Indiachildren - Speech Problems

SPEECH PROBLEMS

Speech is one of the strongest habits of the body. Stammered speech is also a habit. Stammering is not a disease, so it cannot be treated through medicine.

What is Stammering ?
Stammering is the inability of a person to speak in a typically fluent manner. Stammering is predominantly a male condition. Stammering usually starts before the age of five. If left unattended to, it peaks around the age of eight or ten.

A person who is stammering will experience hesitancies and silent pauses. You will notice a kind of tension in his jaw or cheeks, he may look away or blink repeatedly. He may frequently avoid introducing himself, avoid answering phones, making presentations or talking in school.

What are the causes of Stammering ?

a.	It could be genetic factors, hereditary in the family.
b.	It could be due to stress in the family.
c.	Too much expectation from the child.
d.	Change of school, losing good friends.
e.	A sibling jealousy, birth of a younger sibling.
f.	Separation of parents, divorce or any such family situation affects a child the most.
g.	Use of inappropriate speech language i.e. using long complex sentences, speaking at a fast rate, advanced or overly technical vocabulary.

Types of Speech Problems and how to deal with them ?

a.	Mispronunciation : Some children at the age of five, still jumble up the words, for instance they say :
	pasgethi for spaghetti manimal for animal baf for bath These minor pronunciation problems will probably improve over the next year or two. There is no cause of real concern.
	Read a lot to your child. Books help him to add words to his vocabulary, make sense of grammar and link meanings to pictures. Researchers have found that the more words a child hears, the greater is his vocabulary.

b.	Lisping : Your child may lisp or pronounce the "s" sound like "th" for e.g. "Hello Shalini Aunty" would sound as "Hello Thalini Aunty". Many children lisp and most outgrow this by the age of seven.
	Pop a straw in your child's drink, as that makes him use his lips and the sucking motion promotes good oral strength, which is essential for speech development. Blowing bubbles or blowing into a horn with a small round piece is a good option, as the effort needed to make a solid sound strengthens the lips and cheek muscles and tends to push the tongue back in. If a child has any kind of cold or allergies, get it treated as a stuffy nose always hinders speech.

c.	Stuttering : A child usually stutters when his brainpower outstrips his verbal dexterity. Sometimes he is so excited to say what is on his mind, or is angry, or upset that he cannot get the words out easily. If you notice that your child is repeating the first sound of the syllable for e.g. mmmm mummy or if you observe a change in the pitch when he talks, consult a doctor. If you see tension in his jaws or cheeks or if he blinks repeatedly, consult a doctor. It is very important to know how to respond to a child who stutters. Keep your voice soft and your speech slow. If you speak slowly he will follow your lead. Maintain eye contact, smile and be patient. Stress can effect stuttering a lot.

d.	Apraxia : Apraxia is a disorder of the nervous system, that effects a child's ability to say sounds, syllables and words. This takes place due to the brain, which does not send proper transmission to the body parts needed for speech and for making the correct sounds. Children with this speech condition often benefit through an intensive speech therapy. Therapy may focus on repetition of sound sequences and movement patterns to make them automatic.

What you can do to help your Child :

a.	Do not correct him at all times, as that will make him very conscious.
b.	Provide a very pleasant and calm atmosphere at home. Try to slow down the pace of your family life.
c.	Always maintain eye contact with your child and try not to avoid him.
d.	Use meal time as conversation time.
e.	Talk slowly to your child, as he will imitate you and do the same.
f.	Do not tell your child to start all over again, if he stammers.

Case Study

Past History :
Manoj was referred to the child guidance clinic when he was four years of age. He had a speech disorder problem that involved a blocking or repetition of and struggling with speech sounds. He showed difficulty with initial syllables of certain words as in, "D-d-d-don't do that". He spoke fluently under normal circumstances at home, but this blocking tended to occur at moments of important or stressful communication. Speech sounds that require the greatest articulatory effort, such as b,d,s and t were especially troublesome for him. He was going through an internal struggle to speak. When he was at ease, the speech became smooth and fluent until the next stumbling block.

During the counselling sessions with Manoj, it was found that this stammering in Manoj increased both in severity and frequency, in situations where he felt inferior, self conscious and anxious. This anxiety increased when he was asked to read loudly in the class or say a poem. He refused to perform on the stage for the annual day.

Manoj felt eager to answer in class sometimes, but he feared the crushing humiliation of another "block". He wanted to join in a variety of games, but knew the ridicule, which all too often greeted his efforts to speak. Manoj was insecure, not able to cope and could not avoid situations.

Treatment :
"Learned behaviour" was emphasized using behaviour modification techniques and incentives in the form of token coins, stars on a play chart, praise, were given at the time of continuous speech, as encouragement. Aversive stimulation was also given in the form of some punishment, like not paying attention to his demands. This was avoided by continuous fluent speech.

Manoj learned to handle situations in class and social gatherings by first dealing with the anxiety that was created in groups, of which he felt inferior. He was made aware that he is good as he is, he need not prove himself at every social encounter. He was acceptable to others and he needed to accept others in that situation. Once this anxiety was reduced, he was more comfortable to deal with the speech problem. Embarrassment and shame reduced considerably.

Manoj was asked to draw on paper whatever he felt most adequately represented his behaviour before, during and after a moment of stammering in class. Manoj drew three pictures namely, before (of a tall building in front of him), during (a rope with many knots in it) and after (the sun shining away). This proves his high tension just before and during the block and his relief later on. Guilt, shame, dejection and anger were expressed in most sessions.

Manoj was taught to define his problem rather than deny it or conceal it. This made him more validated rather than devaluated or obligated to play the role of a stutterer.

Modern therapy places strong emphasis on self-acceptance but not on self resignation. The Approach - Avoidance technique helped Manoj a lot. In this technique, a vicious circle is played where Manoj first accepts himself, makes himself fluent, this fluency in turn reduces avoidance and tends to break up the vicious circle, at which point self assertion and social reinforcement may be effective in maintaining speech fluency.