The Necessity for Speech Therapy among Children
Some suggestions as to methods of treatment :Author: FRANZ A. HEIMANN, M.D., L.R.C.P.Ed. Assistant School Medical Officer to the County Borough of Bournemouth AND NORA O’DRISCOLL, L.C.S.T.
Speech Therapist to the Royal Victoria and West Hants Hospital, Bournemouth During the last five years 48 children, suffering from speech defects, were discovered at Infant Welfare Centres and at medical inspections, and were sent for treatment to the Speech Therapist attached to the Psychiatric Department at the Royal Victoria and West Hants Hospital, Bournemouth.
This procedure now finds its confirmation in the Statutory Rules and Orders, 1945, No. 1076, dealing with handicapped pupils and the School Health Service. In the Education Act, 1944, under the heading ” Special Methods of Education ” it is stipulated that ” the methods of special educational treatment to be provided for- handicapped pupils attending ordinary schools shall include, in addition to special attention by the teacher for a pupil suffering from speech defect, other than an aphasic pupil, special training and treatment by a duly Qualified speech therapist
In this article it is proposed to consider only three types of speech abnormality, namely, Alalia, Dyslalia, and Stammer. The term Alalia is used to describe the state of a child over 2years of age who makes no attempt to speak, beyond one or two words, but who shows no other evidence of mental defect, and no signs of deafness. The reason for excluding from consideration the Dysphonias and the neuiological speech defects ls that, among the cases under review, there were only seven dysphonias?all post cleft palates?and three childern suffering from speech defects of neurological origin.
The effect of a speech defect on the child’s adjustment to school life is as follows:
Alalia (absence of speech) A child who enters school unable to speak, or with a very small vocabulary, will be unable to co-operate either ^ith his teacher or with his contemporaries. These children soon begin to speak, but they suffer from educational retardation. They may develop a feeling of mferiority, with consequent timidity and lack of initiative, ?r they may attempt to compensate for their low place in class by aggressiveness and disorderly behaviour.
Dyslalia (distortions of speech) These children suffer in the same way as the former group, though to a less severe extent. They are specially handicapped in reading, as the sounds which are not used by the pupil are not recognized by him in a phonetic analysis, e.g. a word such as ” sent ” will not be correctly analysed by a child who in his speech habitually pronounces it as ” 0ent ” or ” Ien Stammer The majority of stammerers are intelligent children. Among 23 cases, we found that 11 were of high intelligence, 8 were average and only 4 dull. These pupils, put for their speech disorder, would hold a high place ln class. Stammering unfortunately appears comic to normal speakers, and the sufferers are ridiculed and often bullied. They are unable to ask questions easily, and generally stammer badly in answering in class. They experience great difficulty in reading aloud and in reciting. They are often aware of their superior intelligence, but feel frustrated because they are unable to express themselves adequately.
In conclusion: There is definite danger that children who feel themselves to be frustrated and inferior during school life may develop into adults whose attitude to society is one of resentment.
Having shown the detrimental effects resulting from untreated speech defects, we have to consider some of the causes from which these disorders arise.
ALALIA
In the cases under review the apparent causes of Alalia were:
1. Lack of stimulus to speak. A child who spends most of his time alone, in a pram or play-pen, will not hear any speech, and therefore has no model to copy and no incentive to try.
2. Neglect. In a child who is neglected and illtreated, retarded speech may be part of a pattern of general backwardness.
3. Overprotection. An overprotected child whose mother, unwittingly, tries to ” keep her baby “, will find that he can obtain all the attention he needs by means of grunts and cries of the first year.
4. Shock. In some cases there is a history of shock ?generally the birth of a sibling?which involves for the child the sudden disappearance of the mother and her return with a stranger, who receives the love and care which were formerly his own property.
5. Partial deafness. It is difficult to be sure how far partial deafness may be a factor in these cases. However, two cases were observed in which the children watched the lips of those who spoke to them and seemed unable to understand if the speaker’s mouth were covered. These children expressed themselves very clearly by signs. They were not grossly deaf as they reacted to sounds made behind their backs.
DYSLALIA
In addition to the above causes, Dyslalia seemed to be induced by: 1. Reversion to infantilism, which is often an attempt to attract the parents’ attention. A little girl was seen whose mother reported that her speech had definitely deteriorated when, at one year and seven months, her baby sister was born. 2. Fear and insecurity. Feelings of fear and prolonged insecurity may retard the all round progress of the child, and the speech retardation is part of the picture. 3. Illness, which acts by exhausting the child and also by cutting him off from the stimulus of companions. A boy of years was seen who had spent a long period in hospital and was living in a Cripples’ Home, where i a great many of his companions were suffering from spastic diplegia and paraplegia. The Matron of the Home reported that his speech while under her care had deteriorated.
STAMMER
The causes giving rise to stammering are obscure, but it is generally conceded that anxiety is an important factor in its aetiology. A stammering child often shows other nervous symptoms, generally timidity and nightmares. A state of anxiety may be induced in a child by shock or unwise handling.
