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A recent bulletin of this office entitled “The Speech Defective School Child" called attention to what is done for speech defective children, and we trust that publication will promote the development of aid for such children through the public schools. For a long time to come, however, there will be schools in which no specially trained teachers are employed. The present publication is an attempt to meet the many requests for assistance that come to us from parents, regular teachers, and from others who are interested in doing what they can to aid speech defective children or adults. We realize that probably in no field (unless it be in that of training in music) is it so difficult to furnish help in mere printed form, and that even if the material furnished is impeccable its use by those not specially trained is nevertheless difficult. However, the need for doing the best we can under the circumstances is imperative. Perhaps suggestions from those who make use of this publication will help us to improve upon it in a second edition.

Where special teachers are employed for speech correction the full cooperation of regular teachers and of parents is essential for best results, and the material in these pages is prepared partly for the purpose of informing parents and teachers concerning their part in seconding the special teacher in her never-easy task.

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Kinds and Causes of Speech Defects

Before a physician can successfully treat a patient he must find out just what ails him. His first business is to diagnose the case. Those who make use of this publication will be aware that the speech of the person to be taught is defective, but they will not be able to aid him efficiently until they have determined just how and when and why it is defective.

The production of speech is an exceedingly complex process. It includes the perfect exercise of a pair of bellows (the lungs and bronchi), the nice adjustment of two vibrating curtains (vocal cords), together with the proper shaping of the lips, tongue, and soft palate for each sound that we make. The whole apparatus is manipulated by many muscles, big and little. Back of all this is the still more complicated machinery of the central nervous system in which speech originates. If this machinery is in average working order we have average speech, but, in the course of development, some part of the elaborate mechanism may not turn out quite no.mally or it may be damaged and we have defective utterance. As old Sir Thomas Browne said, “Men that look no farther than their outsides think health an appurtenance unto life, and quarrel with their constitutions for being sick; but I, that have examined the parts of man, and know upon what tender filaments that fabrick hangs, do wonder that we are not always so."

But this is not all there is to speech. Speech is often a direct response to some outward circumstance-it is the result of being spoken to, and we react with our whole being, emotionally, to the person who speaks. Some of us react so violently on occasion that the exquisitely delicate speech mechanism does not work readily or it may not work at all. We may be speechless, we may be more or less incoherent, or we needlessly repeat certain speech processes; that is, we *stammer" or "stutter." Save for a few phlegmatic fish-like folk we are all more or less speech defective on occasion, but happily our defectiveness is not frequent or very apparent.

It is difficult to draw a line between normal and abnormal speech, between speech defects and poor utterance, but one student of the subject would have it that 18 per cent of school children and about as many adults are defective.

Defective speech arises in general from: (a) Faults of development in the organs of speech, including weakness (from lack of full use) of the muscles managing the tongue and lips. Imperfect sounds are produced or wrong sounds are substituted for right ones. (b) Faults in the nervous machinery and total make-up of the individual which (although the special organs may be perfect) interfere at times with normal speech. These have been called emotional disorders of speech. Under excitement we press the wrong buttons in the brain, and in consequence the speech organs either do not work at all or they produce meaningless repetition of sounds. In some persons the conditions of (a) and (b) may be combined. (c) Speech that is defective may arise purely from faulty learning and imitation, as in foreign accent, local dialect, and family peculiarities of utterance. (d) The acquirement of speech is to a large extent an imitative process; but if he does not hear well, or if he does not hear at all, the learner of a language is greatly handicapped and his utterance is affected. Imperfect hearing may lead therefore to imperfect speech.

The more serious defects fall into the first two classes.

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Faults Chiefly of the Speech Organs—“Mechanical” Defects

(1) Physical conditions which can not be fully overcome by effort. The fol lowing are some of the more frequent defects which interfere with normal speech and which can only be partially compensated for by special efforts in speech pro duction: Obstruction of the nose from injury, abnormal growths in the nose or pharynx (adenoids), etc.; cleft or deformed palate; hare lip; protruding upper or lower front teeth and missing front teeth; relatively large and not easily managed lips; an overlarge tongue or one restricted in its natural movements; abnormalities in the vocal cords and in other structures of the larynx.

(2) Weaknesses in the tongue and lips and soft palate requiring for good speech; more effort in their use than is habitually put forth, and resulting in baby talk," "lisping," "lolling,” or “nasality.”

Some of the speech defects from this latter cause improve or disappear during school life from better physical development and from observation and imitation of better speech. At any rate they are not likely to become worse, though some of them become more fixed with age.

