Stammering in children

Stuttering is called speech disorder, which is characterized by a violation of the correct rhythm of speech, as well as involuntary lapses in the process of uttering thoughts, forced repetition of individual syllables of the word or sounds. This pathology develops due to the appearance in the articulation organs of specific seizures.

In general, stammering in children begins in the 3-5 years period - at this stage, speech develops in the most active way, but since the speech function is not yet fully formed, a certain "failure" may occur.

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Epidemiology

Stammering occurs in about 5% of all children aged six months and older. Three-quarters of them will recover to the beginning of the adolescent period, about 1% of speech loss persists for life.

It should be noted that stuttering several times (2-5) affects men more often than women. Usually, this disease manifests itself in early childhood, and the results of the study demonstrate that in the age group under 5 years stammering develops in 2.5% of children. If we talk about the ratio of sexes, the figures change with the growth of children - in preschool children the proportions are 2k1 (there are more boys), and already to the first class they become larger - 3k1. In the fifth grade, this indicator increases to 5k1, as girls get rid of stuttering at a faster rate. Since in the early stages the recovery rate is quite high (about 65-75%), the total prevalence of this defect is usually not more than 1%.

[2], [3], [4], [5], [6], [7], [8], [9]

Causes of the stammering

Speech therapists distinguish 2 types of children's stuttering. The first of these appears in children who have some defects in the central nervous system. Among the possible causes of the occurrence - a trauma received during childbirth, heredity, severe gestosis during pregnancy, complicated childbirth, frequent illnesses of the child in the first years of life. In the rest it develops normally, there are no health problems.

In the process of neurologic examination, such a child usually shows signs of increased intracranial pressure, as well as an increased threshold of convulsive readiness of the brain, pathological reflexes.

The second type of this defect is observed in children who initially do not have any organic or functional pathologies of the central nervous system. This type of stuttering appears due to a neurosis provoked by stress or strong emotional or physical overwork. In such cases, this speech defect is greatly enhanced when the child is in a state of nervous tension or emotional arousal.

[10], [11], [12]

Pathogenesis

The pathogenesis of stuttering by its mechanism is quite similar to the so-called subcortical dysarthria. In this disease, coordination of the process of breathing, voice, and articulation is disturbed. Because of this, stammering is often called a dysrhythmic dysarthria. Since there is a disruption in the interaction between the cerebral cortex and its subcortical structures, the regulation of the bark itself is also disturbed. As a result, there are shifts in the functioning of the striopallidal system, responsible for "pre-preparedness" for the movement.

In this articulatory process of voice formation, 2 groups of muscles participate, one of which is contracted, and the other, on the contrary, relaxes. Completely coordinated and clear redistribution of the tone of these muscles allows you to make precise, correct and rapid movements that have a strict differentiation. Stryopallidarnaya system controls the rational redistribution of muscle tone. If this speech controller is blocked (due to brain pathologies or strong emotional excitement), a tonic spasm occurs or a tick occurs. This pathological reflex, in which there is an increased tone of the muscles of the speech apparatus, as well as a violation in the child's speech automatism, eventually transforms into a persistent conditioned reflex.

[13], [14], [15], [16], [17], [18], [19]

Symptoms of the stammering

Usually the falters during stuttering sound like prolonging or repeating the initial syllables of the spoken word or repeating individual sounds. As a symptom of stammering, children may still have sudden pauses at the beginning of the word, or a separate syllable. Often, along with a stumbling in the speech, the stuttering child also has involuntary contraction of the facial muscles, as well as the muscles of the neck and limbs. Perhaps such movements appear reflexively to help the pronunciation, although in fact they only reinforce the impression of others about how difficult it is for a stutterer to talk. In addition, children suffering from stuttering begin to fear individual words or sounds, so they try to replace them with some synonyms or explain descriptively. And sometimes stammering children generally try to avoid situations in which they need to talk.

First signs

In order to help your child in time, it is important for parents not to miss the moment when the first signs of stuttering appear:

• The child suddenly begins to refuse to talk (this period can last 2-24 hours, and after that he starts talking again, but at the same time he stutters, so if in that case he has time to take the child to a specialist even before the stammer began, the appearance of a speech defect is quite possible to prevent);
• Pronounces unnecessary sounds before the phrase (for example, it can be "and" or "a");
• At the beginning of a sentence, one has to repeat the initial syllable or the word itself completely;
• Forced stops in the middle of a phrase or a single word;
• Before the beginning of his speech he experiences some difficulties.

[20], [21]

Psychosomatics of stammering in children

Very popular is the view that stuttering is due to a discrepancy between the emotional and psychological load received by the body and its ability and / or ability to process it.

In general, about 70% of parents indicate that stammering in a child is due to some stress factor.

Together with stuttering, children are often diagnosed with logoneurosis or logophobia, thus indicating that psychological health has been disrupted. This led to the appearance of problems with speech, manifested as delays, hesitations, stops and spasms.

Forms

By the nature of seizures that appear during the speech process, it is possible to identify tonic and clonic forms of stammering in children. The convulsions themselves are either inspiratory or expiratory - it depends on when they appear - on inhaling or exhaling. By the nature of the cause of the disease divided into symptomatic or evolutionary (it may be neurotic or neurotic).

Tonic type of stuttering looks like long pauses in the speech process or stretching sounds. In addition, the stutterer usually looks stiff and tense, his mouth is half open or completely closed, and his lips are tightly closed.

