurosis-like stuttering is characteristic of children with diseases of the nervous system (both hereditary and acquired).
Causes of stuttering
There are two groups of causes of stuttering: predisposing and provoking. Among the predisposing causes of stuttering, it is necessary to highlight:
- hereditary burden;
- diseases causing encephalopathic consequences;
- intrauterine, birth trauma ;
- overwork and exhaustion of the nervous system (as a result of infectious diseases ).
Conditions contributing to the occurrence of stuttering can be: impaired development of motor skills and a sense of rhythm; scarcity of emotional development; increased reactivity as a result of abnormal relationships with others; hidden mental disorders (for example, disadvantage). The presence of one of the above conditions is enough for a nervous breakdown and, as a result, stuttering. The reasons that provoke the occurrence of stuttering include: one-stage mental trauma (fear, fright); bilingualism or multilingualism in the family; imitation; tachilalia (accelerated speech). Stuttering symptoms reasons and classification
The pathogenesis of stuttering is similar to the mechanism of subcortical dysarthria . In its composition – a violation of the coordination of the respiratory process, articulation and voice leading. Therefore, stuttering is often referred to as dysrhythmic dysarthria . Disruption of the induction interactions of the cerebral cortex and subcortical structures leads to dysregulation of the cortex. In this regard, there are shifts in the work of the striopallidary system, which is responsible for the “readiness” for the movement.
Two muscle groups are involved in the movement – some contract, others relax. Thanks to the precise and coordinated redistribution of muscle tone, it is possible to perform fast, precise and strictly differentiated movements. It is the striopallidal system that controls the rational redistribution of muscle tone. Blocking the striopallidal speech regulator due to emotional overexcitation or anatomical and pathological damage to the brain leads to clonic repetitions (tic) or tonic spasm. Over time, a pathological reflex – a violation of speech automatism and hypertonicity of the muscles of the speech apparatus – develops into a conditioned reflex.
Breath. Among the violations of the respiratory process during stuttering, there is a huge consumption of air during inhalation and exhalation, which is due to a disorder of resistance in the area of articulation. Violation of speech breathing during stuttering consists in the formation by the patient of inspiratory-vowels or protracted sounds. In other words, the patient uses the inhaled air to move the vocal cords and generate progression. A shortened exhalation is observed not only during speech, but also at rest.
Vote. An attempt to pronounce a sound during stuttering is accompanied by a convulsive closure of the glottis, which prevents the occurrence of sound. During an attack, the larynx moves quickly and sharply up, down and forward. Due to the inability to pronounce fluently, patients try to pronounce vowel sounds firmly. There is a softening of the symptoms of stuttering when singing and whispering, up to the complete normalization of speech.
Articulation. In addition to functional disorders in the articulatory apparatus during stuttering, somatic disorders are also observed. For example, the high vault of the palate, the deviation of the protruding tongue to the side, in the nasal cavity – a curved nasal septum , hypertrophy of the shells .
Accompanying movements are movements that accompany speech during stuttering, which are not necessary, but, at the same time, are produced by the patient as a conscious movement. During an attack of stuttering, patients can tilt their head back, tilt it, close their eyes, clench their fist, shrug their shoulders, stomp their feet, and shift from foot to foot. In a word, make movements that can be designated as tonic or clonic convulsions.
Psyche. With the development of stuttering, certain mental disorders are inevitable. The most common fear of certain sounds, syllables and words, namely their pronunciation. In their speech, patients suffering from stuttering deliberately avoid such sounds and words, if possible, look for a replacement for them. With exacerbations, absolute dumbness may occur. Thoughts about the impossibility of normal communication can lead to a consciousness of inferiority and in relation to the whole “I”.
1st phase. There are small episodes of stuttering, shortening of periods of smooth, measured speech. The end of the first phase of stuttering is determined by the following symptoms:
- pronunciation difficulties arise more often in the initial words of sentences;
- episodes of stuttering occur when pronouncing conjunctions, prepositions and other short parts of speech;
- “Communication pressure” aggravates stuttering;
- the child does not react in any way to his difficulties with pronouncing words, speaks without embarrassment. There is no anxiety, no fear of speech. A momentary emotional outburst is capable of provoking stuttering.
2nd phase. There are problems in contacting, some accompanying movements. The number of situations that are difficult to communicate is gradually increasing. Stuttering symptoms reasons and classification
- stuttering becomes chronic, but the severity of the attacks differs;
- pronunciation problems occur more often in polysyllabic words, during fast speech and much less often in short parts of speech;
- the child is aware of the violation of his speech, but does not consider himself a stutter. Speaks naturally in any situation.