Faults in Nervous Control of the Speech Organs

"Emotional" Defects > Although the organs of speech seem normal, the nervous system in which speech originates gets out of order for the time being and the speech organs do not work right. Because we can not lay our hands on it, the defect is often spoken of as “'mental” or “emotional.” It is mental in that something goes wrong, under certain conditions, when the person attempts to put his ideas into spoken words. Instead of normal speech there is noticeable hesitation in utterance or needless repetition of sounds; in other words, there is stammering" or "stuttering."

During the development of speech, especially in the child's third or fourth year, the very unstable nervous mechanism of

many children does not work fast enough for the expression of what they have in mind and they stammer. This early stammering usually disappears in a few months as better control develops,

a and it probably persists only in those with some definite but hidden fault which on occasion can not be surmounted. Stammering appears in more severe form and is more likely to persist in children of poor health. In older persons the amount of stammering varies with the general physical condition. It has been known to appear in adults during the course of diseases of the central nervous system and has appeared during treatment with thyroid extract, which is known to produce instability of the nervous mechanism.

Some cases of stammering or stuttering (the terms are now used interchangeably) are said to have begun after fright; this is quite probable since the vocal apparatus would be used at such a time, and permanent damage of nerve cells has been produced experimentally by fright in animals. Association with and imitation of stammerers is given as a cause and heredity has been blamed in

some cases.

The origin of stammering and the conditions favoring its continuance are admirably described by Dr. H. C. Cameron: 1

In excitement, and especially when attempting narrative, many little children hesitate and become inarticulate as their tongues trip over the words they are so eager to utter. It depends to a great extent upon the parents' attitude to this difficulty whether it passes or persists. It persists only when the child loses confidence in his power, and when his mind becomes fixed upon the difficulty. Grown-up persons, however badly they may stammer in the presence of others, when alone have usually no difficulty in achieving perfect articulation. I have known more than one bad stammerer who was a good actor, and who when on the stage, divested of his own personality and the selfconsciousness that went with it, had his voice under the most perfect control. If too much attention is paid to an incipient stammer, if it is deplored in his presence, if the other children tease and caricature, if his father complains that the boy gets on his nerves, and the mother keeps appeal. ing to him not to do it, there will be awakened that self-consciousness which inhibits all precise

Cameron, H. C., The Nervous Child. Third Edition, Oxford Medical Publications, Oxford University Press.

controlled movement, whether it be signing some all-important document or holing a 2-foot putt to win a championship.

The child must be taught to believe in his growing power of control, and he must be made to feel that his parents are taking pleasure in watching his daily and weekly progress. When, breathless and eager, he attempts a complicated piece of narrative, the tone of his mother's voice may quiet him before he begins. Excitement, overexertion, and fatigue always show in an increase in the difficulty of articulation.

We have already mentioned the effect of outside human influences upon the speech of most of us, but the emotional disturbance produced in later life by the presence of certain persons or collections of persons probably has little to do with the beginning of stammering or stuttering.

However, once having developed this speech defect, and having become aware that it exists and is noticed by others, the presence of unsympathetic hearers makes the stammerer more certain to stammer.

Normal talking, like walking, is an unconscious process, and the consciousness that, from experience, the nerve messages directed to the speech organs may not produce the desired results becomes a fatal monkey wrench or shower of wrenches which, thrown into the works for starting the machinery of vocal response, makes failure of that response, in the special situation, well-nigh certain.

It is possible that the person possessed of this speech defect is one of those in whom the nervous system responds with more than average speed or force, but he is no more "nervous” to begin with than a very large proportion of his fellows. After becoming aware of his defect and being daily reminded of it, often in his own family in sundry nerve-wracking and soul-destroying ways, it is no wonder if he becomes more nervous than his fellows and far more nervous than he would have been without his defect. Not only does the speech mechanism misbehave but the flood of nervous discharge may overflow into muscles, voluntary and involuntary, outside the speech organs with not only useless but exhausting effects in circulatory disturbances and bodily contortions. It is little wonder that the cure of stuttering or stammering after the earliest years is difficult and yet, when understood, its improvement should not seem at all discouraging. If it is completely overcome (as it often is), well and good.

Finding the Defect Ample time and patience should be taken by the teacher, parent, or patient himself in finding out just where the weakness lies in the speech mechanism.

(a) Does he substitute a wrong sound for the right one? Does he say “muvver" for "mother" or "ith" for "with"?

(b) Does he always exhibit his defect when pronouncing certain letters or syllables?

(c) Whether or not this happens, does he always pronounce these letters in this manner, or does his defeat appear only on certain occasions?

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