1. Shock. The parents of many stammerers report a shock a short time before the stammer was first noticed. It is necessary to be cautious in accepting the evidence, but some of the reports seem impressive. One mother stated that she first observed her son stammering at the age of three years, shortly after he had been badly frightened by the barber’s electric clippers. Another reported that her boy was a noticeably clear speaker until the house was damaged by a bomb when he was five years old. This patient is said to have used his first word at the age of ten months.
2. Unwise handling: (a) excessive severity. A boy was seen whose father habitually punished him severely and for insufficient cause. The child was pale, nervous looking, and, in addition to a’very pronounced stammer, complained of persistent night-mares, all related to the experience of falling.
(6) Overprotection. This was seen in the case of a boy who was an only son. His parents were much attached to him and his mother feared for him for these reasons. His father stammered slightly and she was afraid her son would inherit the defect; there was epilepsy in the father’s family, and the boy, at the age of three, had had a convulsion. Her fearfulness led to overprotection, and caused the boy to be deprived of reasonable liberty and amusement.
(c) Mental instability in parent. A mother with a psychosis, showing symptoms of religious mania, had aroused terrible feelings of guilt and insecurity in her boy. She was too ill to attend properly to her household duties, and the home environment was one of wretched discomfort. There was a perpetual conflict in the child’s mind between his natural instincts and his mother’s prohibitions.
(d) Lack of affection in infancy. A boy was seen whose mother had wanted a girl and foolishly allowed him at a very early age to know this. At the age of 17 he seemed to be unwittingly attempting to simulate a girl. His pastimes were rather feminine, and he dressed in the gayest colours he could obtain. His father, on the other hand, continually urged him to assume a man’s responsibility. The boy was therefore subject to a conflict of ideals, the daughter his mother wished for, and the son his father wanted, and he never felt sure of the affection of either parent.
TREATMENT
Having considered the possible causes of speech defects, we can now make some suggestions as to treatment. It is advisable that all children, who show any impairment of speech, should be sent by their teachers for special examination to the Minor Ailment Clinic, or be presented at the school medical inspection. The education of school children requires a closer collaboration between teachers and school medical officers. In the Reports of the School Medical Officer for 1941-1945 we find in Bournemouth, with an average attendance of 11,005 children, 24 stammerers, or 0- 22 per cent. This percentage is much lower than the percentages quoted as national averages in the annual Reports of the Chief Medical Officer of the Board of Education for 1934 and 1937, entitled ” The Health of the Child in which one per cent, stammerers and one per cent, other speech defects are mentioned. This large discrepancy suggests that a number of cases have not been notified, and that the children concerned have not received the help of which they stood in need. Both medical officers and teachers desire to keep the bodily and mental health of their charges at a high level. The physician should not only be consulted by the Education Authorities if, and when, a child is in obvious need of medical treatment.
As School Medical Officers we are dealing much more with healthy children and with the prevention of diseases, but children exhibiting symptoms of maladjustment also fall under the scope of our activity. Physicians and teachers alike forget that health is something more than not being ill; it is very often dependent on the environment which, if it is unsuitable, may produce mental instability. If the teacher is only concerned with the instruction of the children, he may overlook the fact that their success and progress are only possible as long as there is no interference with mental and physical health. Speech defects are generally symptoms of neurosis and the cause of the condition must be sought for; any treatment which does not do this is wrong and useless. Fear, anxiety, and apprehension will not be relieved by telling the child that his stammer is only a ” bad habit ” which can be overcome by ” will power The duty of the school medical officers is to convince the parents of the necessity for treatment and not to leave the stammer alone in the hope that the child will grow out of it. As a stammer is a serious handicap for every child both in school and in his later career, he should be helped as soon as possible to overcome the defect which is retarding his progress.
It is useless to treat these children with elocution or with breathing exercises. Treatment in speech classes or groups is insufficient; individual treatment is necessary if the cause of the disorder is to be discovered. All patients should be seen by a psychiatrist as soon as possible after they are referred. This is especially important in cases of Alalia because it is difficult to differentiate between mental defectives and cases of the type described. The speech therapist should co-operate with the psychiatrist and adapt her methods to the needs of the individual child. The environment must be studied and adjusted. This must be considered in three divisions:
1. Home. The parents of the child should be interviewed, their difficulties sympathetically discussed and suggestions made of ways to ease the tension in the family circle. If one of the parents is neurotic,’he or she should be encouraged to undergo treatment.
2. School. The teacher should co-operate by adjusting class work so that the child is as little handicapped as possible. If he is very backward in any subject, remedial teaching should be arranged. If the subject in question is reading the pupil should be withdrawn, for a time, from the reading-class, and given short lessons by himself in as friendly and informal an atmosphere as possible.
3. Leisure. A play centre would benefit most of these children, especially if run by someone with a knowledge of play therapy. Those children ill-adjusted at home would find a holiday camp invaluable.
Speech is the means by which the personality expresses itself, and a child whose power of speech is limited or defective is far more seriously handicapped than one who has lost an arm or leg. The Education Act provides for the relief of this most distressing condition.
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