Stuttering in children

Stuttering is a speech disorder characterized by a violation of the correct rhythm of speech, as well as involuntary hesitation in the process of expressing thoughts, forced repetitions of individual syllables of a word or sounds. This pathology develops due to the occurrence of specific convulsions in the organs of articulation.

Stuttering in children usually begins between the ages of 3 and 5 – at this stage, speech develops most actively, but since their speech function is not yet fully formed, some kind of “failure” may occur.

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Epidemiology

Stuttering occurs in approximately 5% of all children aged six months and older. Three-quarters of these will recover by the time they reach adolescence, and about 1% will remain speech impaired for life.

It should be noted that stuttering affects men several times (2-5) more often than women. This disease usually manifests itself in early childhood, and the results of the study show that in the age category under 5 years, stuttering develops in 2.5% of children. If we talk about the gender ratio, the numbers change as children grow up - for preschoolers, the proportions are 2 to 1 (there are more boys), and by the first grade they become larger - 3 to 1. In the fifth grade, this figure increases to 5 to 1, since girls get rid of stuttering at a faster pace. Since in the early stages the recovery rate is quite high (approximately 65-75%), the overall prevalence of this defect is usually no more than 1%.

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Causes of a child who stutters

Speech therapists distinguish 2 types of childhood stuttering. The first of them appears in children with some defects in the central nervous system. Possible causes include birth trauma, heredity, severe gestosis during pregnancy, complicated births, frequent illnesses of the child in the first years of life. Otherwise, he develops normally, there are no health problems.

During a neurological examination of such a child, signs of increased intracranial pressure are usually revealed, as well as an increased seizure threshold of the brain and 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 neurosis provoked by stress or severe emotional or physical fatigue. In such cases, this speech defect is significantly aggravated when the child is in a state of nervous tension or emotional excitement.

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Pathogenesis

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

In this articulation process of voice formation, 2 groups of muscles take part, one of which contracts, and the other, on the contrary, relaxes. A fully coordinated and clear redistribution of the tone of these muscles allows for precise, correct and fast movements that have strict differentiation. The striopallidal system controls the rational redistribution of muscle tone. If this speech regulator is blocked (due to pathologies in the brain or strong emotional arousal), a tonic spasm occurs or a tic 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 automatism of the child's speech, is transformed over time into a stable conditioned reflex.

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Symptoms of a child who stutters

Usually, hesitations during stuttering sound like prolongation or repetition of the initial syllables of the spoken word or repetition of individual sounds. Another symptom of stuttering in children may also be sudden pauses at the beginning of a word or a separate syllable. Often, along with hesitation in speech, a stuttering child also experiences involuntary contractions of the facial muscles, as well as the muscles of the neck and limbs. Perhaps such movements appear reflexively to help pronunciation, although in fact they only reinforce the impression in other people of how difficult it is for the stutterer to speak. In addition, children suffering from stuttering begin to fear individual words or sounds, so they try to replace them with some synonyms or explain them descriptively. And sometimes stuttering children generally try to avoid situations in which it is necessary to speak.

First signs

In order to provide timely assistance to your child, it is important for parents not to miss the moment when the first signs of stuttering appear:

• The child suddenly begins to refuse to speak (this period can last 2-24 hours, and after that he begins to speak again, but stutters; therefore, if in such a case you manage to take the child to a specialist before stuttering begins, the appearance of a speech defect can be completely prevented);
• Pronounces extra sounds before a phrase (for example, it could be “and” or “a”);
• At the beginning of a phrase, he is forced to repeat the initial syllable or the word itself in its entirety;
• Forced to stop in the middle of a phrase or a single word;
• He experiences some difficulty before starting his speech.

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Psychosomatics of stuttering in children

A very popular opinion is that stuttering occurs due to a discrepancy between the emotional and psychological stress received by the body and its ability and/or capacity to process it.

Overall, approximately 70% of parents indicate that their child’s stuttering was caused by some stressful factor.

Along with stuttering, children are often diagnosed with logoneurosis or logophobia, indicating that their psychological health has been compromised. This has led to speech problems, manifested in delays, hesitations, stops and spasms.

Forms

By the nature of the spasms that appear during the speech process, one can distinguish tonic and clonic forms of stuttering in children. The spasms themselves are either inspiratory or expiratory - this depends on when they appear - on inhalation or exhalation. By the nature of the cause of occurrence, the disease is divided into symptomatic or evolutionary (it can be neurosis-like or neurotic).

The tonic type of stuttering looks like long pauses in the speech process or prolongation of sounds. In addition, the stutterer usually looks constrained and tense, the mouth is half-open or completely closed, and the lips are tightly closed.

