Speech disorder

“ The chances for outgrowing a speech disorder at this age are considerably less than at any other time in the previous life of the individual. The unbalanced general condition tends to make the stammerer more susceptible instead of less so. As previously explained, this period marks the time when speech disorders progress rapidly from bad to worse and, as a consequence, the chances for outgrowing diminished from 1 per cent, before the age of 6 to practically zero after the age of 12. ”

“ There should be no dilly-dallying, no foolish belief in the possibility of outgrowing the trouble, for whatever chances once existed are now past. First of all, the child's case should be diagnosed by an expert with the idea of ascertaining the exact nature of the speech disorder, the probable progress of the trouble, the present condition, the curability of the case and the possibilities for early relief. ”

“ Nervousness, while not the cause of speech disorder, is an aggravant of the trouble and should be avoided. The child should not be allowed to engage in anything which has a tendency to make him nervous or highly excited. Such a condition will aggravate the speech trouble, make it worse and tend to fix it more firmly in the child.
Furthermore, parents should not scold or berate the child because he stammers or stutters. No child stammers or stutters because he wants to, but because he has not the power to control his speech organs. ”

“ It is important that the child be not allowed to associate with others who stammer or stutter, or who have any form of speech disorder. Imitation or mimicry, as heretofore stated, is the most prolific cause of speech trouble and to place a child who stammers or stutters in the company of an older person similarly afflicted, is to invite a serious form of the disorder. ”

“ Regardless of under which of these three heads a speech disorder may come, it is commonly spoken of by the laymen as a "speech impediment" or "a stoppage in speech" notwithstanding the fact that the characteristics of the various disorders are quite dissimilar. In certain of the disorders,
(a) —There is an inability to release a word; in others,
(b) —A tendency to repeat a syllable several times before the following syllable can be uttered; in others,
(c) —The tendency to substitute an incorrect sound for the correct one ”

“ If by the time the child is eight years of age, the defective utterance remains, this fact is proof that the speech disorder is of a form that will not yield to the simple methods possible under parental treatment at home and the child should be immediately placed under the care of an expert whose previous knowledge and experience insures his ability to correct the defective utterance quickly and permanently. ”

“ It is a curious feature of the early forms of speech-disorder springing from physical sources—for example, incipient disease of the brain—that particular elements of knowledge seem to be effaced, and special processes of thought or reasoning can no longer be performed, although the great mass of mind-work goes on unimpaired. ”

“ The nervous condition is marked by a much higher nervous irritability, which contributes to a condition most favorable for the rapid progress of the speech disorder, always easily aggravated by a subnormal physical, mental or nervous condition. Cases where the Intermittent Tendency is a pronounced characteristic are liable at this period to find the alternate periods of relief and recurrence to be more frequent than ever before and to note a marked tendency of their trouble to recur with constantly increasing malignancy. ”

“ A person with a slight impediment in his speech, due probably to some minor organic disorder, could be much helped by the average teacher, if the latter would give this subject of speech serious consideration. Of course there are cases where, from birth, the child’s speech organs have been impaired, and again, disease or some surgical operation may have caused interference with their proper functioning. In such cases as these a speech specialist is needed and often medical aid as well. ”

“ No stammerer or stutterer, however, should overlook the value of such diagnosis, for the reason that there are so many forms of speech disorders that it is totally impossible as well as unsafe for the sufferer himself to try to determine the exact nature of his trouble. ”

“ Speech disorders arising in this period may be traced to any one of a number of causes. In a child of five, for instance, the diagnostician would look for evidences of an inherited tendency to stammer or stutter; he would look also for circumstances which would show that the child had acquired defective utterance through mimicry of others similarly afflicted or through the unconscious imitation of the defective speech of those immediately about him. ”

“ While he was a medical man of known ability, he had not made a study of speech disorders and knew practically nothing about either the cause or cure of stammering or stuttering. Even today, prominent medical men will tell you that their profession has given little or no attention to defects of speech and take little interest in such cases. ”

“ At this time, also, there is frequently an excess of blood supplied to the larynx, with possibly some degree of stagnation or congestion, which results in a thickening of the vocal bands, unequal action of muscles, etc., which must involve imperfections in the voice. In all such cases common sense and physiology alike plainly indicate that rest is desirable. All shouting, singing, etc., should be refrained from, and even ordinary speech, as much as possible, in very marked cases, especially when the individual is even slightly indisposed or weary. ”

“ If we admit the conjecture that a mechanism similar to that pointed out in the forgetting of names may also play a part in the phenomena of speech-blunders, we are then led to a better founded judgment of cases of speech-blunders. The speech disturbance which manifests itself as a speech-blunder may in the first place be caused by the influence of another component of the same speech, that is, through a fore-sound or an echo, or through another meaning within the sentence or context which differs from that which the speaker wishes to utter. ”

“ That the soul of language as an instrument of thought consists in this non-presentative element, so often lacking, is conclusively shown in the facts of speech diseases. In the slowly progressive aphasias, of late so carefully studied, the words first lost are those of things and acts most familiar to the patient, while the words that persist longest in the wreckage of the speech-centers are generally words that do not designate the things of sense. ”

“ They are of all ranks and conditions of life, of all sizes and build, and it is evident that the trouble is not physical, but mental. They {571} pay too much attention to their speech and to the co-ordination of the many muscles engaged in speech production and the consequence is that they impair their power to use these organs. Practically all the cures recommended contain some element which distracts the attention from the speech to something else and so permits the function of the speech organs to proceed undisturbed. ”