Neurotic stammering occurs in the child due to a mental trauma, which he receives at the age of 2-6 years. It looks like a clonic convulsion, which is amplified at the beginning of a phrase or with a strong emotional tension. Such children are very worried when they need to talk or even refuse to talk. It should be noted that in general, the development of speech and motor apparatus in such a child is fully consistent with all age stages of development, and some children may even outstrip them.

Clonic stammering in children looks like a constant repetition of individual sounds / syllables, or whole words.

Neurosis-like stuttering usually appears due to some kind of brain imbalance. This defect has the following signs: children are prone to rapid exhaustion and fatigue, very irritable, nervous movements. Such a child is sometimes diagnosed with psychiatric pathological symptoms, characterized by impaired motor reflexes and difficulties in behavior.

There is such a stammering usually in 3-4 years and does not depend on the presence and / or absence of psychological trauma. Basically, it appears at the time of intensive development of the child's phraseological speech. Further violations continue to increase gradually. Speech becomes worse if the child is tired or sick. The development of movements and speech apparatus is carried out in the right time, or it may be a bit delayed. At times the neurosis-like stammering of a child appears against a background of some underdevelopment of his speech function.

Physiological stammering in children

Physiological iterations are repetitions in the child's speech of individual words. In young children, they are observed quite often, and are not considered a sign of the disease. It is believed that this is a physiological symptom that is characteristic for a particular period of development in a child's speech skill, and it is characteristic of 80% of children during the active development of phrase speech at the age of 2-5 years). If there are no complications, the repetition will pass, when the child will strengthen the conditioned reflexes of his speech and learn how to express his thoughts correctly.

Physiological stammering in children is the result of the fact that the child's thinking in its development is ahead of the progress of speech skills. At a small age, children are quite limited in expressing their thoughts, because they have a small vocabulary, they have not yet learned to put thoughts in the right form, and articulation has not yet formed, which makes speech discordant.

Physiological roughness in speech in a child may appear due to some unfavorable factors (such as trauma, illness, inappropriate pedagogical methods).

[22], [23], [24]

Stammering in preschool children

Manifestations of stuttering can occur from 2-3 years. Since in the period of 2-5 years, speech skills develop rapidly, the nature of children's speech can have such differences - the child speaks roughly, at a fast pace, swallows the endings of phrases and words, takes pauses in the middle of the speech, speaks on inspiration.

At this age, such signs are a natural stage in the learning process of a speech skill, but a child with a tendency to stutter has a specific behavior:

• During the speech, he often stops, and at the same time his neck and facial muscles stiffen;
• The child says little, tries to avoid the need to talk;
• He sharply interrupts the speech he started and for a long time he is silent;
• Is in a confused and depressed mood.

Complications and consequences

Among the consequences and complications of stuttering are such problems:

• Difficulties with social adaptation;
• Reduced self-esteem;
• The appearance of fear of speech, as well as the fear of pronouncing individual sounds;
• The aggravation of the speech defect.

[25], [26], [27], [28], [29], [30]

Diagnostics of the stammering

Diagnosis of stammering in children can be performed either by a children's neurologist, a psychologist, a psychiatrist, or a pediatrician or speech therapist. Each of these doctors must necessarily study the anamnesis, find out whether stuttering is hereditary, and also get information about the early motor and psycho-speech development of the child, find out when and under what circumstances stuttering occurred.

In the diagnostic examination of the speech apparatus of a stuttering child, the following manifestations are revealed:

• Form, location, frequency of seizures when pronouncing words;
• The available at the rate of speech, breathing, and also voice specific features;
• The presence of accompanying stuttering disorders in speech and movements, as well as logophobia, is revealed;
• It turns out how the child himself refers to the defect he has.

Also the child necessarily undergoes an examination of the ability to pronounce sounds, phonemic hearing, and also the lexico-grammatical part of speech.

In conclusion, a speech therapist indicates the severity of stuttering and its form, other speech disorders associated with the defect, as well as the nature of seizures of articulatory muscles. Stammering should be differentiated with stumbling and tachillation, as well as dysarthria.

To detect whether there are organic lesions in a child in the central nervous system, the neurologist prescribes the passage of rheoencephalography, EEG procedures, brain MRI, and EchoEG.

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Treatment of the stammering

Treatment of this speech problem is handled by a speech therapist, but if the defect arises from a child's mental trauma, the doctor can send the patient to a consultation with a psychoneurologist.

Now the basis for treating stuttering in children is the stabilization of the functioning of the circle of speech, which is also called the braking of Broca's center. In the course of therapy, the following correction methods are prescribed:

• Hypnosis;
• Anticonvulsants and sedatives;
• Baths for relaxation;
• Acupuncture;
• Procedures for general strengthening of the body;
• Speech training: a rhythmic or slightly speechless speech, a slight slowing of its pace, a prolonged silence.

In addition, a technique is also used in which other motor centers of the body activate. In this case, the regulation of breathing, rhythmic movements with the use of fingers on the hands, accompaniment of oral speech by writing on paper.

Prevention

As a prevention of the appearance of stuttering in the child, it is important that his mother's pregnancy proceeds safely. It is also necessary to take care of his mental and physical stability and development of speech, to select information of entertaining / educational nature that will correspond to his age. To prevent a relapse of stuttering, it is necessary to follow the recommendations of the attending physician-speech therapist in the process of corrective work, and also after its completion. We need to create favorable conditions for the development of the child.

[34], [35], [36]

Forecast

Stammering in children usually completely goes away, if the treatment and health therapy is organized correctly. Sometimes there may be relapses during school and puberty. The result of treatment is most stable, if you start correction in the preschool age. The longer the stuttering period for the child, the more uncertain the forecast becomes.

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