Neurotic stuttering occurs in a child due to a mental trauma that he receives at the age of 2-6 years. It looks like clonic convulsions that intensify at the beginning of a phrase or under strong emotional stress. Such children are very worried when they need to talk or refuse to talk at all. It should be noted that in general, the development of the speech and motor apparatus in such a child fully corresponds to all age stages of development, and in some children it can even be ahead of them.

Clonic stuttering in children appears as a constant repetition of individual sounds/syllables, or entire words.

Neurosis-like stuttering usually appears as a result of some kind of brain disorder. This defect has the following signs - children are subject to rapid exhaustion and fatigue, are very irritable, and their movements are nervous. Such a child is sometimes diagnosed with pathological psychiatric symptoms, characterized by impaired motor reflexes and behavioral difficulties.

This type of stuttering usually occurs at 3-4 years of age and does not depend on the presence and/or absence of psychological trauma. It mainly appears at the time of intensive development of phrasal speech in a child. Later, the disorders continue to gradually increase. Speech becomes worse if the child is tired or sick. The development of movements and the speech apparatus occurs at the correct time or may be slightly delayed. Sometimes neurosis-like stuttering in a child appears against the background of some underdevelopment of his speech function.

Physiological stuttering in children

Physiological iterations are repetitions of individual words in a child's speech. They are observed quite often in small children and are not considered a sign of illness. It is believed that this is a physiological symptom that is characteristic of a separate period of development of speech skills in a child, and it is typical for 80% of children during the process of active development of phrasal speech at the age of 2-5 years). If no complications arise, the repetitions will pass when the child strengthens the conditioned reflexes of his speech and learns to express his thoughts correctly.

Physiological stuttering in children is the result of the child's thinking in its development outpacing the progress of speech skills. At a young age, children are quite limited in expressing their thoughts, because they have a small vocabulary, they have not yet learned to clothe their thoughts in the correct form, and articulation has not yet formed, which is why speech is not clear.

Physiological roughness in a child’s speech may appear due to certain unfavorable factors (such as injuries, illnesses, inappropriate teaching methods).

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Stuttering in preschool children

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

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

• While speaking, he often stops, and at the same time his neck and facial muscles tense up;
• The child speaks little and tries to avoid the need to talk;
• Abruptly interrupts his speech and remains silent for a long time;
• Is in a confused and depressed mood.

Complications and consequences

The consequences and complications of stuttering include the following problems:

• Difficulties with social adaptation;
• Low self-esteem;
• The appearance of a fear of speech, as well as a fear of pronouncing individual sounds;
• Worsening of speech defect.

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Diagnostics of a child who stutters

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

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

• The shape, location, frequency of convulsions when pronouncing words;
• Specific features of speech tempo, breathing, and voice are assessed;
• The presence of speech and movement disorders associated with stuttering, as well as logophobia, is revealed;
• It becomes clear how the child himself feels about the defect he has.

The child also undergoes an examination of the ability to pronounce sounds, phonemic hearing, as well as the lexical and grammatical part of speech.

The speech therapist's report specifies the severity of stuttering and its form, other speech disorders associated with the defect, as well as the nature of the spasms of the articulatory muscles. Stuttering must be differentiated from stumbling and tachylalia, as well as dysarthria.

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

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Treatment of a child who stutters

A speech therapist treats this speech problem, but if the defect arose as a result of mental trauma received by the child, the doctor may refer the patient to a neuropsychiatrist for consultation.

Currently, the basis of treatment for stuttering in children is the stabilization of the functioning of the speech circle, also called inhibition of Broca's center. The following correction methods are prescribed during therapy:

• Hypnosis;
• Anticonvulsants and sedatives;
• Relaxation baths;
• Acupuncture;
• Procedures for general strengthening of the body;
• Speech training: rhythmic or slightly singsong speech, slightly slowing down its tempo, prolonged silence.

In addition, a technique is also used in which other motor centers of the body are activated. In this case, breathing is regulated, rhythmic movements are made using the fingers on the hands, and oral speech is accompanied by writing on paper.

Prevention

In order to prevent the child from developing stuttering, it is quite important that the mother's pregnancy proceeds safely. It is also necessary to take care of his mental and physical stability and speech development, select entertainment/educational information that will correspond to his age. To prevent a relapse of stuttering, it is necessary to follow the recommendations of the attending speech therapist during the process of corrective work, as well as after its completion. It is necessary to create favorable conditions for the child's development.

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Forecast

Stuttering in children usually goes away completely if the medical and health therapy is organized correctly. Sometimes relapses may occur during schooling and puberty. The treatment result is most stable if correction begins at preschool age. The longer the child has been stuttering, the more uncertain the prognosis becomes.

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