“ The reason of this is that the deaf, particularly those who have always been so, being unable to hear, do not know how to use their organs of speech, and especially are unable to modulate their speech by the ear, as the hearing do. If the deaf could regain their hearing, they would have back their speech in short order. The character of the human voice depends thus on the ear to an unrealized degree. ”

“ The more usual order is, as aforesaid, from the tactile, visual, or other properties of the things thought-about to the sound of their names, and then to the latter's utterance. But if in a certain individual's mind the look of an object or the look of its name be what habitually precedes articulation, then the loss of the hearing centre will pro tanto not affect that individual's speech or reading. He will be mentally deaf, i.e. his understanding of the human voice will suffer, but he will not be aphasic. ”

“ Not only are they more dependent for their proper production on intelligence, but in those disorders of speech which occur as a result of degenerative processes of the central nervous system the difficulty of articulate speech precedes that of phonation. Take, for example, bulbar paralysis, a form of progressive muscular atrophy, a disease due to a progressive decay and destruction of the motor nerve cells presiding over the movements of the tongue, lips, and larynx, hence often called glosso-labial-laryngeal palsy. ”

“ A far more difficult co-ordination is required for talking. It is only when we analyze how nicely adjusted must be every movement, in order to pronounce consonants and vowels properly and to combine them in various ways, that we realize how complex is the mechanism of talking. A difference of a hundredth of an inch in the movement of the tongue, or less than that in the movements of various muscles of the larynx, makes all the differences between clear articulation and a defect of speech. ”

“ It IS true, however, that more care on the part of the parent in looking after the formation of speech habits in the Pre-Speaking and Formative Periods of the child's speech development, would result in fewer cases of chronic stammering and stuttering in later life. ”

“ The organ of hearing is injured at its peripheral extremity, or else the acusticus in its course; then occurs difficulty of hearing or deafness. What is spoken is not correctly heard or not heard at all: the utterance is correct only in case the lesion happened late. If it is [Page 37] inborn, then this lack of speech, alalia, is called deaf-mutism, although the so-called deaf and dumb are not in reality dumb, but only deaf. If words spoken are incorrectly heard on account of acquired defects of the peripheral ear, the patient mis-hears, and the abnormal condition is called paracusis. ”

“ I said that the nature of the language was unimportant, except as regarded the physical health of its employer; but that point in itself is worthy of consideration.
Two facts in the physical condition of the deaf and dumb point the instructor to articulation as the best means towards a higher end. They are—
1st. No naturally born deaf child was ever known to be deficient in any of the vocal organs.
2ndly. The constant cause of death among such persons arises from diseases in the lungs and other organs which might have been strengthened by the salutary exercise of speech. ”

“ All deaf cases become mute, unless the disease has occurred in adult life, when the patient has already acquired the power of language. A deaf-mute does not speak, because he cannot hear, and therefore speech is an unknown quantity.
The TREATMENT would consist in treating any middle-ear disease that might exist, such as the sequelæ of purulent inflammation, and the instruction of the patient in acquiring the power of intercommunication either by the methods long employed of finger-reading, or, much better, by the lip method, so called, where the power of speech is given to the patient. ”

“ The disease appears to be due to defective coördination of certain muscles of the larynx, in consequence of which the vocal apparatus fails at intervals to fully obey the will; the failure giving rise to sudden interruptions of the voice, while the articulating power may remain unaffected. As in other impediments of speech the harmonious action of the muscles engaged in articulation may be disturbed, in this case the disordered coordination affects the voice only. ”

“ The defect of speech, accompanied by a strong tendency to lethargy, we accounted for at the time, by a transient cessation or paralysis of the tongue, and a congestion of blood on the brain, all of which frequently attack persons of the soberest habits. ”

“ But since that time it has become clear that speech involves activity not in one part of the brain, but in many. Thus there is a place where the sound of the spoken word is received, another place where it is stored; then there is an attention centre far away, but in connexion with the storage place, and all these various parts must be active and healthy before a word is heard, stored, and attended to. Now the mechanism being so involved, there may be a breakdown at one point or another. One may be deaf through the ear, or through the memory chamber, or through the higher brain. ”

“ It is necessary, first of all, that ideas call up their appropriate symbols; secondly, that we remember how to say words; and, thirdly, that our organ of speech be entire—by which is meant, the whole of the muscular apparatus which is brought into action when one articulates.
Now, each of these three capabilities is liable to injury from disease. When the first is affected, the patient forgets words, or uses wrong words, in which a connection with the right ones may be more or less traceable. In the second case, an individual may have lost speech entirely, or he may retain a few words. ”

“ When stuttering occurs in women the defect is much less tractable and is usually dependent on a more serious disturbance of the psyche or of the central nervous system. The prognosis of cases of stuttering in women is not so good as in men, but remarkable cures are sometimes effected by mental treatment of the self-consciousness which causes the speech defect. ”

“ Lisping, stammering, and other kinds of imperfect speech, are mainly due to nervous disease, stammering being usually caused by temporary spasm of the glottis. Too high a palate is another cause of irregular utterance. Dumbness, when not occasioned by deafness, as is generally the case, must be ascribed either to malformation of the vocal organs, or, more commonly, to disease of the nervous centres. Whistling, it must be remembered, results from the vibration caused by the friction of the breath against the edges of the open lips, and is wholly formed in the mouth. ”