3rd phase. Consolidation of convulsive syndrome. However, patients do not experience any fear of speech or any kind of awkwardness. They use every opportunity to communicate. The offer of treatment does not generate any support or enthusiasm on the part of the patient. They seem to be setting themselves up for calmness.
- patients realize that due to stuttering, some situations become difficult in terms of communication;
- difficulties appear in connection with the pronunciation of certain sounds, words;
- attempts to replace “problem” words with others.
4th phase. At this stage, stuttering is a big personality problem. There are pronounced emotional reactions to stuttering and, as a result, avoidance of speech situations. If earlier the patient resorted to replacing “problem” sounds (words) periodically, now he does it all the time. He begins to pay attention to the reaction of others to his stuttering. Characteristic features of the 4th phase of stuttering:
- expectation of stuttering (anticipation);
- difficulties in pronouncing certain sounds (words) become chronic;
- logophobia (fear of speech);
- answers to questions become evasive.
Complications of stuttering
The presence of stuttering forces the child to avoid speech situations, as a result of which his circle of communication and, as a result, general development is narrowed. Suspiciousness, vigilance, a feeling of difference between oneself and peers appear. As a result of misunderstanding between the child and his parents (classmates, peers), a feeling of infringement develops, his own inferiority. Irritability increases, fearfulness appears, which can lead to depression of the psyche and aggravation of stuttering. Stuttering can lead to poor performance in school due to the child’s awkwardness, shyness, and withdrawal. The development of stuttering can interfere with the choice of a profession, as well as in starting a family.
To diagnose stuttering, you need the following signs:
- violation of the rhythm of speech (scraps of words, phrases, repetition of syllables, stretching of certain sounds);
- difficulties and hesitation at the beginning of speech;
- attempts to cope with stuttering with the help of side movements (grimaces, tics).
In the case of the duration of the above disorders for more than 3 months, stuttering is diagnosed. Such patients need to consult not only a neurologist , but also a speech therapist . To exclude organic diseases of the nervous system, rheoencephalography , EEG of the brain , MRI diagnostics are performed.
The success of the treatment of neurotic stuttering largely depends on the timeliness of diagnosis. In view of the ineffectiveness of traditional psychotherapeutic methods of treating stuttering (behavioral, hypnotic, etc.) in modern medicine, preference is given to special therapeutic approaches that include elements of several treatment methods. Such combined psychotherapeutic methods of stuttering treatment are used both individually and in groups. Correction of speech disorders is carried out through speech therapy classes to correct stuttering and accelerated speech . Stuttering symptoms reasons and classification
Neurotic stuttering in young children responds well to speech therapy kindergartens and groups. Here the emphasis is placed on collective play psychotherapy, speech therapy rhythm. Family psychotherapy , which uses suggestion, distraction, and relaxation , is of no small importance . Children are taught to speak in time with the rhythmic movements of the fingers or in a monotonous and chanting manner. The method of self-regulation is based on the belief that stuttering is a certain behavior subject to change. It includes desensitization, autogenic training . The purpose of ancillary drug treatment is to relieve symptoms of fear, anxiety, depression… The appointment of sedatives (including phytotherapeutic) and restorative agents is recommended.
In the drug treatment of neurosis-like stuttering that occurs in connection with organic brain damage, antispasmodics (tolperisone, benactisin) are used, tranquilizers (in minimal doses) are used with caution. The effectiveness of the course of dehydration has been proven. In the case of clonic stuttering, it is recommended to prescribe several courses (from 1 to 3 months) of hopantenic acid. In addition, it is recommended to include physiotherapy and massage (both general and speech therapy) in the complex treatment of stuttering .
The prognosis is favorable in more than 70% of stuttering cases among children.
Stuttering prevention methods are divided into two groups. One of them is aimed at maintaining and strengthening children’s health, the second – at organizing the child’s speech development. Adequate nutrition, constant care, adherence to the daily routine and hygiene are important components of the mental and speech development of the child, the preservation and strengthening of his health. The correct alternation of wakefulness and sleep contributes to the normal functioning of the nervous system and its protection from overloads. It is necessary to protect the psyche of children from excessive information load (watching “adult” TV programs, reading hyperemotional fairy tales before bedtime), situations that can cause fear.
The full speech development of a child should include three areas. The first is the expansion of horizons, concepts and ideas about the world around, phenomena and objects (games, walks, reading books). The second is the prevention and prevention of stuttering in the child’s speech, teaching the fluency and unhurriedness of speech, the ability to logically and consistently express their thoughts and desires. Third – the formation of the correct sound pronunciation, rhythm and tempo of speech. However, new information should be communicated to the child gradually, dosed. Stuttering symptoms reasons and classification