Psychological, pedagogical and clinical characteristics of stutterers
Studies distinguish two clinical forms of stuttering – neurotic and neurosis-like, which are caused by different pathogenetic mechanisms (Kovalev V.V., 1970; Asatiani N.M. et al., 1973-1985; Drapkin B.Z., 1973; Belyakova L.I. ., 1973-2000 and others).
Clinical and psychological-pedagogical
characteristics of stutterers with a neurotic form of speech pathology
The emergence of neurotic stuttering in children is usually preceded by psychogeny in the form of fright or in the form of chronic mental trauma. Stuttering occurs acutely at the age of 2-6 years.
Anamnestic information shows that in children with this form of stuttering, there are usually no indications of the pathology of intrauterine development and childbirth. Early psychophysical development, as a rule, takes place in accordance with the age norm. Motor skills (sitting, standing, walking) are formed in a timely manner.
Their speech ontogenesis has certain features. Often there is an early development of speech: the first words appear by 10 months, phrasal speech is formed by 16-18 months of age. In a short period of time (2-3 months), children begin to speak in extended phrases, the vocabulary is rapidly replenished, the grammatical structure of speech is formed early with the use of complex speech structures.
The pace of speech is often accelerated, children seem to “choke” on speech, keep back the endings of words and sentences, skip individual words and prepositions, and make grammatical errors. Often there is a “blurring” of the pronunciation of sounds in the speech stream. The state of the sound-producing side of speech is not ahead of the norm.
Such children often have a large number of iterations (repetitions), which often attracts the attention of others. If normally the largest number of iterations coincides with the intensive period of the formation of extended phrasal speech and is limited in time to 2-3 months, then in children of this group the number of iterations may remain significant for a longer time. Thus, the articulatory mechanisms of oral speech remain functionally immature in them for a longer period than in the norm, while the lexico-grammatical side is significantly ahead of the norm.
Before the onset of stuttering, such children show characterological features such as increased impressionability, anxiety, timidity, resentment, mood swings, more often in the direction of decreased mood, irritability, tearfulness, impatience. Some of them have fears at the age of 2-5 years (fear of the dark, fear in the absence of adults in the room, neurotic enuresis, etc.)
These children hardly get used to the new environment, they become irritable, more whiny in it, they usually show poor tolerance to the conditions of the kindergarten.
Stuttering occurs most often acutely against the background of developed phrasal speech after a mental trauma.
In addition to acute and chronic mental trauma, the neurotic form of stuttering in some children develops as a result of the active introduction of a second language into communication at 1.5–2.5 years of age. This happens in children who, due to age characteristics, have not mastered their native language sufficiently. In this period of development of the speech function, mastering a second language is associated with great mental stress, which is a pathogenic factor for a number of children.
Sometimes, before the onset of stuttering, after an acute mental trauma suffered by a child, mutism is observed for some time (from several minutes to a day). The child suddenly stops talking, and an expression of fear often “freezes” on his face.
Simultaneously with the appearance of stuttering, children become even more irritable, motor restless, sleep worse. In a number of cases, painful stubbornness, whims, and crudely expressed violations of disciplinary requirements appear.
In some children, when stuttering occurs, there is a short period when they cover their mouth with their hands during speech, as if fearing the appearance of stuttering, or limit verbal communication.
The dynamics of speech disorders in the neurotic form of stuttering is characterized by a recurrent course, at times speech becomes completely smooth, convulsive stutters are completely absent, but at the slightest emotional stress, somatic illness or fatigue, stuttering reappears.
The neurotic form of stuttering can have both favorable and unfavorable (progredient and recurrent) course. With a favorable course, the severity of stuttering is not severe. Changing the environment for the better, the general improvement of the child’s body, adequate therapeutic and pedagogical measures contribute to a fairly rapid reverse dynamics of speech impairment.
Often, stuttering gradually acquires a chronic course, in which further complete and long-term remissions are no longer observed, and speech impairment becomes more and more severe.
In cases of an unfavorable course of stuttering, there is more often a hereditary burden of stuttering and pathological character traits. In families of children who have an unfavorable course of stuttering, there are often incorrect forms of education that contribute to the chronification of speech pathology.
In children with an unfavorable course of stuttering at the age of 6-7 years, there may already be a situational dependence in the manifestation of the frequency and severity of convulsive stammering, a decrease in speech activity in a new environment or when communicating with unfamiliar faces.
When examining preschool children with a neurotic form of stuttering, the normal development of general motor skills is most often found. General movements in both children and adults are quite graceful and plastic. They switch well from one movement to another, the sense of rhythm is developed quite highly. They easily enter the rhythm of the music and switch from one rhythm to another. Motor errors can be corrected independently. For the correct performance of most motor tasks, verbal instructions are sufficient. The movements of the arms and legs are well coordinated. Fine motor skills of the hands develop in accordance with age. Gestures, facial expressions and pantomime are emotionally colored. At the same time, in comparison with the norm, all stutterers of this group are characterized by not bringing the elements of movement to the end, some of their lethargy, increased motor fatigue, some of the stutterers have a slight tremor of the fingers. In the process of logarithmic exercises, stutterers of this group easily combine movements to music with speech aloud, which has a beneficial effect on the quality of their speech.
Sound pronunciation in children with a neurotic form of stuttering either has no disturbances, or, in accordance with age characteristics, has features of functional dyslalia. The pace of speech is usually fast, the voice is quite modulated.
These children have a close situational dependence of the severity of stuttering. It should also be emphasized that in a state of emotional comfort, in the process of playing or in private, their speech is usually free from convulsive hesitation.
At preschool age, the presence of stuttering usually does not have a noticeable effect on the social behavior of children. Their contacts with peers and adults remain almost normal.
Many children with a neurotic form of stuttering, despite its favorable course and deep remission, have a relapse of stuttering at the age of 7 when they enter school. The recurrence of stuttering at this time is facilitated by both an increase in emotional and physical stress, and an increase in mental and speech tension.
The behavior of stutterers changes dramatically by 10-12 years of age. During this period, there is an awareness of one’s speech defect, a fear of making an unfavorable impression on the interlocutor, drawing the attention of strangers to a speech defect, not being able to express a thought due to convulsive hesitation, etc.
It is at this age that stutterers with a neurotic form of speech pathology begin to manifest a pathological personal reaction to a speech disorder. A persistent logophobia is formed – the fear of speech communication with an obsessive expectation of speech failures. In such cases, a kind of vicious circle is formed, when convulsive hesitations in speech cause strong emotional reactions of a negative sign, which, in turn, contribute to the strengthening of speech disorders.
Adolescents begin to experience difficulty during the answers in the classroom, they are worried when talking to strangers. The gradually increasing need and need for verbal communication, the complication of relationships with peers, the growing requirements for verbal communication in adolescence, lead to the fact that for the vast majority of stutterers, speech becomes a source of constant mental trauma. This, in turn, causes increased exhaustion (both mental and verbal), fatigue and contributes to the development of pathological character traits.
Gradually, some adolescents with a neurotic form of stuttering begin to avoid speech loads, sharply limit speech contacts (passive form of compensation), while others, on the contrary, become aggressive, obsessive in communication (the phenomenon of hypercompensation). At school, the situation is complicated by an insufficient degree of knowledge of the educational material, a feeling of insecurity in one’s abilities, the expectation of failure or trouble, and rejection by fellow students. All this often leads to the fact that teenagers ask teachers to interview them either in writing or after class.
With age, logophobia in some cases acquires a particularly significant place in the overall clinical picture of the neurotic form of stuttering, is obsessive and occurs at the mere thought of the need for verbal communication or with memories of speech failures in the past. In this state, stutterers often do not say what they would like to say, but only what is easier to say.
The severity of logophobia may be disproportionate to the severity of speech convulsions. Often, with a weak, and sometimes barely noticeable speech defect for others, the fear of speech can be pronounced. The emotional life of stutterers is filled with these experiences.
With a particularly unfavorable course of the neurotic form of stuttering in adults, a complex clinical picture is often formed, characterized by disharmonic personality development. In adult stutterers, this manifests itself in a sense of social inferiority with a peculiar system of judgments, a constantly lowered background of mood, a situational fear of speech, which often generalizes, combined with a refusal to speak in general. The effectiveness of a comprehensive medical and pedagogical impact on such individuals is low.
Speech behavior in different conditions of communication with a neurotic form of stuttering is characterized by the fact that in a calm state, when attention is diverted from the process of articulation (for example, with great interest in the topic of conversation), and also when they are alone with themselves, their speech is freer, often completely devoid of convulsive hesitation. A significant improvement in expressive speech is observed in such persons in the process of logorhythmic exercises, autogenic training, under the influence of psychotherapy, hypnosis.
Thus, the following features are characteristic of the neurotic form of stuttering:
1. Before the onset of stuttering, there is a tendency to early speech development.
2. The presence of extended phrasal speech before the onset of the violation.
3. The presence of characterological features (sensibility, anxiety, etc.)
4. Predominantly psychogenic onset of speech pathology (mental acute or chronic traumatization).
5. Stuttering can appear between the ages of 2 and 6.
6. Great dependence of the degree of convulsive hesitation on the emotional state of the stutterer and the conditions of verbal communication.
7. Possibility of smooth speech under certain conditions (speech alone, in conditions of emotional comfort, while diverting active attention from the speaking process, etc.).